Few adults think about the role of emotions in life. But when a married couple has children and suddenly it turns out that the baby cannot control his feelings, the parents begin to panic. In fact, a violation of the emotional-volitional sphere is not such a serious problem if it is detected immediately. You can cure such a disorder either independently or with the help of a qualified doctor.
Causes
What influences the formation of a person’s will and emotions? There are two main reasons that can cause a violation. One of them is heredity, and the other is social circle. The causes of disturbances in the emotional-volitional sphere are discussed in more detail below.
- Impression. If a child does not receive enough impressions and sits at home most of his life, then his development is very slow. In order for the psyche to develop normally, parents should walk with the child in the yard, show him other children, study trees, and give him the opportunity to play with sand. Impressions form a normal nervous system and help the child learn to experience and then control his emotions.
- Another reason for the disturbance of the emotional volitional sphere is the lack of movement. A child whose parents do not bother themselves much with their child’s development may begin to walk late. Such inhibition of normal physical development leads to inhibited emotional reactions. And some parents tend to realize over time that their child is not walking, but the neighbor’s children are already running. Parents begin to catch up, and the child suffers not only physically, but also psychologically.
- A child may suffer greatly due to the lack of maternal love. If a woman does not take her child in her arms, stroke the baby, rock him and sing lullabies to him, the baby will quickly lose contact with his mother. Such a child will grow up inferior, as people say - unloved.
Volitional act
Sphering occurs at an early age. To understand where the failure occurred, you need to know how the will functions. normal person. The sequence of decision-making for all people is as follows:
- Emergence of an impulse. A person has an urge to do something.
- Motivation. The person considers what he will receive when the action is completed. Most often, a person receives emotional satisfaction from his action.
- Instrument of activity. It’s not always possible to do an imagined action without additional equipment. Before starting work, you have to find all the necessary equipment.
- Decision-making. The person once again thinks about whether he should carry out his plan or not.
- Performing an action. The person carries out his idea.
This process occurs in the head of every person before he takes any action. You should not think that children, due to their undeveloped intelligence, do not carry out such work in their heads. Even our primitive ancestors - monkeys, make volitional efforts in order to perform this or that act.
How is emotional-volitional disorder diagnosed? The spheres of application of human will are varied. A person must move to take something or to eat. If a child is apathetic and doesn’t want anything, it means he has some kind of deviation. The same goes for overly active children who take actions without having time to think about the consequences of their decisions.
Main problems
Depending on the degree of disturbance of the emotional-volitional sphere, the child becomes irritable, lethargic or generative. Parents should notice their child's problems as soon as they appear. Any disease, before settling in the body, manifests itself in symptoms. At this stage, it is necessary to determine the extent of the child’s problems and prescribe treatment. What is the classification of persons with disorders of the emotional-volitional sphere?
- Aggressiveness. Persons behave inappropriately, bully others and take pleasure in tears and humiliation of a weaker opponent. Even children who behave aggressively will never bully someone who is stronger than them. They will logically reason that a harmless creature will not be able to fight back, and therefore can be humiliated.
- Slow reaction. Children cannot immediately understand what the problem is. For example, they may feel hungry, but will not make any effort to ask for food or to get food themselves.
- Disinhibited reaction. The second point in the classification of persons with disorders of the emotional-volitional sphere are people who cannot control their emotions. If they cry, they cry too loudly; if they laugh, they do so for an unnaturally long time.
- Excessive anxiety. Downtrodden children of overactive parents become quiet. They are afraid to talk about their desires and problems. They fail to attract attention due to their weakness of character.
Groups of violations
Classification of disorders of the emotional-volitional sphere is necessary in order to correctly prescribe therapeutic measures. All children are different, and their problems may not be the same. Even children who grow up in the same family can suffer from various ailments. The main groups of disorders of the emotional-volitional sphere:
- Mood disorder. Violation of the emotional-volitional sphere in children often manifests itself in uncontrollable emotions. The child cannot control himself, and therefore his feelings are always on edge. If a baby is happy about something, then soon his state reaches euphoria. If a child is sad, he can easily become depressed. And often one state after an hour turns into another, polar to the original one.
- Unusual behavior. When considering children, one cannot fail to mention deviations from the norm of behavior. Guys can be either too calm or overly active. The first case is dangerous due to the fact that the child is lacking initiative, and the second situation threatens because the child has problems with attention.
- Psychomotor problems. The child suffers from strange surges of feelings that overwhelm him for no reason. For example, a child may complain that he is too scared, although in reality the child is not in danger. Anxiety, impressionability and imaginary behavior are well known to children with a violation of the emotional-volitional sphere and behavior that differs from the generally accepted norm.
External manifestation
Violations can be determined by the baby's behavior.
- Strong dependence on parents. A child who, at five years old, cannot trust the people around him causes a strange reaction. The baby hides behind his mother’s skirt all the time and tries to close himself off from the world. Normal childhood embarrassment is one thing. And something completely different - distrust, unsociability and intractability.
- A child who is neglected in the family will feel lonely. The child will not be able to form relationships normally, since the parents will convince the child that he is stupid, crooked and unworthy of love. The loneliness that such a child will exude will be strongly felt.
- Aggression. Children who lack attention or who want to relieve tension may not withdraw into themselves, but, on the contrary, behave too relaxed. Such children will not restrain their emotions and will try with all their might to attract attention to their person.
Methods
Emotional-volitional disturbances in the personality sphere can be subject to correction. What methods do specialists resort to to correct what parents have wrongly instilled in their child?
- Game therapy. With the help of the game, the rules of adequate behavior in the group are explained to the child. The child develops new neural connections that help transform what he sees in the game and transfer examples to life situations.
- Art therapy. With the help of a drawing you can learn a lot about a child’s personality. A creative work will show the specialist how the baby feels in the garden, in the family and in this world. Drawing helps you relax and feel confident. Other types of art work the same way: modeling, embroidery, design.
- Psychoanalysis. An experienced psychotherapist can help a child reconsider his views on familiar things. The doctor will tell the baby what is good and what is bad. The specialist will act in two ways: suggestion and persuasion.
- Trainings. This method of influence involves working with a group of children who have a common problem. The guys will jointly review their habits and form new ones based on old ones.
Psychoanalytic therapy
Correction of disturbances in the emotional-volitional sphere occurs using various methods. One of them is psychoanalytic therapy. Such therapy can be carried out either individually or in a group. If the child studies alone, the psychotherapist talks to the child about feelings in the form of a game. He asks to portray anger, joy, love, etc. in turn. This is done so that the baby learns to distinguish between his feelings and understand at what moment and what exactly he should feel. Also individual consultations help the child understand his significance and importance, and what is very necessary in most cases is to feel loved and welcome in the doctor’s office.
In group therapy, the specialist does not have time to play with each child. Therefore, the procedure for restoring the emotional-volitional sphere goes through drawing. Children express their emotions, and then tell why they feel anger, joy, etc. By telling themselves and listening to others, the children begin to realize in what cases what they need to feel and how to correctly express their emotions.
Behavioral therapy
This type of therapy takes place in the form of a game. The child is offered a simulated situation, and he must show how he will behave in it. The game is aimed at developing in the baby those feelings that any normal individual should experience in a given situation. After conducting a game situation to reinforce the material, the presenter must once again explain what exactly was being modeled and how the patient should behave in such a situation. You should definitely get feedback from your child. The child must explain the material he has learned. Moreover, you need to get the child not only to tell you how to behave in a situation, but also to explain why such behavior will be considered acceptable.
Such therapies should be carried out once a week. And for the remaining 7 days, the child must consolidate the material received in class. Since the child will have little interest in own development, parents should monitor the baby’s behavior. And if the child does something differently from the training, mom or dad must repeat the recently completed lesson with their child.
Cognitive behavioral psychotherapy
Persons with emotional-volitional disorders who have reached adulthood also need help, just like children. But it will be difficult to change a teenager with the help of a game. Therefore, you should use What is its essence?
A person is given a situation and several ways to develop it. The teenager must tell what awaits the person who has gone through each of the fictional paths. In a similar way the person will better master the situation and understand the essence of the consequences of this or that behavior. In a similar way, you can instill responsibility in teenagers and explain the price with your promise. The formation of new behavioral habits will not happen immediately. It’s one thing to theoretically lose a situation, and quite another to change your character.
The older a person is, the less chance he has of making internal changes. Therefore, the specialist who conducts classes with a teenager must positively reinforce the patient’s successes and focus on any positive changes. People who suffer from a disorder of the emotional-volitional sphere are subject to self-criticism and it is very important for them to hear approving words from adults and respected people.
Gestalt therapy
Such therapy allows the child to expand his feelings, or rather develop them. The specialist’s task is to transform the child’s inadequate reactions into ones that will be acceptable to society. How does the transformation process work? The specialist identifies a problem, such as excessive aggression, which the child expresses by beating his opponent. The doctor should tell the child that his way of solving the problem is ineffective, and in return offer more civilized methods of expressing emotions. For example, a verbal form of expressing your dissatisfaction. Then you need to play out the situation with the child. After your child loses his temper, you should remind him of the recent conversation and ask him to express his feelings in words.
The child's anger should decrease over time as the task will seem too difficult at first. Over time, the baby should get used to new strategy expressions of aggression. And in order for the learned material to be better understood, the child needs to be constantly reminded of the lesson completed. And it is advisable for the child to see similar methods in adults. For example, when mom and dad quarrel, they should not shout at each other, but calmly and measuredly express dissatisfaction with one or another offense of their spouse.
Emotions are one of the most important mechanisms of mental activity. It is emotions that produce sensually colored total score incoming information from inside and outside. In other words, we evaluate the external situation and our own internal state. Emotions should be assessed along two axes: strong-weak and negative-positive.
Emotion is a feeling, an internally subjective experience that is inaccessible to direct observation. But even this deeply subjective form of manifestation can have disturbances called emotional-volitional disorders.
Emotional-volitional disorders
The peculiarity of these disorders is that they combine two psychological mechanisms: emotions and will.
Emotions have external expression: facial expressions, gestures, intonation, etc. By the external manifestation of emotions, doctors judge a person’s internal state. A long-term emotional state is characterized by the term “mood”. A person’s mood is quite flexible and depends on several factors:
- external: luck, defeat, obstacles, conflicts, etc.;
- internal: health, activity.
Will is a mechanism for regulating behavior that allows you to plan activities, satisfy needs, and overcome difficulties. The needs that contribute to adaptation are usually called “drive”. Attraction is special condition human needs for certain conditions. Conscious attractions are usually called desires. A person always has several pressing and competing needs. If a person does not have the opportunity to fulfill his needs, then an unpleasant condition occurs called frustration.
Directly, emotional disorders represent an excessive manifestation of natural emotions:
Disorders of will and desires
IN clinical practice Disorders of will and desires are manifested by behavioral disorders:
Emotionally volitional disorders need treatment. It is often effective drug therapy in combination with psychotherapy. For effective treatment, the choice of specialist plays a decisive role. Trust only real professionals.
Emotions - this is one of the most important mechanisms of mental activity, producing a sensually colored subjective summary assessment of incoming signals, the well-being of a person’s internal state and the current external situation.
A general favorable assessment of the current situation and existing prospects is expressed in positive emotions - joy, pleasure, tranquility, love, comfort. The general perception of the situation as unfavorable or dangerous is manifested by negative emotions - sadness, melancholy, fear, anxiety, hatred, anger, discomfort. Thus, the quantitative characteristics of emotions should be carried out not along one, but along two axes: strong - weak, positive - negative. For example, the term “depression” refers to strong negative emotions, while the term “apathy” indicates weakness or complete absence of emotions (indifference). In some cases, a person does not have sufficient information to evaluate a particular stimulus - this can cause vague emotions of surprise and bewilderment. Healthy people rarely experience conflicting feelings: love and hatred at the same time.
Emotion (feeling) is an internally subjective experience that is inaccessible to direct observation. The doctor judges the emotional state of a person by affect (in the broad sense of this term), i.e. by external expression of emotions: facial expressions, gestures, intonation, vegetative reactions. In this sense, the terms “affective” and “emotional” are used interchangeably in psychiatry. Often one has to deal with a discrepancy between the content of the patient’s speech and the facial expression and tone of the statement. Facial expressions and intonation in this case make it possible to assess the true attitude to what was said. Statements by patients about love for relatives, desire to get a job, combined with monotony of speech, lack of proper affect, indicate the unfoundedness of the statements, the predominance of indifference and laziness.
Emotions are characterized by some dynamic features. Prolonged emotional states correspond to the term “ mood", which in a healthy person is quite flexible and depends on a combination of many circumstances - external (success or failure, the presence of an insurmountable obstacle or expectation of a result) and internal (physical ill health, natural seasonal fluctuations in activity). A change in the situation in a favorable direction should lead to an improvement in mood. At the same time, it is characterized by a certain inertia, so joyful news against the background of sorrowful experiences cannot evoke an immediate response from us. Along with stable emotional states, there are also short-term violent emotional reactions - a state of affect (in the narrow sense of the word).
There are several main functions of emotions. The first of them, signal, allows you to quickly assess the situation - before a detailed logical analysis is carried out. Such an assessment, based on a general impression, is not completely perfect, but it allows you to avoid wasting unnecessary time on the logical analysis of unimportant stimuli. Emotions generally signal to us about the presence of some kind of need: we learn about the desire to eat by feeling hungry; about the thirst for entertainment - through a feeling of boredom. The second important function of emotions is communicative. Emotionality helps us communicate and act together. The collective activity of people involves emotions such as sympathy, empathy (mutual understanding), and mistrust. Violation of the emotional sphere in mental illness naturally entails a violation of contacts with others, isolation, and misunderstanding. Finally, one of the most important functions of emotions is shaping behavior person. It is emotions that make it possible to assess the significance of a particular human need and serve as an impetus for its implementation. Thus, the feeling of hunger prompts us to look for food, suffocation - to open the window, shame - to hide from spectators, fear Ha- flee. It is important to consider that emotion does not always accurately reflect the true state of internal homeostasis and the characteristics of the external situation. Therefore, a person, experiencing hunger, can eat more than the body needs; experiencing fear, he avoids a situation that is not actually dangerous. On the other hand, a feeling of pleasure and satisfaction (euphoria) artificially induced with the help of drugs deprives a person of the need to act despite a significant violation of his homeostasis. Loss of the ability to experience emotions during mental illness naturally leads to inaction. Such a person does not read books or watch TV because he does not feel bored, and does not take care of his clothes and body cleanliness because he does not feel shame.
Based on their influence on behavior, emotions are divided into: sthenic(inducing action, activating, exciting) and asthenic(depriving activity and strength, paralyzing the will). The same traumatic situation can different people cause excitement, flight, frenzy or, conversely, numbness (“the legs gave way from fear”). So, emotions provide the necessary impetus for taking action. Direct conscious planning of behavior and the implementation of behavioral acts is performed by the will.
Will is the main regulatory mechanism of behavior, allowing one to consciously plan activities, overcome obstacles, and satisfy needs (drives) in a form that promotes greater adaptation.
Attraction is a state of specific human need, a need for certain conditions of existence, dependence on their presence. We call conscious attractions desires. It is almost impossible to list all possible types of needs: each person’s set of needs is unique and subjective, but several of the most important needs for most people should be indicated. These are physiological needs for food, safety (instinct of self-preservation), sexual desire. In addition, a person, as a social being, often needs communication (affiliative need), and also strives to take care of loved ones (parental instinct).
A person always simultaneously has several competing needs that are relevant to him. The choice of the most important of them on the basis of an emotional assessment is carried out by the will. Thus, it allows you to realize or suppress existing drives, focusing on the individual scale of values - hierarchy of motives. Suppressing a need does not mean reducing its relevance. The inability to fulfill a need that is urgent for a person causes an emotionally unpleasant feeling - frustration. Trying to avoid it, a person is forced either to satisfy his need later, when conditions change to more favorable ones (as, for example, a patient with alcoholism does when he receives a long-awaited salary), or to attempt to change his attitude towards the need, i.e. apply psychological defense mechanisms(see section 1.1.4).
Weakness of will as a personality trait or as a manifestation of mental illness, on the one hand, does not allow a person to systematically satisfy his needs, and on the other hand, leads to the immediate implementation of any desire that arises in a form that is contrary to the norms of society and causes maladjustment.
Although in most cases it is impossible to associate mental functions with any specific neural structure, it should be mentioned that experiments indicate the presence of certain centers of pleasure (a number of areas of the limbic system and the septal region) and avoidance in the brain. In addition, it has been noted that damage to the frontal cortex and pathways leading to the frontal lobes (for example, with lobotomy operations), often leads to loss of emotions, indifference and passivity. In recent years, the problem of functional asymmetry of the brain has been discussed. It is assumed that the emotional assessment of the situation mainly occurs in the non-dominant (right) hemisphere, the activation of which is associated with states of melancholy and depression, while when the dominant (left) hemisphere is activated, an increase in mood is more often observed.
8.1. Symptoms of Emotional Disorders
Emotional disorders are an excessive expression of a person’s natural emotions (hyperthymia, hypothymia, dysphoria, etc.) or a violation of their dynamics (lability or rigidity). We should talk about the pathology of the emotional sphere when emotional manifestations deform the patient’s behavior as a whole and cause serious maladjustment.
Hypotymia - persistent painful depression of mood. The concept of hypothymia corresponds to sadness, melancholy, and depression. Unlike the natural feeling of sadness caused by an unfavorable situation, hypothymia in mental illness is surprisingly persistent. Regardless of the immediate situation, patients are extremely pessimistic about their current state and existing prospects. It is important to note that this is not only a strong feeling of sadness, but also an inability to experience joy. Therefore, a person in such a state cannot be cheered up by either a witty anecdote or good news. Depending on the severity of the disease, hypothymia can take the form of mild sadness, pessimism to a deep physical (vital) feeling, experienced as “mental pain,” “tightness in the chest,” “stone on the heart.” This feeling is called vital (pre-cardiac) melancholy, it is accompanied by a feeling of catastrophe, hopelessness, collapse.
Hypotymia as a manifestation of strong emotions is classified as a productive psychopathological disorder. This symptom is not specific and can be observed during an exacerbation of any mental illness; it is often found in severe somatic pathology (for example, with malignant tumors), and is also part of the structure of obsessive-phobic, hypochondriacal and dysmorphomanic syndromes. However, first of all, this symptom is associated with the concept depressive syndrome for which hypothymia is the main syndrome-forming disorder.
Hyperthymia - persistent painful increase in mood. This term is associated with bright positive emotions- joy, fun, delight. Unlike situationally determined joy, hyperthymia is characterized by persistence. Over the course of weeks and months, patients constantly maintain amazing optimism and a feeling of happiness. They are full of energy, show initiative and interest in everything. Neither sad news nor obstacles to the implementation of plans disturb their general joyful mood. Hyperthymia - characteristic manifestation manic syndrome. The most acute psychoses are expressed by especially strong exalted feelings, reaching the degree ecstasy. This condition may indicate the formation of oneiric stupefaction (see section 10.2.3).
A special variant of hyperthymia is the condition euphoria, which should be considered not so much as an expression of joy and happiness, but as a complacent and carefree affect. Patients do not show initiative, are inactive, and are prone to empty talk. Euphoria can be a sign of a wide variety of exogenous and somatogenic brain lesions (intoxication, hypoxia, brain tumors and extensive disintegrating extracerebral neoplasms, severe damage to hepatic and renal function, myocardial infarction, etc.) and can be accompanied by delusional ideas of grandeur (with paraphrenic syndrome, in patients with progressive paralysis).
The term Moria denote foolish, careless babbling, laughter, and unproductive agitation in deeply mentally retarded patients.
Dysphoria are called sudden attacks of anger, malice, irritation, dissatisfaction with others and with oneself. In this state, patients are capable of cruel, aggressive actions, cynical insults, crude sarcasm and bullying. The paroxysmal course of this disorder indicates the epileptiform nature of the symptoms. In epilepsy, dysphoria is observed either as an independent type of seizures, or is part of the structure of the aura and twilight stupefaction. Dysphoria is one of the manifestations of psychoorganic syndrome (see section 13.3.2). Dysphoric episodes are also often observed in explosive (excitable) psychopathy and in patients with alcoholism and drug addiction during the period of abstinence.
Anxiety - the most important human emotion, closely related to the need for security, expressed by a feeling of an impending uncertain threat, internal excitement. Anxiety is a sthenic emotion: accompanied by tossing, restlessness, restlessness, and muscle tension. As an important signal of trouble, it can arise in the initial period of any mental illness. In obsessive-compulsive neurosis and psychasthenia, anxiety is one of the main manifestations of the disease. IN last years As an independent disorder, panic attacks that occur suddenly (often against the background of a traumatic situation) are distinguished, manifested by acute attacks of anxiety. A powerful, groundless feeling of anxiety is one of the early symptoms incipient acute delusional psychosis.
In acute delusional psychoses (syndrome of acute sensory delirium), anxiety is extremely expressed and often reaches the degree confusion, in which it is combined with uncertainty, misunderstanding of the situation, and impaired perception of the surrounding world (derealization and depersonalization). Patients are looking for support and explanations, their gaze expresses surprise ( affect of bewilderment). Like the state of ecstasy, such a disorder indicates the formation of oneiroid.
Ambivalence - simultaneous coexistence of 2 mutually exclusive emotions (love and hatred, affection and disgust). In mental illness, ambivalence causes significant suffering to patients, disorganizes their behavior, and leads to contradictory, inconsistent actions ( ambition). Swiss psychiatrist E. Bleuler (1857-1939) considered ambivalence as one of the most typical manifestations of schizophrenia. Currently, most psychiatrists consider this condition to be a nonspecific symptom, observed, in addition to schizophrenia, in schizoid psychopathy and (in a less pronounced form) in healthy people prone to introspection (reflection).
Apathy - absence or sharp decrease in the expression of emotions, indifference, indifference. Patients lose interest in loved ones and friends, are indifferent to events in the world, and are indifferent to their health and appearance. The patients' speech becomes boring and monotonous, they do not show any interest in the conversation, their facial expressions are monotonous. The words of others do not cause them any offense, embarrassment, or surprise. They may claim that they feel love for their parents, but when meeting with loved ones they remain indifferent, do not ask questions and silently eat the food brought to them. The unemotionality of patients is especially pronounced in a situation that requires an emotional choice (“What food do you like best?”, “Who do you love more: dad or mom?”). Lack of feelings prevents them from expressing any preference.
Apathy refers to negative (deficit) symptoms. It often serves as a manifestation of final states in schizophrenia. It should be taken into account that apathy in patients with schizophrenia is constantly increasing, going through a number of stages that differ in the degree of severity of the emotional defect: smoothness (leveling) of emotional reactions, emotional coldness, emotional dullness. Another cause of apathy is damage to the frontal lobes of the brain (trauma, tumors, partial atrophy).
A symptom should be distinguished from apathy painful mental insensibility (anaesthesiapsychicadolorosa, mournful insensibility). The main manifestation of this symptom is not considered to be the absence of emotions as such, but a painful feeling of one’s own immersion in selfish experiences, the consciousness of the inability to think about anyone else, often combined with delusions of self-blame. The phenomenon of hypoesthesia often occurs (see section 4.1). Patients complain that they have become “like a piece of wood”, that they “don’t have a heart, but an empty tin can”; They lament that they do not feel worried about their young children and are not interested in their successes at school. The vivid emotion of suffering indicates the severity of the condition, the reversible productive nature of the disorders. Anaesthesiapsychicadolorosa is a typical manifestation of the depressive syndrome.
Symptoms of disturbances in the dynamics of emotions include emotional lability and emotional rigidity.
Emotional lability - this is extreme mobility, instability, ease of emergence and change of emotions. Patients easily move from tears to laughter, from fussiness to carefree relaxation. Emotional lability is one of the important characteristics of patients with hysterical neurosis and hysterical psychopathy. A similar condition can also be observed in syndromes of stupefaction (delirium, oneiroid).
One of the options for emotional lability is weakness (emotional weakness). This symptom is characterized not only by rapid changes in mood, but also by the inability to control external manifestations of emotions. This leads to the fact that every (even insignificant) event is experienced vividly, often causing tears that arise not only from sad experiences, but also express tenderness and delight. Weakness is a typical manifestation of vascular diseases of the brain (cerebral atherosclerosis), but can also occur as a personal trait (sensitivity, vulnerability).
A 69-year-old patient with diabetes mellitus and severe memory disorders vividly experiences her helplessness: “Oh, doctor, I was a teacher. The students listened to me with their mouths open. And now kneading kneading. Whatever my daughter says, I don’t remember anything, I have to write everything down. My legs can’t walk at all, I can barely crawl around the apartment...” The patient says all this while constantly wiping her eyes. When the doctor asks who else lives in the apartment with her, he answers: “Oh, our house is full of people! It's a pity my dead husband didn't live long enough. My son-in-law is hard-working and caring. The granddaughter is smart: she dances, and draws, and speaks English... And her grandson will go to college next year - his school is so special!” The patient pronounces the last phrases with a triumphant face, but the tears continue to flow, and she constantly wipes them with her hand.
Emotional rigidity - stiffness, stuckness of emotions, tendency to experience feelings for a long time (especially emotionally unpleasant ones). Expressions of emotional rigidity are vindictiveness, stubbornness, and perseverance. In speech, emotional rigidity is manifested by thoroughness (viscosity). The patient cannot move on to discussing another topic until he fully speaks out about the issue that interests him. Emotional rigidity is a manifestation of the general torpidity of mental processes observed in epilepsy. There are also psychopathic characters with a tendency to get stuck (paranoid, epileptoid).
8.2. Symptoms of disorders of will and desires
Disorders of will and drives manifest themselves in clinical practice as behavioral disorders. It is necessary to take into account that the statements of patients do not always accurately reflect the nature of existing disorders, since patients often hide their pathological desires and are ashamed to admit to others, for example, their laziness. Therefore, the conclusion about the presence of violations of the will and drives should be made not on the basis of declared intentions, but based on an analysis of the actions performed. Thus, a patient’s statement about his desire to get a job looks unfounded if he has not worked for several years and has not attempted to find a job. A patient’s statement that he likes to read should not be taken as adequate if he read the last book several years ago.
Quantitative changes and distortions of drives are distinguished.
Hyperbulia - a general increase in will and drives, affecting all the basic drives of a person. An increase in appetite leads to the fact that patients, while in the department, immediately eat the food brought to them and sometimes cannot resist taking food from someone else’s nightstand. Hypersexuality is manifested by increased attention to the opposite sex, courtship, and immodest compliments. Patients try to attract attention with bright cosmetics, flashy clothes, stand for a long time in front of the Mirror, tidying up their hair, and can engage in numerous casual sexual relationships. There is a pronounced desire to communicate: every conversation of others becomes interesting for patients, they try to join in the conversations of strangers. Such people strive to provide patronage to any person, give away their things and money, make expensive gifts, get involved in a fight, wanting to protect the weak (in their opinion). It is important to take into account that a simultaneous increase in drives and will, as a rule, does not allow patients to commit obviously dangerous and rude acts. illegal actions, sexual violence. Although such people usually do not pose a danger, they can disturb others with their intrusiveness, fussiness, behave carelessly, and misuse property. Hyperbulia is a characteristic manifestation manic syndrome.
Tipobulia - general decrease in will and drives. It should be borne in mind that in patients with hypobulia, all basic drives are suppressed, including physiological ones. There is a decrease in appetite. The doctor can convince the patient of the need to eat, but he takes food reluctantly and in small quantities. A decrease in sexual desire is manifested not only by a drop in interest in the opposite sex, but also by a lack of attention to one’s own appearance. Patients do not feel the need to communicate, are burdened by the presence of strangers and the need to maintain a conversation, and ask to be left alone. Patients are immersed in a world of their own suffering and cannot take care of loved ones (the behavior of a mother with postpartum depression, who is unable to bring herself to care for her newborn, is especially surprising). Suppression of the instinct of self-preservation is expressed in suicidal attempts. Characteristic is a feeling of shame for one’s inaction and helplessness. Hypobulia is a manifestation depressive syndrome. Suppression of impulses in depression is a temporary, transient disorder. Relieving an attack of depression leads to renewed interest in life and activity.
At abulia Usually there is no suppression of physiological drives; the disorder is limited to a sharp decrease in will. The laziness and lack of initiative of people with abulia are combined with a normal need for food and a clear sexual desire, which are satisfied in the simplest, not always socially acceptable, ways. Thus, a patient who is hungry, instead of going to the store and buying the food he needs, asks his neighbors to feed him. The patient satisfies her sexual desire with continuous masturbation or makes absurd demands on her mother and sister. In patients suffering from abulia, higher social needs disappear, they do not need communication or entertainment, they can spend all their days inactive, and are not interested in events in the family and in the world. In the department, they do not communicate with their ward neighbors for months, do not know their names, the names of doctors and nurses.
Abulia is a persistent negative disorder, together with apathy it forms a single apathetic-abulic syndrome, characteristic of final states in schizophrenia. With progressive diseases, doctors can observe an increase in the phenomena of abulia - from mild laziness, lack of initiative, inability to overcome obstacles to gross passivity.
A 31-year-old patient, a turner by profession, after suffering an attack of schizophrenia, left work in the workshop because he considered it too difficult for himself. He asked to be hired as a photographer for the city newspaper, since he had done a lot of photography before. One day, on behalf of the editors, I had to write a report about the work of collective farmers. I arrived in the village in city shoes and, in order not to get my shoes dirty, did not approach the tractors in the field, but only took a few pictures from the car. He was fired from the editorial office for laziness and lack of initiative. I didn’t apply for another job. At home he refused to do any household chores. I stopped caring for the aquarium that I had built with my own hands before I got sick. All day long I lay in bed dressed and dreamed of moving to America, where everything was easy and accessible. He did not object when his relatives turned to psychiatrists with a request to register him as disabled.
Many symptoms described perversions of drives (parabulia). Manifestations of mental disorders may include perversion of appetite, sexual desire, desire for antisocial behavior (theft, alcoholism, vagrancy), and self-harm. Table 8.1 shows the main terms denoting impulse disorders according to ICD-10.
Parabulia is not considered as an independent disease, but is only a symptom. The reasons arose
Table 8.1. Clinical variants of impulse disorders
|
Code according to ICD-10 |
Name of disorder |
Nature of manifestation |
|
Pathological | ||
|
passion for gambling | ||
|
games | ||
|
Pyromania |
The desire to commit arson |
|
|
Kleptomania |
Pathological theft |
|
|
Trichotillomania |
The urge to snatch at myself |
|
|
Pica (pica) |
The desire to eat inedible things |
|
|
» in children |
(as a variety, coprofa- |
|
|
Gia- eating excrement) |
||
|
Dipsomania |
Craving for alcohol |
|
|
Dromomania |
The desire to wander |
|
|
Homicidomania |
A senseless desire to |
|
|
commit murder |
||
|
Suicidemania |
Suicidal impulse |
|
|
Oniomania |
The urge to shop (often |
|
|
unnecessary) |
||
|
Anorexia nervosa |
The desire to limit oneself |
|
|
food, lose weight |
||
|
Bulimia |
Binges of overeating |
|
|
Transsexualism |
The desire to change gender |
|
|
Transvestism |
The desire to wear clothes |
|
|
opposite sex |
||
|
Paraphilias, |
Sexual predilection disorders |
|
|
including: |
respects |
|
|
fetishism |
Getting sexual pleasure |
|
|
joy from contemplating before |
||
|
intimate wardrobe items |
||
|
exhibitionism |
Passion for nudity |
|
|
voyeurism |
Passion for peeping |
|
|
married |
||
|
pedophilia |
Attraction to minors |
|
|
in adults |
||
|
sadomasochism |
Achieving sexual pleasure |
|
|
creation by causing |
||
|
pain or mental distress |
||
|
homosexuality |
Attraction to one's own person |
|
Note. Terms for which a code is not provided are not included in ICD-10.
there are pathological drives gross violations intelligence (oligophrenia, total dementia), various forms of schizophrenia (both in the initial period and at the final stage with the so-called schizophrenic dementia), as well as psychopathy (persistent personality disharmony). In addition, desire disorders are a manifestation of metabolic disorders (for example, eating inedible things during anemia or pregnancy), as well as endocrine diseases (increased appetite in diabetes, hyperactivity in hyperthyroidism, abulia in hypothyroidism, sexual behavior disorders due to an imbalance of sex hormones).
Each of the pathological drives can be expressed to varying degrees. There are 3 clinical variants of pathological drives - obsessive and compulsive drives, as well as impulsive actions.
Obsessive (obsessive) attraction involves the emergence of desires that the patient can control in accordance with the situation. Attractions that clearly diverge from the requirements of ethics, morality and legality are in this case never implemented and are suppressed as unacceptable. However, refusal to satisfy the drive gives rise to strong feelings in the patient; against your will, thoughts about an unfulfilled need are constantly stored in your head. If it is not clearly antisocial in nature, the patient carries it out as soon as possible. Thus, a person with an obsessive fear of contamination will restrain the urge to wash his hands for a short time, but will definitely wash them thoroughly when no one is looking at him, because all the time he endures, he constantly thinks painfully about his need. Obsessive drives are included in the structure of obsessive-phobic syndrome. In addition, they are a manifestation of mental dependence on psychotropic drugs (alcohol, tobacco, hashish, etc.).
Compulsive drive - a more powerful feeling, since its strength is comparable to such vital needs as hunger, thirst, and the instinct of self-preservation. Patients are aware of the perverted nature of the desire, try to restrain themselves, but when the need is unsatisfied, an unbearable feeling of physical discomfort arises. The pathological need occupies such a dominant position that a person quickly stops the internal struggle and satisfies his desire, even if this is associated with gross antisocial actions and the possibility of subsequent punishment. Compulsive drives can be a cause of repeated violence and serial killings. A striking example of a compulsive desire is the desire for a drug during withdrawal syndrome in those suffering from alcoholism and drug addiction (physical dependence syndrome). Compulsive drives are also a manifestation of psychopathy.
Impulsive actions are committed by a person immediately, as soon as a painful attraction arises, without a previous struggle of motives and without a decision-making stage. Patients can think about their actions only after they have been committed. At the moment of action, an affectively narrowed consciousness is often observed, which can be judged by subsequent partial amnesia. Among impulsive actions, absurd ones, devoid of any meaning, predominate. Often patients subsequently cannot explain the purpose of what they did. Impulsive actions are a frequent manifestation of epileptiform paroxysms. Patients with catatonic syndrome are also prone to commit impulsive actions.
Actions caused by pathology in other areas of the psyche should be distinguished from impulse disorders. Thus, refusal to eat can be caused not only by a decrease in appetite, but also by the presence of delusions of poisoning, imperative hallucinations that prohibit the patient from eating, as well as a severe motor disorder - catatonic stupor (see section 9.1). Actions that lead patients to their own death do not always express a desire to commit suicide, but are also caused by imperative hallucinations or clouding of consciousness (for example, a patient in a state of delirium, fleeing from imaginary pursuers, jumps out of a window, believing that it is a door).
8.3. Syndromes of emotional-volitional disorders
The most striking manifestations of the disorder affective sphere depressive and manic syndromes appear (Table 8.2).
8.3.1. Depressive syndrome
Clinical picture of a typical depressive syndrome usually described as a triad of symptoms: decreased mood (hypotymia), slowed thinking (associative inhibition) and motor retardation. It should, however, be taken into account that a decrease in mood is the main syndrome-forming symptom of depression. Hypotymia can be expressed in complaints of melancholy, depression, and sadness. Unlike the natural reaction of sadness in response to a sad event, melancholy in depression is deprived of connection with the environment; patients do not react either to the good news or to new blows of fate. Depending on the severity of the depressive state, hypothymia can manifest itself as feelings of varying intensity - from mild pessimism and sadness to a severe, almost physical feeling of “a stone on the heart” ( vital melancholy).
Manic syndrome
Table 8.2. Symptoms of manic and depressive syndromesDepressive syndrome
Depressive triad: decreased mood, ideational retardation, motor retardation
Low self-esteem
pessimism
Delusions of self-blame, self-abasement, hypochondriacal delusions
Suppression of desires: decreased appetite, decreased libido, avoidance of contacts, isolation, devaluation of life, suicidal tendencies
Sleep disorders: decreased duration early awakening no sense of sleep
Somatic disorders: dry skin, decreased skin tone, brittle hair and nails, lack of tears, constipation
tachycardia and increased blood pressure, pupil dilation (mydriasis), weight loss
Manic triad: increased mood, accelerated thinking, psychomotor agitation
High self-esteem, optimism
Delusions of grandeur
Disinhibition of drives: increased appetite, hypersexuality, desire for communication, need to help others, altruism
Sleep disorder: reduced sleep duration without causing tiredness
Somatic disorders are not typical. Patients have no complaints, look young; increased blood pressure corresponds to high activity of patients; body weight decreases with pronounced psychomotor agitation
Slowing down of thinking in mild cases is expressed by slow monosyllabic speech, long thinking about the answer. In more severe cases, patients have difficulty comprehending the question asked and are unable to cope with solving the simplest logical tasks. They are silent, there is no spontaneous speech, but complete mutism (silence) usually does not occur. Motor retardation is manifested in stiffness, slowness, clumsiness, and in severe depression it can reach the level of stupor (depressive stupor). The posture of stuporous patients is quite natural: lying on their backs with their arms and legs outstretched, or sitting with their heads bowed and their elbows resting on their knees.
The statements of depressed patients reveal sharply low self-esteem: they describe themselves as insignificant, worthless people, devoid of talents. Surprised that the doctor
devotes his time to such an insignificant person. Not only their present state, but also their past and future are assessed pessimistically. They declare that they could not do anything in this life, that they brought a lot of trouble to their family, and were not a joy for their parents. They make the saddest forecasts; as a rule, they do not believe in the possibility of recovery. In severe depression, delusional ideas of self-blame and self-deprecation are not uncommon. Patients consider themselves deeply sinful before God, guilty of the death of their elderly parents and the cataclysms occurring in the country. They often blame themselves for losing the ability to empathize with others (anaesthesiapsychicadolorosa). The appearance of hypochondriacal delusions is also possible. Patients believe they are hopelessly ill, perhaps a shameful disease; They are afraid of infecting their loved ones.
Suppression of desires, as a rule, is expressed by isolation, decreased appetite (less often, attacks of bulimia). Lack of interest in the opposite sex is accompanied by distinct changes in physiological functions. Men often experience impotence and blame themselves for it. In women, frigidity is often accompanied by menstrual irregularities and even prolonged amenorrhea. Patients avoid any communication, feel awkward and out of place among people, and the laughter of others only emphasizes their suffering. Patients are so immersed in their own experiences that they are unable to care for anyone else. Women stop doing housework, cannot care for young children, and do not pay any attention to their appearance. Men cannot cope with the work they love, are unable to get out of bed in the morning, get ready and go to work, and lie awake all day long. Patients have no access to entertainment; they do not read or watch TV.
The greatest danger with depression is a predisposition to suicide. Among mental disorders, depression is the most common cause of suicide. Although thoughts of death are common to almost all people suffering from depression, the real danger arises when severe depression is combined with sufficient activity of patients. With pronounced stupor, the implementation of such intentions is difficult. Cases of extended suicide have been described, when a person kills his children in order to “save them from future torment.”
One of the most difficult experiences of depression is persistent insomnia. Patients sleep poorly at night and cannot rest during the day. Waking up in the early morning hours (sometimes at 3 or 4 o'clock) is especially typical, after which patients no longer fall asleep. Sometimes patients insist that they did not sleep a minute at night and never slept a wink, although relatives and medical staff saw them sleeping ( lack of feeling of sleep).
Depression is usually accompanied by a variety of somatovegetative symptoms. As a reflection of the severity of the condition, peripheral sympathicotonia is more often observed. A characteristic triad of symptoms is described: tachycardia, dilated pupils and constipation ( Protopopov's triad). Attracts attention appearance sick. The skin is dry, pale, flaky. A decrease in the secretory function of the glands is expressed in the absence of tears (“I cried all my eyes out”). Hair loss and brittle nails are often noted. A decrease in skin turgor manifests itself in the fact that wrinkles deepen and patients look older than their age. An atypical eyebrow fracture may be observed. Fluctuations in blood pressure with a tendency to increase are recorded. Gastrointestinal disorders are manifested not only by constipation, but also by deterioration of digestion. As a rule, body weight decreases noticeably. Various pains are frequent (headaches, heartaches, stomach pains, joint pains).
A 36-year-old patient was transferred to a psychiatric hospital from the therapeutic department, where he was examined for 2 weeks due to constant pain in the right hypochondrium. The examination did not reveal any pathology, but the man insisted that he had cancer and admitted to the doctor his intention to commit suicide. Didn't object to transfer to mental asylum. Upon admission he is depressed and answers questions in monosyllables; declares that he “doesn’t care anymore!” He doesn’t communicate with anyone in the department, he lies in bed most of the time, eats almost nothing, constantly complains about lack of sleep, although the staff reports that the patient sleeps every night, according to at least until 5 o'clock in the morning. One day, during a morning examination, a strangulation groove was discovered on the patient’s neck. Upon persistent questioning, he admitted that in the morning, when the staff fell asleep, he tried, while lying in bed, to strangle himself with a noose tied from 2 handkerchiefs. After treatment with antidepressants, painful thoughts disappeared and all discomfort in the right hypochondrium.
Somatic symptoms of depression in some patients (especially during the first attack of the disease) may act as the main complaint. This is the reason why they contact a therapist and undergo long-term, unsuccessful treatment for “ischemic heart diseases”, “hypertension”, “biliary dyskinesia”, “vegetative-vascular dystonia”, etc. In this case we talk about masked (larved) depression, described in more detail in Chapter 12.
The intensity of emotional experiences, the presence of delusional ideas, and signs of hyperactivity of the autonomic systems allow us to consider depression as a syndrome of productive disorders (see Table 3.1). This is confirmed by the characteristic dynamics of depressive states. In most cases, depression lasts several months. However, it is always reversible. Before the introduction of antidepressants and electroconvulsive therapy into medical practice, doctors often observed spontaneous recovery from this state.
The most typical symptoms of depression have been described above. In each individual case, their set may vary significantly, but a depressed, melancholy mood always prevails. Full-blown depressive syndrome is considered a psychotic level disorder. The severity of the condition is evidenced by the presence of delusional ideas, lack of criticism, active suicidal behavior, pronounced stupor, suppression of all basic drives. The mild, non-psychotic version of depression is referred to as subdepression. When conducting scientific research, special standardized scales (Hamilton, Tsung, etc.) are used to measure the severity of depression.
Depressive syndrome is not specific and can be a manifestation of a variety of mental illness: manic-depressive psychosis, schizophrenia, organic brain damage and psychogenic disorders. For depression caused by an endogenous disease (MDP and schizophrenia), pronounced somatovegetative disorders are more typical; an important sign of endogenous depression is the special daily dynamics of the state with increased melancholy in the morning and some weakening of feelings in the evening. It is the morning hours that are considered to be the period associated with the greatest risk of suicide. Another marker endogenous depression the dexamethasone test is considered positive (see section 1.1.2).
In addition to the typical depressive syndrome, a number of atypical variants of depression are described.
Anxious (agitated) depression characterized by the absence of pronounced stiffness and passivity. The sthenic affect of anxiety makes patients fuss, constantly turn to others with a request for help or with a demand to stop their torment, to help them die. The premonition of an imminent catastrophe does not allow patients to sleep; they may attempt to commit suicide in front of others. At times, the patients' excitement reaches the level of frenzy (melancholic raptus, raptus melancholicus), when they tear their clothes, make terrible screams, and bang their heads against the wall. Anxious depression is more often observed at involutionary age.
Depressive-delusional syndrome, in addition to the melancholy mood, it is manifested by such plots of delirium as delusions of persecution, staging, and influence. Patients are confident of severe punishment for their crimes; “notice” constant observation of themselves. They fear that their guilt will lead to oppression, punishment or even the murder of their relatives. Patients are restless, constantly asking about the fate of their relatives, trying to make excuses, swearing that they will never make a mistake in the future. Such atypical delusional symptoms are more characteristic not of MDP, but of an acute attack of schizophrenia (schizoaffective psychosis in terms of ICD-10).
Apathetic depression combines the affects of melancholy and apathy. Patients are not interested in their future, they are inactive, and do not express any complaints. Their only desire is to be left alone. This condition differs from apathetic-abulic syndrome in its instability and reversibility. Most often, apathetic depression is observed in people suffering from schizophrenia.
8.3.2. Manic syndrome
It manifests itself primarily as an increase in mood, acceleration of thinking and psychomotor agitation. Hyperthymia in this condition is expressed by constant optimism and disdain for difficulties. Denies the presence of any problems. Patients constantly smile, do not make any complaints, and do not consider themselves sick. The acceleration of thinking is noticeable in fast, jumping speech, increased distractibility, and superficiality of associations. With severe mania, speech is so disorganized that it resembles “verbal hash.” The pressure of speech is so great that patients lose their voice, and saliva, whipped into foam, accumulates in the corners of the mouth. Due to severe distractibility, their activities become chaotic and unproductive. They cannot sit still, they want to leave home, they ask to be released from the hospital.
There is an overestimation of one's own abilities. Patients consider themselves surprisingly charming and attractive, constantly boasting about their supposed talents. They try to write poetry, demonstrate their vocal abilities to others. A sign of extremely pronounced mania is delusions of grandeur.
An increase in all basic drives is characteristic. Appetite increases sharply, and sometimes there is a tendency to alcoholism. Patients cannot be alone and are constantly looking for communication. When talking with doctors, they do not always maintain the necessary distance, calling simply “brother!” Patients pay a lot of attention to their appearance, try to decorate themselves with badges and medals, women use excessively bright cosmetics, and try to emphasize their sexuality with clothes. Increased interest in the opposite sex is expressed in compliments, immodest proposals, and declarations of love. Patients are ready to help and patronize everyone around them. At the same time, it often turns out that there is simply not enough time for one’s own family. They waste money and make unnecessary purchases. If you are too active, you will not be able to complete any of the tasks because new ideas arise every time. Attempts to prevent the realization of their drives cause a reaction of irritation and indignation ( angry mania).
Manic syndrome is characterized by a sharp decrease in the duration of night sleep. Patients refuse to go to bed on time, continuing to fuss at night. In the morning they wake up very early and immediately get involved in vigorous activity, but they never complain of fatigue and claim that they sleep quite enough. Such patients usually cause a lot of inconvenience to others, harm their financial and social situation, but, as a rule, they do not pose an immediate threat to the life and health of other people. Mild subpsychotic mood elevation ( hypomania) in contrast to severe mania, it may be accompanied by awareness of the unnaturalness of the state; no delirium is observed. Patients can make a favorable impression with their ingenuity and wit.
Physically, those suffering from mania look completely healthy, somewhat rejuvenated. With pronounced psychomotor agitation, they lose weight, despite their voracious appetite. With hypomania, significant weight gain may occur.
The patient, 42 years old, has been suffering from attacks of inappropriately elevated mood since the age of 25, the first of which occurred during her postgraduate studies at the Department of Political Economy. By that time, the woman was already married and had a 5-year-old son. In a state of psychosis, she felt very feminine and accused her husband of not being affectionate enough towards her. She slept no more than 4 hours a day, passionately engaged in scientific work, and paid little attention to her son and household chores. I felt a passionate attraction to my supervisor. I sent him bouquets of flowers in secret. I attended all his lectures for students. One day, in the presence of all the department staff, on her knees she asked him to take her as his wife. She was hospitalized. After the attack ended, she was unable to finish her dissertation. During the next attack, I fell in love with a young actor. She went to all his performances, gave flowers, and secretly invited him to her dacha, secretly from her husband. She bought a lot of wine to get her lover drunk and thereby overcome his resistance, and she drank a lot and often. In response to her husband’s perplexed questions, she ardently confessed everything. After hospitalization and treatment, she married her lover and went to work for him in the theater. During the interictal period she is calm and rarely drinks alcohol. She speaks warmly about her former husband and regrets the divorce a little.
Manic syndrome is most often a manifestation of MDP and schizophrenia. Occasionally, manic states caused by organic brain damage or intoxication (phenamine, cocaine, cimetidine, corticosteroids, cyclosporine, teturam, hallucinogens, etc.) occur. Mania is a sign of acute psychosis. Availability of bright productive symptoms allows us to count on a complete reduction of painful disorders. Although individual attacks can be quite long (up to several months), they are still often shorter than attacks of depression.
Along with typical mania, atypical syndromes of complex structure are often encountered. Manic-delusional syndrome, in addition to the affect of happiness, it is accompanied by unsystematized delusional ideas of persecution, staging, and megalomaniacal delusions of grandeur ( acute paraphrenia). Patients declare that they are called upon to “save the whole world,” that they are endowed with incredible abilities, for example, they are “the main weapon against the mafia,” and criminals are trying to destroy them for this. A similar disorder does not occur in MDP and most often indicates acute attack schizophrenia. At the height of a manic-delusional attack, oneiric stupefaction can be observed.
8.3.3. Apathetic-abulic syndrome
It manifests itself as a pronounced emotional-volitional impoverishment. Indifference and indifference make patients quite calm. They are hardly noticeable in the department, spend a lot of time in bed or sitting alone, and can also spend hours watching TV. It turns out that they did not remember a single program they watched. Laziness is evident in their entire behavior: they don’t wash their face, don’t brush their teeth, refuse to take a shower or cut their hair. They go to bed dressed, because they are too lazy to take off and put on clothes. It is impossible to attract them to activities by calling them to responsibility and a sense of duty, because they do not feel shame. The conversation does not arouse interest among patients. They speak monotonously and often refuse to talk, declaring that they are tired. If the doctor manages to insist on the need for dialogue, it often turns out that the patient can talk for a long time without showing signs of fatigue. During the conversation, it turns out that the patients do not experience any suffering, do not feel sick, and do not make any complaints.
The described symptoms are often combined with disinhibition of the simplest drives (gluttony, hypersexuality, etc.). At the same time, the lack of modesty leads them to try to realize their needs in the simplest, not always socially acceptable form: for example, they can urinate and defecate right in bed, because they are too lazy to go to the toilet.
Apathetic-abulic syndrome is a manifestation of negative (deficient) symptoms and has no tendency to develop reversely. Most often, the cause of apathy and abulia are the final states of schizophrenia, in which the emotional-volitional defect increases gradually - from mild indifference and passivity to states of emotional dullness. Another reason for the occurrence of apathetic-abulic syndrome is organic damage to the frontal lobes of the brain (trauma, tumor, atrophy, etc.).
8.4. Physiological and pathological affect
The reaction to a traumatic event can proceed very differently depending on the individual significance of the stressful event and the characteristics of the person’s emotional response. In some cases, the form of manifestation of affect can be surprisingly violent and even dangerous for others. There are well-known cases of murder of a spouse due to jealousy, violent fights between football fans, heated disputes between political leaders. A grossly antisocial manifestation of affect can be facilitated by a psychopathic personality type (excitable psychopathy - see section 22.2.4). Still, we have to admit that in most cases such aggressive actions are committed consciously: participants can talk about their feelings at the moment of committing the act, repent of their incontinence, and try to smooth out a bad impression by appealing to the severity of the insult inflicted on them. No matter how serious the crime committed, in such cases it is considered as physiological affect and entails legal liability.
Pathological affect is called short-term psychosis, which occurs suddenly after the action of psychological trauma and is accompanied by clouding of consciousness with subsequent amnesia for the entire period of psychosis. The paroxysmal nature of the onset of pathological affect indicates that a psychotraumatic event becomes a trigger for the implementation of existing epileptiform activity. Patients often have a history of severe injuries head or signs of organic dysfunction since childhood. The confusion of consciousness at the moment of psychosis is manifested by fury, the amazing cruelty of the violence committed (dozens of severe wounds, numerous blows, each of which can be fatal). Those around him are unable to correct the patient’s actions because he does not hear them. Psychosis lasts several minutes and ends with severe exhaustion: patients suddenly collapse without strength, sometimes falling into deep sleep. Upon emerging from psychosis, they cannot remember anything that happened, they are extremely surprised when they hear about what they have done, and cannot believe those around them. It should be recognized that disorders of pathological affect can only conditionally be classified as emotional disorders, since the most important expression of this psychosis is twilight stupefaction(see section 10.2.4). Pathological affect serves as the basis for declaring the patient insane and releasing him from responsibility for the crime committed.
BIBLIOGRAPHY
Izard K. Human emotions. - M.: Moscow State University Publishing House, 1980.
Numer Yu.L., Mikhalenko I.N. Affective psychoses. - L.: Medicine, 1988. - 264 p.
Psychiatric diagnosis / Zavilyansky I.Ya., Bleikher V.M., Kruk I.V., Zavilyanskaya L.I. - Kyiv: Vyshcha School, 1989.
Psychology emotions. Texts / Ed. V.K.Vilyunas, Yu.B.Gippen-reuter. - M.: MSU, 1984. - 288 p.
Psychosomatic disorders in cyclothymic and cyclothymic-like conditions. - Proceedings of MIP., T.87. - Answer. ed. S.F. Semenov. - M.: 1979. - 148 p.
Reikovsky Ya. Experimental psychology of emotions. - M.: Progress, 1979.
Sinitsky V.N. Depressive states(Pathophysiological characteristics, clinical picture, treatment, prevention). - Kyiv: Naukova Dumka, 1986.
Violations and their causes in alphabetical order:
violation of the emotional-volitional sphere -
Violations of the emotional-volitional sphere include:
Hyperbulia is a general increase in will and drives, affecting all the basic drives of a person. For example, an increase in appetite leads to the fact that patients, while in the department, immediately eat the food brought to them. Hyperbulia is a characteristic manifestation of manic syndrome.
Hypobulia is a general decrease in will and drives. Patients do not feel the need to communicate, are burdened by the presence of strangers and the need to maintain a conversation, and ask to be left alone. Patients are immersed in a world of their own suffering and cannot take care of loved ones.
Abulia is a disorder limited to a sharp decrease in will. Abulia is a persistent negative disorder; together with apathy, it forms a single apathetic-abulia syndrome, characteristic of the final conditions of schizophrenia.
Obsessive (obsessive) attraction involves the emergence of desires that the patient can control in accordance with the situation. Refusal to satisfy an instinct gives rise to strong feelings in the patient, and thoughts of an unsatisfied need constantly persist. Thus, a person with an obsessive fear of contamination will restrain the urge to wash his hands for a short time, but will definitely wash them thoroughly when no one is looking at him, because all the time he endures, he constantly thinks painfully about his need. Obsessive drives are included in the structure of obsessive-phobic syndrome.
Compulsive drive is a more powerful feeling because it is comparable in strength to instincts. The pathological need occupies such a dominant position that a person quickly stops the internal struggle and satisfies his desire, even if this is associated with gross antisocial actions and the possibility of subsequent punishment.
What diseases cause a violation of the emotional-volitional sphere:
Schizophrenia
Manic syndrome
Depressive syndrome
Obsessive-phobic syndrome
Psychopathy
Alcoholism
Addiction
Which doctors should you contact if there is a violation of the emotional-volitional sphere:
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The concept of emotional regulation and emotional norms, individual psychological characteristics of the manifestation of emotions and feelings. Classification of emotional disorders. Emotional disorders in various pathological processes and conditions. Methods and techniques for studying emotions (Lüscher’s MCV, Sondi’s MCV, assessment questionnaire emotional state, drawing projective techniques).
Pathopsychological classification of volitional disorders: disorders at the level motivational components act of will(oppression and strengthening of motives for activity, perversion of motives), pathology at the level of implementation of a volitional act (oppression and strengthening motor functions, parakinesia). Study of volitional qualities of personality.
Emotions- this is the mental process of subjective reflection of a person’s most general attitude towards objects and phenomena of reality, towards other people and himself in relation to the satisfaction or dissatisfaction of his needs, goals and intentions.
Individual psychological characteristics – depend on a person’s age, temperament and personality as a whole. Emotions as complex systemic psychological formations that make up the emotional sphere of the individual are characterized by many parameters: sign(positive or negative) and modality(quality of emotion), duration and intensity(by force) mobility(speed of change of emotional states) and reactivity(speed of occurrence, severity and adequacy of the emotional response to external and internal stimuli), as well as the degree awareness emotions and their degree voluntary control.
Classification of emotional disorders:
- emotional lability(weakness) – excessive mobility, ease of change of emotions.
- emotional rigidity(inertia, stiffness) – the experience of emotions remains long time, although the event that caused it has long passed.
- emotional excitability is determined by the minimum strength, intensity of external or internal stimuli that can cause a person’s emotional reaction.
- explosiveness(explosiveness)
- emotional monotony(cold)
- emotional paralysis– acute, short-term shutdown of emotions.
- apathy(indifference)
Emotional instability(emotions are less susceptible to conscious control).
Emotional incontinence is the inability to control and master your emotions.
Pathology of the emotional sphere
Symptoms of emotional disorders are varied and numerous, but five main types of pathological emotional response can be distinguished:
catathymic type- usually occurs in stressful situations, pathological emotional reactions are relatively short-term, changeable, psychogenic (neuroses and reactive psychoses);
holothymic type- characterized by endogenous conditioning (primacy) of mood disorders, which is manifested by the polarity of emotional states, their stability and frequency of occurrence (manic-depressive and involutional psychosis, schizophrenia);
parathymic type- characterized by dissociation, disruption of unity in emotional sphere between emotional manifestations and other components of mental activity (schizophrenia);
explosive type- characterized by a combination of inertia emotional manifestations with their explosiveness, impulsiveness (signs of paroxysmalness), an angry-sad or ecstatically elated mood dominates (epilepsy, organic brain diseases);
dementia type- combined with increasing signs of dementia, uncriticality, disinhibition of lower drives against a background of complacency, euphoria or apathy, indifference, aspontaneity (senile dementia of the Alzheimer's type, atherosclerotic dementia, progressive paralysis and other diseases).
In pathology, the following are of practical importance: hypothymia(pathological decrease in background mood), hyperthymia(pathological increase in background mood) and parathymia(perverted emotionality).
Methods for studying emotions MCV Luscher, MPV Sondi, questionnaire for assessing emotional state, drawing projective techniques
Luscher Test (Color Choice Method)). Includes a set of eight cards - four with primary colors (blue, green, red, yellow) and four with additional colors (purple, brown, black, gray). The choice of color in order of preference reflects the subject’s focus on a certain activity, his mood, functional state, as well as the most stable personality traits. The Luscher test cannot be used as an independent technique in the practice of examination, professional selection, and personnel assessment.
Questionnaire for assessing emotional state - this technique effective if it is necessary to identify changes in a person’s emotional state over a certain period of time. The following indicators are determined:
I1– “Calmness – anxiety” (individual self-esteem - I1- equals the number of the judgment selected by the subject from this scale. Individual values for indicators are obtained similarly I2-I4).
AND 2– “Energy – fatigue.”
FROM- "Elation - depression."
I4- “A feeling of self-confidence is a feeling of helplessness.”
I5– Total (on four scales) assessment of condition
Volitional violations.
Will is a mental process of conscious control and regulation of one’s behavior, ensuring overcoming difficulties and obstacles on the way to the goal.
Pathology of volitional and voluntary regulation
1) Violations at the level of the motivational component of the volitional act - three groups: oppression, strengthening and distortion of motives of activity and drives.
A) Suppression of motives for activity
Hypobulia- reduction in intensity and reduction in the number of incentives for activity with regression. Extreme severity – abulimia - complete absence of desires, aspirations and motivations for activity.
B) Strengthening motives for activity
Hyperbulia- pathological increase in the intensity and number of impulses and motives for activity. Hyperbulia usually makes the patient's behavior inappropriate. Excessive activity and an increase in the number of impulses is also found in painful high mood(manic states) and intoxication. A very characteristic feature of hyperbulia is decreased fatigue of patients.
C) Perversion of motives and motives of activity
Parabulia- qualitative changes, distortion of both the motivational and intellectual components of the volitional act, can manifest themselves in three main forms:
1. They resemble rituals and are more common when neurotic disorders. Usually, only those obsessive actions are performed that do not threaten the life of the patient himself or those around him, and also do not contradict his moral and ethical principles.
2. Compulsive actions - realized compulsive drives. In most cases, compulsive drives are monothematic and manifest themselves as peculiar repeated irresistible paroxysms of behavioral disorders. Quite often they are stereotypically repeated, acquiring the character of a kind of morbid obsession (“monomania”) with arson, senseless theft, gambling, etc.
3. Impulsive actions are manifested in absurd actions and actions that last seconds or minutes, are committed by patients without thinking and are unexpected for others. The motives for these behavioral reactions are little understood and incomprehensible even to the patient himself.
4. Violent actions, i.e. movements and actions that arise against the will and desire. These include violent crying and laughter, grimaces, coughing, smacking, spitting, rubbing hands and others. Violent actions are most often found in organic brain diseases.
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