3. Basic psychopathological syndromes. The concept of nosology
Translated from Greek, “syndrome” means “accumulation”, “confluence”. At the moment, the medical term “syndrome” means a set of symptoms united by a single pathogenesis, a natural combination of productive and negative symptoms. German psychiatrist K. Kahlbaum in 1863, when describing catatonia, proposed the term “symptom complex”. At that time, catatonia was considered a separate disease, but later it became clear that this was a typical variant of the symptom complex.
The syndrome as a stage of the disease can be the same for various mental disorders, which is due to the body’s adaptation to changed living conditions (diseases) and is achieved using the same type of response methods. This manifestation is observed in the form of symptoms and syndromes, which become more complex as the disease develops, transforming from simple to complex or from small to large. With various mental illnesses, the clinical picture changes in a certain sequence, that is, there is a developmental stereotype characteristic of each disease. There is a general pathological developmental stereotype, characteristic of all diseases, and a nosological stereotype, which is typical for individual diseases.
A general pathological stereotype of the development of diseases assumes the presence of general patterns in their course. At the initial stages of progressive mental illnesses, neurotic disorders are more often detected, and only then affective, delusional and psychoorganic disorders appear, i.e., with the progression of mental illnesses, the clinical picture steadily becomes more complicated and deepens.
For example, the formation of clinical manifestations in patients with schizophrenia is as follows: at the initial stages, disorders of a neurotic level, asthenic, phobic, are detected, then affective disorders appear, delusional symptoms, complicated by hallucinations and pseudohallucinations, Kandinsky-Clerambault syndrome is added, accompanied by paraphrenic delusions and leading to apathetic dementia.
Nosological diagnosis reflects the integrity of productive and negative disorders.
It should be noted that neither productive nor negative disorders have absolute nosological specificity and only apply to a type of disease or group of diseases - psychogenic, endogenous and exogenous-organic. In each of these groups of diseases, all identified productive symptoms occur. For example: asthenic and neurotic syndromes are characteristic of neuroses and neurotic personality development; affective, delusional, hallucinatory, motor - for reactive psychoses, such as depression, paranoid, stuporous states, transient intellectual disorders - for hysterical psychoses.
Both exogenous-organic and endogenous diseases have all of the above syndromes. There is also a certain preference, which consists in their greatest frequency and severity for a particular group of diseases. Despite the general pathological patterns of the formation of personality defects, negative mental disorders in connection with the disease have ambiguous trends in groups of diseases.
As a rule, negative disorders are represented by the following syndromes: asthenic or cerebroasthenic personality changes, including psychopathic-like disorders, which in psychogenic diseases manifest themselves in the form of pathocharacterological disorders. Negative disorders in exogenous-organic diseases are characterized by psychopathic personality changes, manifested by excessive intensity of experiences, inadequacy in the strength and severity of emotional reactions and aggressive behavior.
In schizophrenia, personality changes are characterized by emotional impoverishment and dissociation of emotional manifestations, their disorder and inadequacy.
As a rule, memory does not suffer in patients with schizophrenia, however, there are well-known cases when patients, being in the department for a long time, do not know the name of the attending physician, roommates, and find it difficult to name dates. These memory disorders are not true, but are caused by affective disorders.
A syndrome is a complex of symptoms. Psychopathological syndrome is a complex, more or less typical set of internally (pathogenetically) interconnected psychopathological symptoms, in the particular clinical manifestations of which the volume and depth of the lesion is expressed mental functions, the severity and massiveness of the action of pathogenic harmfulness on the brain.
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.
6.1. Positive psychopathological syndromes
There is currently practically no single view on the concept of positive, and therefore negative, syndromes. Syndromes that are qualitatively new, absent normally, are considered positive syndromes (they are also called pathological positive, “plus” disorders, phenomena of “irritation”), indicating the progression of a mental illness, qualitatively changing the mental activity and behavior of the patient.
6.1.1. 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 predominantly quantitative disorders psyche. The leading manifestation is mental asthenia itself. There are two main variants of asthenic syndrome - emotional-hyperesthetic weakness (hypersthenic and hyposthenic).
With emotional-hyperesthetic weakness, short-term emotional reactions of dissatisfaction, irritability, anger for minor reasons (the “match” symptom), emotional lability, faint-heartedness easily and quickly arise; patients are capricious, gloomy, dissatisfied. Drives are also labile: appetite, thirst, food cravings, decreased libido and potency. Characterized by hyperesthesia to loud sounds, bright lights, 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.
In the hyposthenic variant, primarily physical asthenia, lethargy, fatigue, weakness, fast fatiguability, pessimistic mood with decreased performance, increased drowsiness with lack of satisfaction from sleep and a feeling of weakness, heaviness in the head in the morning.
Asthenic syndrome occurs in somatic (infectious and non-infectious) diseases, intoxications, organic and endogenous mental illnesses, and neuroses. It constitutes the essence of neurasthenia (asthenic neurosis), going through three stages: hypersthenic, irritable weakness, hyposthenic.
6.1.2. Affective syndromes. The syndromes of affective disorders are very diverse. At the core modern classification affective syndromes are based on three parameters: the affective pole itself (depressive, manic, mixed), the structure of the syndrome (harmonious - disharmonious; typical - atypical) and the degree of severity of the syndrome (non-psychotic, psychotic).
Typical (harmonious) syndromes include a uniformly depressive or manic triad of obligatory symptoms: pathology of emotions (depression, mania), changes in the course of the associative process (slowdown, acceleration) and motor-volitional disorders / inhibition (substupor) - disinhibition (excitement), hypobulia-hyperbulia /. The main (core) among them are emotional. Additional symptoms appear: reduced or increased self-esteem, disturbances of self-awareness, obsessive, overvalued or delusional ideas, suppression or increased desires, suicidal thoughts and actions in depression. In the most classic form, endogenous affective psychoses occur and, as a sign of endogeneity, include the somato-vegetative symptom complex of V.P. Protopopov (arterial hypertension, tachycardia, constipation, miosis, hyperglycemia, menstrual irregularities, changes in body weight), daily fluctuations in affect (improved well-being during afternoon), seasonality, periodicity and autochthony.
Atypical affective syndromes are characterized by a predominance of optional symptoms (anxiety, fear, senestopathies, phobias, obsessions, derealization, depersonalization, non-holothymic delusions, hallucinations, catatonic symptoms) over the main affective syndromes. Mixed affective syndromes include those disorders that seem to be introduced from the opposite triad (for example, motor agitation during the affect of melancholy - depressive agitation).
There are also subaffective disorders (subdepression, hypomania; they are also non-psychotic), classical affective and complex affective disorders (affective-delusional: depressive-paranoid, depressive-hallucinatory-paranoid, depressive-paraphrenic or manic-paranoid. manic-hallucinatory-paranoid , matsnakal-paraphrenic).
6.1.2.1. Depressive syndromes. The classic depressive syndrome includes the depressive triad: severe melancholy, depressed gloomy mood with a touch of vitality; 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 represented by not clearly expressed 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. Additional symptoms include obsessive doubts, low self-esteem, and disturbances in self-awareness and activity.
Classic depressive syndrome is characteristic of endogenous depressions (manic-depressive psychosis, schizophrenia); subdepression in reactive psychoses, neuroses.
Atypical depressive syndromes include subdepressive ones. relatively simple and complex depression.
The most common subdepressive syndromes are:
Astheno-subdepressive syndrome - low mood, spleen, sadness, boredom, combined with a feeling of loss of vitality and activity. Symptoms of physical and mental fatigue, exhaustion, weakness combined with emotional lability, and mental hyperesthesia predominate.
Adynamic subdepression includes low mood with a hint of indifference, physical inactivity, lethargy, lack of desire, and a feeling of physical impotence.
Anesthetic subdepression is a low mood with a change in affective resonance, the disappearance of feelings of closeness, sympathy, antipathy, empathy, etc. with a decrease in motivation for activity and a pessimistic assessment of the present and future.
Masked (manifested, hidden, somatized) depression (MD) is a group of atypical subdepressive syndromes in which facultative symptoms (senestopathies, algia, paresthesia, intrusiveness, vegetative-visneral, drug addiction, sexual disorders) come to the fore, and the actual affective (subdepressive manifestations) erased, inexpressive, appearing in the background.The structure and severity of optional symptoms determine various options MD (Desyatnikov V.F., Nosachev G.N., Kukoleva I.I., Pavlova I.I., 1976).
The following variants of MD have been identified: 1) algic-senestopathic (cardialgic, cephalgic, abdominal, arthralgic, panalgic); agrypnic, vegetative-visceral, obsessive-phobic, psychopathic, drug addict, variants of MD with sexual disorders.
Algic-senestopathic variants of MD. Optional symptoms are represented by a variety of senestopathies, paresthesias, algias in the heart area (cardialgic), in the head area (cephalgic), in the epigastric area (abdominal), in the joint area (arthralgic), and various “walking” symptoms (panalgic). They constituted the main content of the patients’ complaints and experiences, and subdepressive manifestations were assessed as secondary, insignificant.
Agripnic variant of MD presented pronounced violations sleep: difficulty falling asleep, shallow sleep, early awakening, lack of a feeling of rest from sleep, etc., while experiencing weakness, decreased mood, lethargy.
The vegetative-visceral variant of MD includes painful, diverse manifestations of vegetative-visceral disorders: pulse lability, increased blood pressure, dipnea, tachypnea, hyperhidrosis, feeling of chills or heat, low-grade fever, dysuric disorders, false urges for defecation, flatulence, etc. In structure and character, they resemble diencephalic or hypothalamic paroxysms, episodes of bronchial asthma or vasomotor allergic disorders.
The psychopathic-like variant is represented by behavioral disorders, most often in adolescence and adolescence: periods of laziness, spleen, leaving home, periods of disobedience, etc.
The drug-addicted variant of MD is manifested by episodes of alcohol or drug intoxication with subdepression without a clear connection with external causes and reasons and without signs of alcoholism or drug addiction.
A variant of MD with disorders in the sexual sphere (periodic and seasonal impotence or frigidity) against the background of subdepression.
Diagnosis of MD presents significant difficulties, since complaints are represented only by optional symptoms, and only a special questioning allows one to identify the leading and obligatory symptoms, but they are often assessed as secondary personal reactions to the disease. But all variants of MD are characterized by the obligatory presence in the clinical picture, in addition to somato-vegetative manifestations, senestopathies, paresthesias, and algia, of affective disorders in the form of subdepression; signs of endogeneity (daily hypothmic disorders of both leading and obligatory symptoms and (optional; periodicity, seasonality, autochthony of occurrence, recurrence of MD, distinct somato-vegetative components of depression), lack of effect from somatic therapy and success of treatment with antidepressants.
Subdepressive disorders occur in neuroses, cyclothymia, cyclophrenia, schizophrenia, involutional and reactive depression, and organic diseases of the brain.
Simple depressions include:
Adynamic depression is a combination of melancholy with weakness, lethargy, powerlessness, lack of motivation and desires.
Anesthetic depression is the predominance of mental anesthesia, painful insensibility with painful experience.
Tearful depression is a depressed mood with tearfulness, weakness and asthenia.
Anxious depression, in which, against a background of melancholy, anxiety with obsessive doubts, fears, and ideas about relationships predominate.
Complex depression is a combination of depression with symptoms of other psychopathological syndromes.
Depression with delusions of enormity (Cotard's syndrome) is a combination of melancholy depression with nihilistic delirium of megalomaniac fantastic content and delirium of self-blame, guilt in serious crimes, expectation of terrible punishment and cruel executions.
Depression with delusions of persecution and poisoning (depressive-paranoid syndrome) is characterized by a picture of sad or anxious depression combined with delusions of persecution and poisoning.
Depressive-paranoid mentaldromas, in addition to those described above, include depressive-hallucinatory-paranoid, depressive-paraphrenic. In the first case, in combination with melancholy, less often anxious depression, there are verbal true or pseudo-hallucinations of accusing, condemning and slanderous content. phenomena of mental automatism, delusions of persecution and influence. Depressive-paraphrenic, in addition to the listed symptoms, includes megalomanic delusional ideas of nihilistic, cosmic and apoplectic content, up to depressive oneiroid.
Characteristic for affective psychoses, schizophrenia, psychogenic, organic and infectious mental diseases.
6.1.2.2. Manic syndromes. Classic manic syndrome includes severe mania with a feeling of immense happiness, joy, delight, ecstasy (obligatory symptoms are manic hyperbulia with many plans, their extreme instability, significant distractibility, which is caused by impaired productivity of thinking, acceleration of its pace, “jumping” ideas, inconsistency logical operations, and increased motor activity, they take on a lot of things without bringing any of them to the end, they are verbose, they talk incessantly.Additional symptoms are an overestimation of the qualities of one’s personality, reaching unstable holotymic ideas of greatness, disinhibition and increased drives.
Hypomanic (non-psychotic) syndrome includes a confidently expressed increase in mood with a predominant feeling of the joy of being, fun, and cheerfulness; with a subjective feeling of creative enthusiasm and increased productivity, some acceleration of the pace of thinking, with fairly productive activity, although with elements of distraction, behavior is not seriously affected,
Atypical manic syndromes. Unproductive mania involves elevated mood, but is not accompanied by a desire for activity, although it may be accompanied by a slight acceleration of the associative process.
Angry mania is characterized by increased mood with incontinence, irritability, pickiness with the transition to anger; inconsistency of thinking and activity.
Complex mania is a combination of mania with other non-affective syndromes, mainly delusional ones. The structure of the manic syndrome is joined by delusions of persecution, relationships, poisoning (manic-paranoid), verbal true and pseudohallucinations, phenomena of mental automatism with delusions of influence (manic-hallucinatory-paranoid), fantastic delusions and delusions of grandeur (manic-paraphrenic) up to oneiroid.
Manic syndromes are observed in cyclophrenia, schizophrenia, epilepsy, symptomatic, intoxication and organic psychoses.
6.1.2.3. Mixed affective syndromes. Agitated depression is characterized by an anxious affect combined with fussy anxiety and delusional ideas of condemnation and self-blame. Fussy anxiety can be replaced by motor agitation up to depressive raptus with increased suicidal danger.
Dysphoric depression, when a feeling of melancholy and displeasure is replaced by irritability, grumbling, spreading to everything around and to one’s well-being, outbursts of rage, aggression against others and self-aggression.
Manic stupor occurs at the height of manic excitement or a change from a depressive phase to a manic phase, when increasing mania is accompanied (or replaced) by persistent motor and intellectual retardation.
Occurs in endogenous psychoses, infectious, somatogenic, intoxicating and organic mental diseases.
6.1.3. Neurotic syndromes. It is necessary to distinguish between neurotic syndromes themselves and the neurotic level of disorders. The neurotic level of the disorder (borderline neuropsychiatric disorders), according to most domestic psychiatrists, also includes asthenic syndromes and non-psychotic affective disorders (subdepression, hypomania).
The actual neurotic syndromes include obsessive (obsessive-phobic, obsessive-compulsive syndrome), senestopathic and hypochondriacal, hysterical syndromes, as well as depersonalization-derealization syndromes, syndromes of overvalued ideas.
6.1.3.1. Obsessive-compulsive syndromes. The most common types are obsessive and phobic syndromes.
6.1.3.1.1. Obsessive syndrome includes as the main symptoms obsessive doubts, memories, ideas, an obsessive feeling of antipathy (blasphemous and blasphemous thoughts), “mental chewing gum,” obsessive desires and associated motor rituals. Additional symptoms include emotional stress, a state of mental discomfort, powerlessness and helplessness in the fight against obsessions. In their “pure” form, affectively neutral obsessions are rare and are represented by obsessive philosophizing, counting, obsessive remembering of forgotten terms, formulas, phone numbers, etc.
Obsessive syndrome (without phobias) occurs in psychopathy, low-grade schizophrenia, and organic diseases of the brain.
6.1.3.1.2. Phobic syndrome represented predominantly by a variety of obsessive fears. The most unusual and senseless fears may arise, but most often at the beginning of the disease there is a distinct monophobia, which gradually grows “like a snowball” with more and more new phobias. For example, cardiophobia is joined by agorophobia, claustophobia, thanatophobia, phobophobia, etc. Social phobias can be isolated for quite a long time.
The most common and diverse nosophobias are: cardiophobia, cancerophobia, AIDS phobia, alienophobia, etc. Phobias are accompanied by numerous somato-vegetative disorders: tachycardia, increased blood pressure, hyperhidrosis, persistent red dermographism, peristalsis and antiperistalsis, diarrhea, vomiting, etc. They join very quickly motor rituals, in some cases turning into additional obsessive actions performed against the desire and will of the patient, and abstract obsessions become rituals.
Phobic syndrome occurs in all forms of neuroses, schizophrenia, and organic diseases of the brain.
6.1.3.2. Senestopathic-hypochondriacal syndromes. They include a number of options: from “pure” senestopathic and hypochondriacal syndromes to senestopathosis. For the neurotic level of the syndrome, the hypochondriacal component can only be represented by overvalued ideas or obsessions.
At the initial stage of development of the syndrome, numerous senestopathies occur in various parts of the body, accompanied by dull depressiveness, anxiety, and mild restlessness. Gradually, a monothematic overvalued idea of hypochondriacal content emerges and is formed on the basis of senestolations. Based on unpleasant, painful, extremely painful sensations and existing experience of communication, diagnosis and treatment, health workers develop judgment: using senestopathies and real circumstances to explain and form a pathological “concept of illness”, which occupies a significant place in the patient’s experiences and behavior and disorganizes mental activity .
The place of overvalued ideas can be taken by obsessive doubts, fears regarding senesthopathy, with the rapid addition of obsessive fears and rituals.
They are found in various forms of neuroses, low-grade schizophrenia, and organic diseases of the brain. With hypochondriacal personality development, sluggish schizophrenia, senestopathic disorders with hypochondriacal overvalued ideas are gradually transformed into paranoid (delusional) syndrome.
Senestopathosis is the simplest syndrome, represented by monotonous senestopathies, accompanied by autonomic disorders and hypochondriacal fixation of attention on senestopathies. Occurs with organic lesions of the thalamo-hypothalamic region of the brain.
6.1.3.3. Depersonalization-derealization syndromes. The most poorly defined in general psychopathology. Symptoms and partly syndromes of impaired self-awareness are described in Chapter 4.7.2. Usually the following variants of depersonalization are distinguished: allopsychic, autopsychic, somatopsychic, bodily, anesthetic, delusional. The last two cannot be attributed to the neurotic level of disorders.
6.1.3.3.1. Depersonalization syndrome at the neurotic level includes violations of self-awareness of activity, unity and constancy of the “I”, slight blurring of the boundaries of existence (allopsychic depersonalization). In the future, the blurring of the boundaries of self-awareness, the impenetrability of the “I” (autopsychic depersonalization) and vitality (somatopsychic depersonalization) becomes more complicated. But there are never any gross changes in the boundaries of self-awareness, alienation of the “I” and stability of the “I” in time and space. It is found in the structure of neuroses, personality disorders, neurosopod schizophrenia, cyclothymia, and residual organic diseases of the brain.
6.1.3.3.2. Derealization syndrome includes as a leading symptom a distorted perception of the surrounding world, the surrounding environment is perceived by patients as “ghostly,” unclear, indistinct, “as in a fog,” colorless, frozen, lifeless, decorative, unreal. Individual metamorphopsia may also be observed (impaired perception of individual parameters of objects - shape, size, color, quantity, relative position, etc.).
Usually accompanied different symptoms disturbances of self-awareness, subdepression, confusion, fear. Most often occurs in organic diseases of the brain, as part of epileptic paroxysms, and intoxication.
Derealization also includes: “already experienced,” “already seen,” “never seen,” “never heard.” They are found mainly in epilepsy, residual organic diseases of the brain, and some intoxications.
6.1.3.4. Hysterical syndromes. A group of functional polymorphic and extremely variable symptoms and syndromes of mental, motor, sensitivity, speech and somatovegetative disorders. Hysterical disorders also include a psychotic level of disorders: affective (hysterical) twilight states of consciousness, ambulatory automatisms (trances, Ganser syndrome, pseudodementia, puerilism (see section 5.1.6.3.1.1.).
Common to hysterical symptoms are egocentrism, a clear connection with the traumatic situation and the degree of its personal significance, demonstrativeness, external deliberateness, great suggestibility and self-hypnosis of patients (“a great simulator” of other diseases and syndromes), the ability to derive external or “internal” benefit from their painful states that are poorly understood or not even recognized by the patient (“flight into illness,” “desirability or conditional pleasantness” of manifestations of the disease).
Mental disorders: severe asthenia with physical and mental fatigue, phobias, subdepression, amnesia, hypochondriacal experiences, pathological deceit and fantasies, emotional lability, weakness, sensitivity, impressionability, demonstrativeness, suicidal statements and demonstrative preparations for suicide.
Motor disorders: classic grand mal hysterical attack (“motor storm”, “hysterical arc”, clowning, etc.), hysterical paresis and paralysis, both spastic and flaccid; paralysis of the vocal cords (aphonia), stupor, contractures (trismus, torticollis-torticollis, strabismus, joint contractures, flexion of the body at an angle - captocormia); hyperkinesis, professional dyskinesia, astasia-abasia, hysterical lump in the throat, swallowing disorders, etc.
Sensory disorders: various paresthesias, decreased sensitivity and anesthesia of the “gloves”, “stockings”, “panties”, “jackets” type, etc.; painful sensations (pains), loss of function of the sensory organs - amaurosis (blindness), hemianopsia, scotomas, deafness, loss of smell and taste.
Speech disorders: stuttering, dysarthria, aphonia, mutism (sometimes surdomutism), aphasia.
Somato-vegetative disorders occupy the largest place in hysterical disorders and are the most diverse. Among them are spasms of smooth muscles in the form of lack of air, which sometimes simulates asthma, dysphagia (disturbances in the passage of the esophagus), paresis of the gastrointestinal tract, simulating intestinal obstruction, constipation, and urinary retention. Vomiting, hiccups, regurgitation, nausea, anorexia, and flatulence occur. Disorders of the cardiovascular system are common: pulse lability, blood pressure fluctuations, hyperemia or pallor of the skin, acrocyanosis, dizziness, fainting, pain in the heart area simulating heart disease.
Occasionally, vicarious bleeding (from intact areas of the skin, uterine and throat bleeding), sexual dysfunction, and false pregnancy occur. As a rule, hysterical disorders are caused by psychogenic diseases, but they also occur in schizophrenia and organic diseases of the brain.
6.1.3.5. Anorectic syndrome (anorexia nervosa syndrome) It is characterized by progressive self-limitation in food, selective consumption of food by the patient in combination with incomprehensible arguments about the need to “lose weight”, “get rid of fat”, “correct the figure”. Less common is the bulimic variant of the syndrome, when patients consume a lot of food and then induce vomiting. Often combined with body dysmorphomania syndrome. Occurs in neurotic conditions, schizophrenia, endocrine diseases.
Close to this group of syndromes are psychopathic syndromes, which can include both positive and negative symptoms (see section 5.2.4.).
6.1.3.6. Heboid syndrome. The core disorders in this syndrome are considered to be disturbances of drives in the form of painful intensification and especially their perversion. There is an exaggeration and distortion of affective and personal characteristics characteristic of adolescence, exaggerated oppositional tendencies, negativism, aggressive manifestations, there is a loss, or weakening, or slowdown in the development of higher moral principles (the concepts of good and evil, permitted and unlawful, etc.), sexual perversions, tendencies towards vagrancy, and the use of alcohol and drugs are observed. Occurs in psychopathy and schizophrenia.
Syndrome of delusional fantasies - unstable, changeable, outwardly similar to delirium, reasoning with fantastic content. Close to some psychopathic individuals prone to daydreaming and daydreaming.
6.1.3.7. Syndromes of overvalued ideas. A group of syndromes that are characterized by judgments that arose as a result of real circumstances and on the basis of actual facts, acquiring in the consciousness the leading pathological monothematic one-sided, affectively-saturated opinion of the patient, without having a distorted, absurd content that does not capture the entire worldview of the patient. They can be an independent syndrome, or part of the structure of other more complex psychopathological syndromes. In content they can be hypochondriacal, invention, jealousy, reformism, querulyantism, etc. They are found in psychopathy, reactive diseases, schizophrenia, organic mental illnesses.
6.1.3.7.1. Syndrome of dysmorphophobia and dysmorphomania - painful preoccupation with one’s physical characteristics, which are presented as extremely unpleasant to others and therefore create a hostile attitude towards the patient. Most often, flaws are seen on your face, less often on your figure. Mostly found in adolescence for schizophrenia, neuroses, reactive states.
6.1.3.7.2. Syndrome of “metaphysical (philosophical intoxication" - monotonously abstract intellectual activity aimed at independent decision by thinking about and “solving” “eternal problems” - about the meaning of life, about the purpose of humanity, about the eradication of wars, the search for philosophical, religious and worldview systems. May include ideas of invention, self-improvement, all kinds of intellectual and aesthetic hobbies.
Close to them is the syndrome of pathological hobbies (“pathological hobby”). Unlike the previous syndrome, what is observed here is not so much daydreaming, fantasy and reflection, but active activity, which is characterized by the intensity of obsession, unusualness, pretentiousness and unproductive hobbies. Occurs in neuroses and schizophrenia.
6.1.4. Hallucinatory-delusional syndromes. A group of syndromes, including as leading symptoms delusional ideas of varying content and different types of hallucinations, illusions, and senestopathies.
6.1.4.1. Paranoid syndrome. Primary systematized delirium (persecution, invention, jealousy, hypochondriacal, etc.) with thorough thinking and sthenic affect, developing with unchanged consciousness. In addition to the indicated delusional ideas, monothematic delirium of reformism, erotic, high birth, litigious (querulyant).
Depending on the course, acute and chronic paranoid syndromes are distinguished.
6.1.4.1.1. Acute paranoid syndrome occurs in diseases in the form of an attack. It is characterized by “insight,” a sudden thought that forms an interpretative delirium, the systematization of which occurs only in general terms without elaborate detail. Accompanied by affective disorders (anxiety, fear, ecstasy), confusion.
6.1.4.1.2. Chronic paranoid syndrome characterized by the consistent development of the plot of delirium, its expansion, systematization and often pronounced detail and “crooked logic”. The full-blown syndrome is combined with increased activity (open struggle for one’s ideas) and mild affective disorders.
Occurs in schizophrenia, psychopathy, organic mental diseases of the brain, involutional psychoses.
6.1.4.2. Hallucinosis. A group of syndromes, predominantly limited to abundant hallucinations, most often of one type, sometimes secondary delusions and not accompanied by clouding of consciousness. There are variants of the syndrome based on the type of hallucinations - verbal, visual, tactile, olfactory; according to the dynamics of occurrence - acute and chronic.
6.1.4.2.1. Verbal hallucinosis- an influx of verbal (verbal) hallucinations or pseudohallucinations in the form of a monologue (monovocal hallucinosis), dialogue, multiple “voices” (polyvocal hallucinosis) of various contents (threatening, imperative, scolding, etc.), accompanied by fear, anxiety, motor restlessness, often figurative delusional. With auditory pseudohallucinosis, “voices” are “mental,” “mental,” “made,” localized in the head, or heard from space, other cities and countries. Occurs in meta-alcohol psychoses, schizophrenia, and organic mental diseases of the brain.
6.1.4.2.2. Visual hallucinosis characterized by an influx of bright, moving, multiple scene-like visual hallucinations. There are several types of visual hallucinosis. Lhermitte's visual hallucinosis (peduncular hallucinosis), which occurs as a result of a pathological process in the peduncles of the midbrain, is characterized by mobile, multiple, lilliputian, animated visual hallucinations and is accompanied by an affect of surprise and interest when critically assessing them. Bonnet visual hallucinosis, observed with loss of vision or in extreme old age, develops acutely from planar, moving, multiple visual hallucinations. Van Bogart visual hallucinosis occurs in the subacute period of encephalitis and is characterized by multiple, colorful, moving, zooptic hallucinations.
6.1.4.2.4. Olfactory hallucinosis - a rather rare independent syndrome, where the leading place is occupied by olfactory hallucinations in the form of the smell of rot, feces, most often emanating from the patient’s body. Accompanied by hypochondriacal and perfume dysmorphomanic overvalued or delusional ideas.
Hallucinosis occurs in somatic, infectious, intoxication psychoses, and schizophrenia.
6.1.4.3. Paranoid syndrome. A combination of interpretative or interpretative-figurative persecutory delusions (delusions of persecution, relationships, poisoning, surveillance, damage, etc.) with pathology of perception (hallucinations, illusions) and sensations (senesthopathy).
There are acute, subacute and chronic course of the syndrome.
Many psychiatrists identify paranoid syndrome with mental automatism syndrome. Indeed, in a number of mental illnesses (for example, schizophrenia), the paranoid syndrome and the syndrome of mental automatism merge, including in the first pseudohallucinations, the phenomena of mental automatism. However, there is a whole group of diseases, for example, psychogenic paranoid, road paranoid, induced paranoid, where the symptoms of mental automatism are completely absent.
6.I.4.4. Mental automatism syndromeKandinsky-Clerambault (syndrome external influence, alienation syndrome)
Includes the phenomena of alienation, loss, imposition, madeness of mental processes with pronounced violations of self-awareness of simplicity, identity, constancy, impenetrability of the “I”, accompanied by delusions of mental and physical influence and persecution. There are three types of mental automatism: associative (ideational, ideoverbal); sensory (senestopathic, sensual); motor (motor, kinesthetic).
6.1.4.4.1. Associative automatism includes an involuntary influx of thoughts (mentism), interruption of thoughts (sperrung), “parallel”, “intersecting”, “obsessive” thoughts; a symptom of openness of thought, when the patient's thoughts and feelings somehow become known to others; a symptom of “echo thoughts”, when others, in the patient’s opinion, pronounce or repeat his thoughts out loud. As the variant becomes more complex, “mental conversations”, “telepathic mental communication”, “thought transfer”, “silent negotiations” are added, accompanied by anxiety and depressive affect. Transitivism may be observed - the belief that they are not the only ones who hear internal “voices” and feel the impact.
6.1.4.4.2. Sensory automaticity characterized by senestopathies with a component of being made, imposed, caused, affecting sensations, internal organs, physiological functions. Patients report sensations of squeezing, tightening, twisting, burning, cold, heat, pain, etc.; impact on physiological functions: cause peristalsis and antiperistalsis, tachycardia, sexual arousal, urination, increase blood pressure, etc.
6.1.4.4.3. Motor (kinesthetic) automatism manifested by alienation of movements and actions. Patients are convinced that all movements and actions they perform are forcibly caused by outside influence. Because of the unnaturalness and alienness of their motor acts, they call themselves “robots”, “puppets”, “controlled dolls”. There is a feeling of movement in the lips, tongue, throat when thoughts are sounded and arising, up to real articulatory movements, forced speaking (Segle speech-motor hallucinations).
The presence of phenomena of mental automatism in all spheres of mental activity (associative, sensory, kinesthetic automatism) allows us to speak about the developed Kandinsky-Clerambault syndrome of mental automatism.
6.1.4.4.4. There are also delusional and hallucinatory variants of mental automatism syndrome. In the delusional version, the leading place is occupied by delusions of physical, hypnotic or telepathic influence, mastery, persecution in combination with fragments of all types of automatisms. In the hallucinatory variant, auditory true ones predominate, and later pseudo-hallucinations with delusions of influence, persecution and fragments of other symptoms of mental automatism.
According to the dynamics, acute and chronic variants of the syndrome are distinguished. At acute development The syndrome is essentially represented by an acutely emerging affective-hallucinatory-delusional syndrome, which was characterized by pronounced affective disorders (fear, anxiety, depression, mania, confusion), insensitive delusions of influence, persecution, staging, verbal hallucinations, and vivid sensory automatisms. May be accompanied by optional symptoms such as catatonic (excitement or stupor).
6.1.4.4.5. Capgras syndrome. The leading symptom is impaired recognition of people. The patient does not recognize his relatives and acquaintances, speaks of them as fake people, twins, doubles (a symptom of a negative double). In other cases, on the contrary, unfamiliar faces are perceived as familiar (positive double symptom). Fregoli's symptom is characteristic, when “pursuers” constantly change their appearance in order to remain unrecognized. Capgras syndrome also includes delusional ideas of persecution, influence, phenomena of “already seen”, “never seen”, with phenomena of mental automatism.
6.1.4.5. Paraphrenic syndrome. The most complex delusional syndrome, including the leading symptoms of fantastic, confabulatory delusions of grandeur, and may also have delusions of persecution and influence, phenomena of mental automatism, and hallucinations. In a number of diseases, this syndrome is the initial stage of chronic delusional formation.
A distinction is made between acute and chronic paraphrenia. In the acute or subacute development of paraphrenic syndrome, the leading place is occupied by sensual, unstable, fantastic delusional ideas of greatness, reformation, high origin, verbal and visual pseudo-hallucinations, confabulations and pronounced fluctuations in affect from anxious-melancholy to ecstatic-euphoric. Additional symptoms indicating the severity of the development of the syndrome consist of delusions of intermetamorphosis, false recognitions, and delusions of special significance. Occurs in paroxysmal schizophrenia, infectious and intoxication psychoses.
Chronic paraphrenia is characterized by stable, monotonous delusional ideas of grandeur, poverty and monotony of affect and less relevant symptoms of previous delusional syndromes, primarily hallucinatory-delusional syndrome.
6.1.4.5.1. Variants of paraphrenic syndrome . Even E. Kraepelin (1913) distinguished paraphrenia into systematized, expansive, confabulatory and fantastic. Currently, it is customary to distinguish systematized, unsystematized, hallucinatory and confabulatory paraphrenia.
Systematized paraphrenia includes, in a systematized form, delusions of persecution, antagonistic delusions, and delusions of grandeur.
Unsystematized paraphrenia is observed during the acute development of the syndrome.
Hallucinatory paraphrenia is characterized by an influx of verbal true hallucinations or pseudohallucinations of praising, exalting and antagonistic content, which determine the content of delusions of grandeur, less often persecution.
Confabulatory paraphrenia is presented as the leading symptoms by confabulations, combined with the symptom of unwinding memories that define delusions of grandeur, high origin, reformism, and wealth.
6.1.4.5.2. Cotard's syndrome . It is characterized by nihilistic-hypochondriacal delirium combined with ideas of enormity. Patients express ideas of damage, destruction of the world, death, self-accusation, often on a large scale. All these symptoms are combined with anxiety-depressive or depressive syndrome (see section 5.1.2.1.).
Occurs in moderately progressive continuous schizophrenia and involutional psychoses.
6.1.5. Lucid catatonic syndromes. Lucid catatonic syndromes are understood as disorders of the motor sphere against the background of a formally unchanged consciousness, having the form of stupor or agitation without the presence of pathology in other areas of mental activity.
Psychomotor agitation and stupor can be obligate and auxiliary symptoms in many psychopathological syndromes (manic, depressive, delusional, hallucinatory stupor, or manic, depressive, delusional, hallucinatory agitation, with stupefaction syndromes).
6.1.5.1. Catatonic stupor. The main symptoms are hypokinesia, parakinesia. The most common and first symptoms are motor retardation from lethargy, passivity (substupor) up to complete immobility, hypo- and amymia with a mask-like face, mutism. Parakinesia is usually represented by active and (or) passive negativism, pretentiousness and mannerisms of poses, increased muscle tone (catalepsy, including symptoms of “air cushion”, “waxy flexibility”, “proboscis”, “fetal “pose” “hood”, etc.) , passive obedience. Neuro-vegetative disorders are also obligatory: greasiness of the skin with acne vulgaris, acrocyanosis and cyanosis of the tips of the ears and nose, less often of the hands, pallor of the skin, tachycardia, fluctuations in blood pressure, often towards hypotension, decreased pain sensitivity up to anesthesia , tendon hyperreflexia, decreased skin and mucous reflexes, nausea, vomiting, anorexia up to complete refusal of food with cachexia.Optional symptoms can be represented by fragmentary delusions, hallucinations, preserved from previous stages of the disease, for example, in continuous, paroxysmal schizophrenia.
Based on the nature of the severity of parakinesia, several variants of catatonic stupor are distinguished, sometimes acting as stages in the development of stupor.
“Sluggish” stupor is hypokinesia, represented by lethargy, passivity, not achieving pronounced or complete immobility (substupor). Parakinesias include passive negativism and passive submission.
Stupor with waxy flexibility is manifested by general motor retardation up to complete immobility. Among parakinesias - pronounced passive negativism with elements and episodes of active negativism, clearly expressed waxy flexibility with mannerism, pretentiousness, and a significant increase in muscle tone.
Stupor with numbness - persistent, complete immobility with clearly expressed active negativism with complete refusal of food, retention of urination and defecation. Muscle tone sharply increases, in which tension in the flexors predominates, which is accompanied by an abundance of parakinesia.
6.1.5.2. Catatonic excitement. Includes, as leading symptoms, catatonic hyperkinesia and parakinesia. Hyperkinesia is represented by chaotic, destructive, impulsive psychomotor agitation. Parakinesias include echopraxia, echolalia, motor and speech stereotypies, pretentiousness, mannered postures, passive and active negativism, and impulsiveness. Parakinesia is often combined with parathymia, perversions of drives, motives, and motives for activity (homicidomania, suicidomania, self-mutilation, coprophagia, etc.). Additional symptoms are acceleration of speech, verbigeration, perseveration, and speech interruption.
Impulsive catatonic arousal is characterized by sudden short-term episodes of impulsive behavior and actions, often with aggressive and destructive content. Most often, impulsive agitation occurs as an episode interspersed with catatonic stupor.
Silent catatonic excitation is represented by severe hyperkinesia with mutism, motor stereotypies and “echo” symptoms,
Hebephrenic arousal is considered as a variant or stage of catatonic arousal and as an independent syndrome. The leading symptoms are pretentiousness, mannerisms, grimacing, antics, echolalia, echopraxia, echothymia. Pretentiousness, mannerism, grotesqueness concerns both pantomime, facial expressions, and speech activity (stereotypical speech patterns, intonations (puerilism), neologisms, discontinuity, verbiage, flat jokes). Among the optional symptoms are fragmentary delusional ideas and episodic hallucinations.
Lucid catatonic states occur in continuously progressive schizophrenia, organic diseases of the brain, neuroinfections, traumatic brain injuries, tumors in the region of the third ventricle, pituitary gland, optic thalamus and basal ganglia.
An individual symptom acquires diagnostic significance only in combination and in relationship with other symptoms, that is, in a symptom complex syndrome. The syndrome is a set of symptoms united by a single pathogenesis. The clinical picture of the disease and its development are formed from the syndromes and their sequential changes.
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PSYCHOPATHOLOGICAL SYNDROMES
Recognition of any disease, including mental illness, begins with a symptom (a sign that reflects certain disorders of one or another function). However, the symptom-sign has many meanings and it is impossible to diagnose the disease on its basis. An individual symptom acquires diagnostic significance only in its aggregate and in relation to other symptoms, that is, in a syndrome (symptom complex). A syndrome is a set of symptoms united by a single pathogenesis. The clinical picture of the disease and its development are formed from the syndromes and their sequential changes.
Neurotic (neurosis-like) syndromes
Neurotic syndromes are observed with neurasthenia, hysterical neurosis, obsessive-compulsive neurosis; neurosis-like - for diseases of an organic and endogenous nature and correspond to the mildest level of mental disorders. Common to all neurotic syndromes is the presence of criticism of one’s condition, the absence of pronounced phenomena of disadaptation to ordinary living conditions, the concentration of pathology in the emotional-volitional sphere.
Asthenic syndrome- characterized by a noticeable decrease in mental activity, increased sensitivity to ordinary irritations (mental hyperesthesia), rapid fatigue, difficulty in mental processes, incontinence of affect with quickly onset fatigue (irritating weakness). A number of somatic functional disorders with autonomic disorders are observed.
Obsessive Obsessive Syndrome(anankast syndrome) - manifested by obsessive doubts, ideas, memories, various phobias, obsessive actions, rituals.
Hysterical syndrome- a combination of egocentrism, excessive self-suggestivity with increased affectivity and instability emotional sphere. An active desire for recognition from others by demonstrating one's own advantage or the desire to arouse sympathy or self-pity. The experiences of patients and behavioral reactions are characterized by exaggeration, hyperbolization (of the merits or severity of their condition), increased fixation on painful sensations, demonstrativeness, mannerisms, and exaggeration. This symptomatology is accompanied by elementary functional somatoneurological reactions, which are easily recorded in psychogenic situations; functional disorders motor system (paresis, astasia-abasia), sensitivity, activity of internal organs, analyzers (deaf-mute, aphonia).
Affective disorder syndromes
Dysphoria - grouchy-irritable, angry and gloomy mood with increased sensitivity to any external stimulus, aggressiveness and explosiveness. Accompanied by unfounded accusations of others, scandalousness, and cruelty. There are no disturbances of consciousness. Equivalents of dysphoria can be binge drinking (dipsomania) or aimless wandering (dromomania).
Depression melancholia, depressive syndrome - a suicidal condition, which is characterized by a depressed, depressed mood, deep sadness, despondency, melancholy, ideational and motor retardation, agitation (agitated depression). The structure of depression includes possible depressive delusional or overvalued ideas (of low value, worthlessness, self-blame, self-destruction), decreased desire, vital depression of self-feelings. Subdepression is a mild depressive affect.
Cotard's syndrome nihilistic-hypochondriacal delirium combined with ideas of enormity. It is most common in involutional melancholia, much less common in recurrent depression. There are two variants of the syndrome: hypochondriacal is characterized by a combination of anxious-melancholic affect with nihilistic-hypochondriacal delirium; Depressive is characterized by anxious melancholy with predominantly depressive delusions and ideas of denial of the outside world of a megalomaniac nature.
Masked (larvated) depression- characterized by a feeling of general vague diffuse somatic discomfort, vital senestopathic, algic, vegetodystonic, agrypnic disorders, concern, indecision, pessimism without clear depressive changes in affect. Often found in somatic practice.
Mania (manic syndrome) - a painfully elevated joyful mood with increased drives and tireless activity, accelerated thinking and speech, inadequate joy, cheerfulness and optimism. A manic state is characterized by distractibility of attention, verbosity, superficiality of judgment, incompleteness of thoughts, hypermnesia, overvalued ideas of overestimation of one’s own personality, and lack of fatigue. Hypomania is a mildly expressed manic state.
Affective syndromes (depression and mania) are the most common mental disorders and are noted in the onset of mental illnesses; they may remain the predominant disorders throughout the course of the disease.
When diagnosing depression, it is necessary to focus not only on the complaints of patients: sometimes complaints of decreased mood may be absent, and only targeted questioning reveals depression, loss of interest in life (“satiety with life” - taedium vitae), decreased overall vital activity, boredom, sadness, anxiety, etc. In addition to targeted questioning about actual mood changes, it is important to actively identify somatic complaints that can mask depressive symptoms, signs of sympathicotonia (dry mucous membranes, skin, tendency to constipation, tachycardia - the so-called “Protopopov’s sympathicotonic symptom complex”), characteristic of endogenous depressions. A large number of diagnostically significant signs can be detected by studying the appearance and behavior of patients by observation: motor retardation or, conversely, fussiness, agitation, neglected appearance, characteristic physical phenomena - a frozen expression of melancholy, a depressive "omega" (a fold between the eyebrows in the form greek letter“omega”), Veragut fold (oblique fold on upper eyelid). Physical and neurological examination reveals objective signs of sympathicotonia. Biological tests such as therapy with tricyclic antidepressants and the dexamethasone test allow paraclinical clarification of the nature of depression. Clinical and psychopathological studies using standardized scales (Zung and Spielberger scales) make it possible to quantify the severity of depression and anxiety.
Hallucinatory and delusional syndromes
Hallucinosis syndrome- influxes of verbal hallucinations such as different “voices” (conversations) against the background of relative preservation of consciousness.
Paranoid syndrome- primary systematized delirium (jealousy, reformism, “struggle for justice”, etc.), is distinguished by the plausibility of the plot, the system of evidence of the “correctness” of one’s statements, and the fundamental impossibility of their correction. The behavior of patients when implementing these ideas is characterized by sthenicity and persistence (delusional behavior). There are no perceptual disturbances.
Paranoid syndrome- characterized by secondary sensory delusions (persecution, relationships, influences), occurs acutely, against the background of emotional disorders (fear, anxiety) and disturbances of perception (illusions, hallucinations). Delirium is unsystematized, inconsistent, and may be accompanied by impulsive, unmotivated actions.
Kandinsky-Clerambault mental automatism syndromeconsists of pseudohallucinations, delusional ideas of influence and various mental automatisms, conviction of impartiality, involuntary occurrence, subjective coercion, violence of mental processes (thinking, speech, etc.)
Paraphrenic syndrome- a combination of senseless delusional ideas of greatness of fantastic content with phenomena of mental automatism, hallucinations, and euphoria.
To identify hallucinatory-delusional disorders, it is important not only to take into account spontaneous complaints of patients, but also to be able to conduct targeted questioning, which allows you to clarify the nature of painful experiences. Objective signs of hallucinations and delusional behavior, which were revealed during observation, significantly complement the clinical impression.
Syndromes of impaired consciousness
All syndromes of impaired consciousness have a number of common features, first described by K. Jaspers:
1. Alienation from the environment, unclear, fragmentary perception of it.
2. Disorientation in time, place, situation, and in the most difficult cases, in one’s own personality.
3. More or less pronounced incoherence of thinking with weakness or impossibility of judgment and speech disorders.
4. Complete or partial amnesia during the period of disorder of consciousness.
Coma - complete shutdown of consciousness with loss of conditioned and unconditioned reflexes, lack of chop activity.
Sopor confusion of consciousness with preservation of defensive and other unconditional reactions.
Stun - relatively light form clouding of consciousness. It is characterized by unclear orientation in the environment, a sharp increase in the threshold for all external stimuli, slowdown and difficulty in mental activity.
Nullification - slight clouding of consciousness while maintaining all types of orientation and the ability to carry out normal actions, while difficulties arise in understanding the complexity of the situation, the content of what is happening, the content of someone else’s speech.
Delirious syndrome- a form of confused consciousness, which is characterized by disorientation in place, time and situation, an influx of vivid true visual hallucinations, visual illusions and pareidolia, a feeling of fear, imaginative delusions and motor disturbances. Delirium is accompanied by autonomic disorders.
Amentive syndrome- a form of confused consciousness with a sharp depression of mental activity, complete disorientation, fragmented perception, inability to comprehend the situation, disordered physical activity, followed by complete amnesia of the experience.
Oneiric (dream-like) syndrome- a form of confused consciousness with an influx of involuntarily arising fantastic dream-like delusional ideas; accompanied by partial or complete alienation from the environment, a disorder of self-awareness, depressive or manic affect, signs of catatonia, retention in consciousness of the content of experiences with amnesia of the environment.
Twilight Syndrome- characterized by a sharp narrowing of the volume of consciousness and complete disorientation. The unproductive twilight state manifests itself in the implementation of a number of ordinary automated and externally ordered actions in an inappropriate situation for this in a state of wakefulness (ambulatory automatism) and during sleep (somnambulism). Productive twilight is characterized by an influx of true, extremely frightening hallucinations, an affect of fear and anger, destructive actions and aggression.
Syndromes caused by gross organic pathology of the brain
Convulsive syndrome- manifests itself in a variety of generalized and focal seizures (suddenly onset, rapidly passing states with impaired consciousness up to its loss and convulsive involuntary movements). To the structure convulsive syndrome More or less pronounced changes (decreases) in personality and intelligence are often intertwined.
Korsakovsky amnestic syndrome - characterized by a complete loss of the ability to remember current events, amnestic disorientation, memory distortions with relative preservation of memory for the past and a diffuse decrease in all components of mental functioning.
Psychoorganic syndrome- a more or less pronounced state of general mental helplessness with decreased memory, weakened understanding, incontinence of affect (Walter-Bühel triad).
Intellectual disability syndromes
Mental retardation- congenital total mental underdevelopment with a predominant lack of intelligence. Degrees: mild, moderate, severe, profound mental retardation.
Dementia syndrome- acquired persistent defect of intelligence, which is characterized by the inability to acquire new knowledge and skills and the loss of previously acquired ones. Lacunar (dysmnestic) dementia is a cellular intellectual defect with partial preservation of criticism, professional skills and the “core of personality.” Total dementia is a violation of all components of the intellect with a lack of criticism and the disintegration of the “core of personality” (moral and ethical properties).
Mental insanity- extreme degree of mental disintegration with extinction of all types of mental activity, loss of language, helplessness.
Syndromes with predominantly motor-volitional disorders
Apathetic-abulic syndrome- a combination of indifference (apathy) and a significant weakening of the motivation for activity (abulia).
Catatonic syndrome- manifests itself in the form of a catatonic stupor or in the form of stereotypical impulsive excitement. During stupor, patients freeze in a motionless state, muscle tone increases (rigidity, catalepsy), negativism appears, speech and emotional reactions are absent. During excitement, senseless, absurdly foolish behavior with impulsive actions, speech disturbances with the phenomena of fragmentation, grimacing, and stereotypy are noted.
Other syndromes
Depersonalization syndrome- a disorder of self-awareness with a feeling of alienation from some or all mental processes (thoughts, ideas, memories, relationships to the outside world), which is realized and painfully experienced by the patient himself.
Derealization syndrome- a disorder of mental activity, which is expressed in a painful feeling of unreality, the illusory nature of the surrounding world.
Irritable weakness syndrome- characterized by a combination of affective lability and irritability with decreased ability to work, weakened concentration and increased fatigue.
Hebephrenic syndrome- motor and speech disorders with senseless, mannered and foolish behavior, unmotivated gaiety, emotional devastation, impoverishment of motives, fragmented thinking with progressive disintegration of the personality.
Heboid syndrome- combination affective-volitional disorders with relative preservation of intellectual functions, which is manifested by rudeness, negativism, weakening of self-control, distorted nature of emotional reactions and drives and leads to pronounced social maladaptation and antisocial behavior.
Withdrawal syndrome- a condition that occurs as a result of a sudden cessation of taking (introducing) substances that caused substance abuse or after the introduction of their antagonists; characterized by mental, vegetative-somatic and neurological disorders; The clinical picture depends on the type of substance, dose and duration of its use.
Hypochondriacal syndrome- consists of an erroneous (overvalued or delusional) belief of the patient that he has a serious somatic illness, in an overestimation (dramatization) of the severity of his painful condition. The syndrome consists of senestopathies and emotional disorders in the form of depressive mood, fear, and anxiety. Hypochondriacal fixation is an excessive focus on the state of one’s health, one or another of its slightest deviations, complications that threaten one’s own health.
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APATHY (indifference). At the initial stages of the development of apathy, there is a slight weakening of hobbies; the patient reads or watches TV mechanically. In case of psycho-affective indifference, during questioning he expresses relevant complaints. With shallow emotional decline, for example in schizophrenia, calmly reacts to events of an exciting, unpleasant nature, although in general external events are not indifferent to the patient.
In a number of cases, the patient’s facial expressions are impoverished, he is not interested in events that do not concern him personally, and almost does not participate in entertainment. Some patients are little affected even by their own situation and family affairs. Sometimes there are complaints about “stupidity”, “indifference”. The extreme degree of apathy is characterized by complete indifference. The patient's facial expression is indifferent, there is indifference to everything, including his appearance and cleanliness of his body, to his stay in the hospital, to the appearance of relatives.
ASTHENIA (increased fatigue). For minor events, fatigue occurs more often with increased load, usually in the afternoon. In more pronounced cases, even with relatively simple types of activity, a feeling of fatigue, weakness, and an objective deterioration in the quality and pace of work quickly appear; rest doesn't help much. Asthenia is noticeable at the end of a conversation with a doctor (for example, the patient talks sluggishly, tries to quickly lie down or lean on something). Among autonomic disorders, the predominant ones are increased sweating, pallor of the face. Extreme degrees of asthenia are characterized by severe weakness up to prostration. Any activity, movement, short-term conversation is tiring. Rest doesn't help.
AFFECTIVE DISORDERS characterized by instability (lability) of mood, a change in affect towards depression (depression) or elevation (manic state). At the same time, the level of intellectual and motor activity changes, and various somatic equivalents of the condition are observed.
Affective lability (increased emotional reactivity). With unexpressed disorders, the range of situations and reasons in connection with which affect arises or mood changes are somewhat expanded compared to the individual norm, but these are still quite intense emotiogenic factors (for example, actual failures). Typically, affect (anger, despair, resentment) occurs rarely and its intensity largely corresponds to the situation that caused it. With more severe affective disorders, mood often changes for minor and varied reasons. The intensity of the disorders does not correspond to the real significance of psychogenicity. At the same time, affects can become significant, arise for completely insignificant reasons or without perceptible external cause, change several times within a short time, which makes targeted activity extremely difficult.
Depression. For minor depressive disorders The patient sometimes has a noticeably sad expression on his face and sad intonations in conversation, but at the same time his facial expressions are quite varied and his speech is modulated. The patient manages to be distracted and cheered up. There are complaints of “feeling sad” or “lack of cheerfulness” and “boredom.” Most often, the patient is aware of the connection between his condition and traumatic influences. Pessimistic experiences are usually limited conflict situation. There is some overestimation of real difficulties, but the patient hopes for a favorable resolution of the situation. A critical attitude towards the disease has been maintained. With a decrease in psycho-traumatic influences, the mood normalizes.
As depressive symptoms worsen, facial expressions become more monotonous: not only the face, but also the posture expresses despondency (shoulders are often slumped, the gaze is directed into space or down). There may be sad sighs, tearfulness, a pitiful, guilty smile. The patient complains of a depressed, “decadent” mood, lethargy, and unpleasant sensations in the body. He considers his situation gloomy and does not notice anything positive in it. It is almost impossible to distract and cheer up the patient.
With severe depression, a “mask of grief” is observed on the patient’s face; the face is elongated, grayish-cyanotic in color, the lips and tongue are dry, the gaze is suffering, expressive, there are usually no tears, blinking is rare, sometimes the eyes are half-closed, the corners of the mouth are downturned, the lips are often compressed. Speech is not modulated, up to an unintelligible whisper or silent lip movements. The pose is hunched over, with head down, knees together. Raptoid states are also possible: the patient groans, sobs, rushes about, tends to self-harm, and breaks his arms. Complaints of “unbearable melancholy” or “despair” predominate. He considers his situation hopeless, hopeless, hopeless, his existence unbearable.
Manic state. With the development of a manic state, a barely noticeable elation of mood appears at first, in particular the revival of facial expressions. The patient notes vigor, tirelessness, good health, “is in excellent shape,” and somewhat underestimates the real difficulties. Subsequently, there is a clear revival of facial expressions, the patient smiles, his eyes sparkle, he is often prone to humor and witticisms, in some cases he states that he feels a “special surge of strength”, “rejuvenated”, is unreasonably optimistic, considers events with an unfavorable meaning to be trivial, all difficulties - easily overcome. The pose is relaxed, there are excessively sweeping gestures, and sometimes a raised tone slips into the conversation.
In a pronounced manic state, generalized, non-targeted motor and ideational excitation occurs, with extreme expression of affect - to the point of frenzy. The face often turns red and the voice becomes hoarse, but the patient notes “unusually good health.”
DELUSIONAL SYNDROMES. Rave- a false, but not amenable to logical correction, belief or judgment that does not correspond to reality, as well as to the social and cultural attitudes of the patient. Delusions must be differentiated from delusional ideas that characterize erroneous judgments expressed with excessive persistence. Delusional disorders characteristic of many mental illnesses; as a rule, they are combined with other mental disorders, forming complex psychopathological syndromes. Depending on the plot, delusions of relation and persecution are distinguished (the patient’s pathological belief that he is a victim of persecution), grandeur (the belief in a high, divine purpose and special personal importance), changes in one’s own body (the belief in physical, often bizarre changes in body parts ), the appearance of a serious illness (hypochondriacal delusion, in which, on the basis of real somatic sensations or without them, concern develops, and then a belief in the development of a particular disease in the absence of its obvious signs), jealousy (usually a painful conviction of a spouse’s infidelity is formed on the basis complex emotional state).
ATTRACTION, VIOLATIONS. The pathology of desire reflects a weakening as a result of various reasons(hypothalamic disorders, organic disorders Central nervous system, state of intoxication, etc.) volitional, motivated mental activity. The consequence of this is a “deep sensory need” for the realization of impulses and the strengthening of various drives. Clinical manifestations of desire disorders include bulimia (sharp increase in food instinct), dromomania (attraction to vagrancy), pyromania (attraction to arson), kleptomania (attraction to theft), dipsomania (alcoholic binges), hypersexuality, various variants of perversion of sexual desire, etc. Pathological attraction can have a character obsessive thoughts and actions, are determined by mental and physical discomfort (dependence), and also arise acutely as impulsive reactions.
HALLUCINATIVE SYNDROMES. Hallucinations are a truly felt sensory perception that occurs in the absence of an external object or stimulus, displaces actual stimuli and occurs without phenomena of impaired consciousness. There are auditory, visual, olfactory, tactile (the sensation of insects crawling under the skin) and others. hallucinations.
A special place belongs to verbal hallucinations, which can be commentary or imperative, manifesting themselves in the form of a monologue or dialogue. Hallucinations can appear in healthy people in a state of half-sleep (hypnagogic hallucinations). Hallucinations are not specific psychopathological manifestations of endogenous or other mental illnesses. They are observed in schizophrenia, epilepsy, intoxication, organic and other psychoses, and can be both acute and chronic. As a rule, hallucinations are combined with other mental disorders; most often various variants of hallucinatory-paranoid syndrome are formed.
DELIRIUM- a nonspecific syndrome characterized by a combined disorder of consciousness, perception, thinking, memory, sleep-wakefulness rhythm, and motor agitation. The delirious state is transient and fluctuating in intensity. It is observed against the background of various intoxicating effects caused by alcohol, psychoactive substances, as well as liver diseases, infectious diseases, bacterial endocarditis and other somatic disorders.
DEMENTIA- a condition caused by a disease, usually of a chronic or progressive nature, in which there are disturbances in higher cortical functions, including memory, thinking, orientation, understanding of what is happening around, and the ability to learn. At the same time, consciousness is not changed, disturbances in behavior, motivation, and emotional response are observed. Characteristic of Alzheimer's disease, cerebrovascular and other diseases that primarily or secondary affect the brain.
HYPOCHONDRIC SYNDROME characterized by unjustifiably increased attention to one’s health, extreme preoccupation with even minor ailments, conviction of the presence of a serious illness in the absence of it objective signs. Hypochondria is usually integral part more complex senestopathic-hypochondriacal, anxiety-hypochondriacal and other syndromes, and is also combined with obsessions, depression, and paranoid delusions.
THINKING, VIOLATION. Characteristic symptoms are thoroughness of thinking, mentalism, reasoning, obsessions, and increased distractibility. At first, these symptoms are almost invisible and have little effect on the productivity of communication and social contacts. However, as the disease progresses, they become more pronounced and permanent, which makes it difficult to communicate with the patient. When they are most severe, productive contact with patients is practically impossible due to the development of significant difficulties in them in appropriate behavior and decision-making.
MEMORY, VIOLATION. With a mild degree of hypomnesia for current events, the patient generally remembers the events of the next 2-3 days, but sometimes makes minor errors or uncertainty when remembering individual facts (for example, he does not remember the events of the first days of his stay in the hospital). With increasing memory impairment, the patient cannot remember which procedures he took 1-2 days ago; only when reminded does he agree that he already talked to the doctor today; does not remember the dishes he received during yesterday's dinner or today's breakfast, and confuses the dates of his next visits with relatives.
With severe hypomnesia, there is a complete or almost complete absence of memory about immediate events. At the same time, the memory of events in his personal life is grossly impaired; he answers questions approximately or after complex calculations. With severe hypomnesia, there is a complete or almost complete absence of memory of past events; patients answer “I don’t remember” to the relevant questions. In these cases, they are socially helpless and disabled.
PSYCHOORGANIC (organic, encephalopathic) SYNDROME- a state of fairly stable mental weakness, expressed in the mildest form by increased exhaustion, emotional lability, instability of attention and other manifestations of asthenia, and in more severe forms severe cases- also psychopathic-like disorders, memory loss, increasing mental helplessness. The basis of the pathological process in psychoorganic syndrome is determined by the current disease of the brain of an organic nature (traumatic disease, tumor, inflammation, intoxication) or its consequences.
Nonspecific psychopathological symptoms are often combined with focal brain lesions with corresponding neurological and mental disorders. Variants of the syndrome include asthenic with a predominance of physical and mental exhaustion; explosive, determined by affective lability; euphoric, accompanied by increased mood, complacency, decreased critical attitude towards oneself, as well as affective outbursts and bouts of anger, ending in tearfulness and helplessness; apathetic, characterized by a decrease in interests, indifference to the environment, weakening of memory and attention.
dated June 14, 2007Karaganda State Medical University
Department of Psychology, Psychiatry and NarcologyLECTURE
Subject:
Discipline "Neurology, psychiatry, narcology"
Specialty 051301 – General medicine
Time (duration) 1 hour
Karaganda 2011
Approved at a methodological meeting of the department
05/07/2011 Protocol No. 10
Head of the departmentpsychology, psychiatry and narcology
Candidate of Medical Sciences, Associate Professor M.Yu.Lyubchenko
Subject : Main psychopathological syndromes
The goal is to familiarize students with the classification of mental illnesses
Lecture outline
2. Asthenic syndrome
3. Hallucinosis syndrome
4. Paranoid syndrome
5. Paranoid syndrome.
6. Mental automatism syndrome
7. Paraphrenic syndrome
8. Syndromes of impaired consciousness
9. Korsakoff syndrome
10.Psycho-organic syndrome
A syndrome is a stable combination of symptoms that are closely related to each other and united by a single pathogenetic mechanism and characterize the current condition of the patient.
Thus, peripheral sympathicotonia characteristic of depression leads to the appearance of tachycardia, constipation, and pupil dilation. However, the connection between symptoms can be not only biological, but also logical. Thus, the lack of the ability to remember current events with fixation amnesia naturally leads to disorientation in time and confusion in a new, unfamiliar environment.
Syndrome is the most important diagnostic category in psychiatry, while syndromic diagnosis is not considered as one of the stages in establishing a nosological diagnosis. When solving many practical issues in psychiatry, a correctly described syndrome means much more than a correctly stated nosological diagnosis. Since the causes of most mental disorders have not been determined, and the main drugs used in psychiatry do not have a nosologically specific effect, the prescription of therapy in most cases is focused on the leading syndrome. Thus, a pronounced depressive syndrome suggests the presence of suicidal thoughts, and therefore indicates to the doctor the need for urgent hospitalization, careful supervision and the use of antidepressants.
Some diseases are characterized by significant polymorphism of symptoms.
Although syndromes do not directly indicate a nosological diagnosis, they are divided into more and less specific. Thus, apathetic-abulic states and mental automatism syndrome are quite specific for paranoid schizophrenia. Depressive syndrome extremely nonspecific and occurs in a wide range of endogenous, psychogenic, somatogenic and exogenous-organic diseases.
There are simple (small) and complex (large) syndromes. An example of the first is asthenic syndrome, manifested by a combination of irritability and fatigue. Typically, simple syndromes do not have nosological specificity and occur in various diseases. Over time, the syndrome may become more complicated, i.e. the addition of more severe symptoms in the form of delusions, hallucinations, pronounced changes personalities, i.e. formation of a complex syndrome.
^ ASTHENIC SYNDROME.
This condition is manifested by increased fatigue, weakening or loss of the ability for prolonged physical and mental stress. Patients experience irritable weakness, expressed by increased excitability and quickly followed by exhaustion, affective lability with a predominance of low mood. Asthenic syndrome is characterized by hyperesthesia.
Asthenic states are characterized by the phenomena of asthenic or figurative mentism, manifested by a stream of vivid figurative ideas. There may also be influxes of extraneous thoughts and memories that involuntarily appear in the patient’s mind.
Headaches, sleep disturbances, and vegetative manifestations are often observed.
The patient's condition may change depending on the level of barometric pressure (meteopathic Pirogov syndrome).
Asthenic syndrome is the most nonspecific of all psychopathological syndromes. It can be observed with cyclothymia, symptomatic psychoses, organic brain lesions, neuroses, intoxication psychoses.
The occurrence of asthenic syndrome is associated with depletion of the functional capabilities of the nervous system when it is overstrained, as well as due to autointoxication or exogenous toxicosis, impaired blood supply to the brain and metabolic processes in brain tissue. This allows us to consider the syndrome in some cases as an adaptive reaction, manifested by a decrease in the intensity of activity of various body systems with the subsequent possibility of restoring their function.
^ HALLUCINOSIS SYNDROMES.
Hallucinosis is manifested by numerous hallucinations (usually simple), which constitute the main and practically the only manifestation of psychosis. There are visual, verbal, tactile, olfactory hallucinosis. Hallucinosis can be acute (lasting several weeks) or chronic (lasting years).
Most typical reasons hallucinosis are exogenous hazards (intoxication, infection, trauma) or somatic diseases (cerebral atherosclerosis). Some intoxications are distinguished by special variants of hallucinosis. Thus, alcoholic hallucinosis is more often manifested by verbal hallucinations of a condemning nature. Tetraethyl lead poisoning causes a sensation of hair in the mouth. Cocaine intoxication results in tactile hallucinosis with the sensation of insects crawling under the skin.
In schizophrenia, this syndrome occurs in the form of pseudohallucinosis.
^ PARANOIAL SYNDROME.
Paranoid syndrome manifests itself as a primary, interpretive monothematic, systematized delusion. The predominant content of delusional ideas is reformism, relationships, jealousy, and the special importance of one’s own personality. There are no hallucinatory disorders. Delusional ideas are formed as a result of a paralogical interpretation of the facts of reality. The manifestation of delusion may be preceded by the long existence of overvalued ideas. Paranoid syndrome tends to be chronic and difficult to treat with psychotropic drugs.
The syndrome occurs in schizophrenia, involutional psychoses, and decompensation of paranoid psychopathy.
^ PARANOID SYNDROME
Paranoid syndrome is characterized by systematized ideas of persecution. Delusions are accompanied by hallucinations, most often auditory pseudohallucinations. The occurrence of hallucinations determines the emergence of new plots of delirium - ideas of influence, poisoning. A sign of an allegedly existing influence, from the point of view of patients, is a feeling of mastery (mental automatism). Thus, in its main manifestations, paranoid syndrome coincides with the concept of mental automatism syndrome. The latter does not include only variants of the paranoid syndrome, accompanied by true taste or olfactory hallucinations and delusions of poisoning. With paranoid syndrome, there is a certain tendency towards the collapse of the delusional system, delirium acquires features of pretentiousness and absurdity. These features become especially pronounced during the transition to paraphrenic syndrome.
SYNDROME OF MENTAL AUTOMATISM (Kandinsky-Clerambault syndrome).
This syndrome consists of delusions of persecution and influence, pseudohallucinations and phenomena of mental automatism. The patient can feel the influence carried out in various ways - from witchcraft and hypnosis, to the action of cosmic rays and computers.
There are 3 types of mental automatism: ideational, sensory, motor.
Ideatorial automatisms are the result of an imaginary influence on thinking processes and other forms of mental activity. Manifestations of this type of automatism are mentism, “sounding” of thoughts, “taking away” or “putting in” thoughts, “madeness” of dreams, a symptom of unwinding memories, “madeness” of mood and feelings.
Sensory automatisms usually include extremely unpleasant sensations that occur in patients also as a result of the influence of an external force.
Motor automatisms include disorders in which patients have the belief that the movements they make are carried out against their will under external influence, as well as speech motor automatisms.
An inverted version of the syndrome is possible, the essence of which is that the patient himself allegedly has the ability to influence others, recognize their thoughts, influence their mood, feelings and actions.
^ PARAPHRENIC SYNDROME.
This condition is a combination of fantastic delusions of grandeur, delusions of persecution and influence, phenomena of mental automatism and affective disorders. Patients call themselves rulers of the Earth, the Universe, heads of state, etc. When presenting the content of delirium, they use figurative and grandiose comparisons. As a rule, patients do not seek to prove the correctness of statements, citing the indisputability of their beliefs.
The phenomena of mental automatism also have a fantastic content, which is expressed in mental communication with outstanding representatives of humanity or with creatures inhabiting other planets. Positive or negative twin syndrome is often observed.
Pseudohallucinations and confabulatory disorders can occupy a significant place in the syndrome. In most cases, the mood of patients is elevated.
^ SYNDROMES OF DISTURBED CONSCIOUSNESS.
Criteria for impaired consciousness have been developed (Karl Jaspers):
Detachment from surrounding reality. The outside world is not perceived or is perceived fragmentarily.
Disorientation in surroundings
Thinking disorder
Amnesia of the period of impaired consciousness, complete or partial
switched off syndromes
clouded consciousness syndromes
Syndromes of clouded consciousness: delirium, amentia, oneiroid, twilight disorder of consciousness.
Delirium may be alcoholic, intoxication, traumatic, vascular, infectious. This is an acute psychosis with impaired consciousness, which is most often based on signs of cerebral edema. The patient is disoriented in time and place, experiencing frightening visual hallucinations. Often these are zoohallucinations: insects, lizards, snakes, scary monsters. The patient's behavior is largely determined by psychopathological experiences. Delirium is accompanied by multiple somatovegetative disorders (increased blood pressure, tachycardia, hyperhidrosis, tremor of the body and limbs). In the evening and at night, all these manifestations intensify, and in the daytime they usually weaken somewhat.
Upon completion of psychosis, partial amnesia is observed.
The course of psychosis is characterized by a number of features. Symptoms increase in a certain sequence. It takes from several days to 2 days for psychosis to fully develop. Early signs of developing psychosis are anxiety, restlessness, hyperesthesia, insomnia, against the background of which hypnogogic hallucinations appear. As psychosis increases, illusory disorders appear, turning into complex hallucinatory disorders. This period is characterized by pronounced fear and psychomotor agitation. Delirium lasts from 3 to 5 days. The cessation of psychosis occurs after prolonged sleep. After recovery from psychosis, residual delusions may persist. Abortive delirium lasts several hours. However, severe forms of delirium are not uncommon, leading to a gross organic defect (Korsakoff syndrome, dementia).
Signs of an unfavorable prognosis are occupational and persistent delirium.
Oneiric(dreamlike) darkening of consciousness. Distinguished by the extreme fantastic nature of psychotic experiences.
Oneiroid is a peculiar alloy of real, illusory and hallucinatory perception of the world. A person is transported to another time, to other planets, is present at great battles, the end of the world. The patient feels responsible for what is happening, feels like a participant in the events. However, the behavior of patients does not reflect the richness of experiences. The movement of patients is a manifestation of the catatonic syndrome - stereotypical swaying, mutism, negativism, waxy flexibility, impulsiveness. Patients are disoriented in place, time and self. A symptom of double false orientation is possible, when patients consider themselves patients in a psychiatric hospital and at the same time participants in fantastic events. Feelings of rapid movement, movement in time and space are often observed.
Oneiroid is most often a manifestation of an acute attack of schizophrenia. The formation of psychosis occurs relatively quickly, but can last for several weeks. Psychosis begins with sleep disturbances and the appearance of anxiety; concern quickly reaches the level of confusion. Acute sensory delirium and derealization phenomena appear. Then fear gives way to an affect of bewilderment or ecstasy. Later, catatonic stupor or agitation often develops. The duration of psychosis is up to several weeks. The exit from the oneiric state is gradual. First, hallucinations are leveled out, then catatonic phenomena. Ridiculous statements and actions sometimes persist for quite a long time.
Oneiric experiences that develop against the background of exogenous and somatogenic factors are classified as manifestations fantastic delirium. Among exogenous psychoses, the most consistent with the picture of a typical oneiroid are the phenomena observed with the use of hallucinogens (LSD, hashish, ketamine) and hormonal drugs (corticosteroids).
Amentia – severe clouding of consciousness with incoherent thinking, complete inaccessibility to contact, fragmentary deceptions of perception and signs of severe physical exhaustion. A patient in an amental state usually lies down, despite chaotic agitation. His movements sometimes resemble some actions indicating the presence of hallucinations, but are often completely meaningless and stereotypical. Words are not connected into phrases and are fragments of speech (incoherent thinking). The patient reacts to the doctor’s words, but cannot answer questions and does not follow instructions.
Amentia occurs most often as a manifestation of long-term debilitating somatic diseases. If it is possible to save the lives of patients, the outcome is a pronounced organic defect (dementia, Korsakoff syndrome, affected asthenic conditions). Many psychiatrists consider amentia as one of the options for severe delirium.
^ Twilight darkness of consciousness is a typical epileptiform paroxysm. Psychosis is characterized by a sudden onset, a relatively short duration (from tens of minutes to several hours), an abrupt cessation and complete amnesia of the entire period of upset consciousness.
The perception of the environment at the moment of clouding of consciousness is fragmentary, patients snatch from surrounding stimuli random facts and react to them in unexpected ways. Affect is often characterized by malice and aggressiveness. Antisocial behavior is possible. Symptoms lose all connection with the patient’s personality. Possible productive symptoms in the form of delusions and hallucinations. Once psychosis ends, there are no memories of psychotic experiences. Psychosis usually ends in deep sleep.
There are variants of twilight stupefaction with vivid productive symptoms (delusions and hallucinations) and with automated actions (outpatient automatisms).
^ Outpatient automatisms manifest themselves in short periods of confusion without sudden excitement with the ability to perform simple automated actions. Patients can take off their clothes, get dressed, go outside, and give brief, not always appropriate answers to the questions of others. Upon recovery from psychosis, complete amnesia is noted. Varieties of ambulatory automatisms include fugues, trances, and somnambulism.
Twilight stupefactions are a typical sign of epilepsy and other organic diseases (tumors, cerebral atherosclerosis, head injuries).
It should be distinguished from epileptic hysterical twilight states that arise immediately after the action of mental trauma. At the time of psychosis, the behavior of patients may be characterized by foolishness, infantilism, and helplessness. Amnesia can cover large periods preceding psychosis or following its cessation. However, fragmentary memories of what happened may remain. Resolving a traumatic situation usually leads to restoration of health.
^ KORSAKOV SYNDROME
This is a condition in which memory disorders for events of the present (fixation amnesia) predominate, while it is preserved for events of the past. All information coming to the patient instantly disappears from his memory; patients are not able to remember what they just saw or heard. Since the syndrome can occur after an acute cerebral accident, along with anterograde amnesia, retrograde amnesia is also noted.
One of the characteristic symptoms is amnestic disorientation. Memory gaps are filled with paramnesias. Confabulatory confusion may develop.
The occurrence of Korsakoff syndrome as a result of acute brain damage in most cases allows us to hope for some positive dynamics. Although complete memory restoration is impossible in most cases, during the first months after treatment the patient can record individual repeated facts, the names of doctors and patients, and navigate the department.
^ PSYCHOORGANIC SYNDROME
A state of general mental helplessness with decreased memory, intelligence, weakened will and affective stability, decreased ability to work and other adaptation capabilities. In mild cases, psychopathic states of organic origin, mild asthenic disorders, affective lability, and weakening of initiative are revealed. Psychoorganic syndrome can be a residual condition that occurs during progressive diseases of organic origin. In these cases, psychopathological symptoms are combined with signs organic damage brain.
There are asthenic, explosive, euphoric and apathetic variants of the syndrome.
At asthenic variant The clinical picture of the syndrome is dominated by persistent asthenic disorders in the form of increased physical and mental exhaustion, symptoms of irritable weakness, hyperesthesia, affective lability, and disorders of intellectual functions are slightly expressed. There is a slight decrease in intellectual productivity and mild dysmnestic disorders.
For explosive version Characterized by a combination of affective excitability, irritability, aggressiveness with mildly expressed dysmnestic disorders and decreased adaptation. Characterized by a tendency towards overvalued paranoid formations and querulant tendencies. Quite frequent alcoholization is possible, leading to the formation alcohol addiction.
As with the asthenic and explosive variants of the syndrome, decompensation of the condition is expressed in connection with intercurrent diseases, intoxications and mental trauma.
Painting euphoric version The syndrome is determined by an increase in mood with a tinge of euphoria, complacency, confusion, a sharp decrease in criticism of one’s condition, dysmnestic disorders, and increased drives. Anger and aggressiveness are possible, followed by helplessness and tearfulness. Signs of a particularly serious condition are the development in patients of symptoms of forced laughter and forced crying, in which the reason that caused the reaction is amnesic, and the grimace of laughter or crying persists for a long time in the form of a facial reaction devoid of affect content.
^ Apathetic option The syndrome is characterized by aspontaneity, a sharp narrowing of the range of interests, indifference to the environment, including one’s own fate and the fate of one’s loved ones, and significant dysmnestic disorders. Noteworthy is the similarity of this condition with the apathetic pictures observed in schizophrenia, however, the presence of mnestic disorders, asthenia, spontaneously occurring syndromes of forced laughter or crying helps to distinguish these pictures from similar conditions in other nosological units.
The listed variants of the syndrome are often stages of its development, and each of the variants reflects a different depth and different extent of damage to mental activity.
Illustrative material (slides – 4 pcs.)
Slide 2
Slide 3
Slide 3
Literature
Mental illnesses with a course in narcology / edited by prof. V.D. Mendelevich. M.: Academy 2004.-240 p.
Medelevich D.M. Verbal hallucinosis. - Kazan, 1980. - 246 p.
Guide to Psychiatry / Ed. A. V. Snezhnevsky. T. 1-2- M.: Medicine, 1983.
Jaspers K. General psychopathology: Trans. with him. - M.: Practice,
1997. - 1056 p.
Zharikov N.M., Tyulpin Yu.G. Psychiatry. M.: Medicine, 2000 – 540 p.
Psychiatry. Tutorial for students of medical universities, edited by V.P. Samokhvalova – Rostov on Don: Phoenix 2002
Rybalsky M.I. Illusions and hallucinations. - Baku, 1983., 304 p.
Popov Yu. V., Vid V. D. Clinical psychiatry. - St. Petersburg, 1996.
Security questions (feedback)
name the main features of paraphrenic syndrome
What is included in the concept of psychoorganic syndrome
What are the main reasons for the development of Korsakoff's syndrome?
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