Few adults think about the role of emotions in life. But when a married couple has children and it suddenly turns out that the baby cannot control his feelings, then 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 treat such a disorder both on your own and with the help of a qualified doctor.
Causes
What influences the formation of the will and emotions of a person? There are two main reasons that can cause a violation. One of them is heredity, and the other is the social circle. In more detail, the reasons for the violation of the emotional-volitional sphere are discussed below.
- Impressions. 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 form 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 their emotions.
- Another reason for the violation of the emotional volitional sphere is the lack of movement. A child whose parents do not bother themselves with the development of the child may begin to walk late. Such inhibition of normal physical development leads to inhibited emotional reactions. And some parents tend to understand over time that their child does not walk, 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 can suffer greatly due to the lack of motherly 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 touch with his mother. Such a child will grow up inferior, as the people say - unloved.
act of will
Spheres occurs at an early age. To understand where the failure occurred, you need to know how the will functions in a normal person. The sequence of decision making for all people is as follows:
- The emergence of an impulse. A person is motivated to do something.
- Motivation. The person considers what she will get when the action is completed. Most often, a person receives emotional satisfaction from his act.
- Activity tool. Not always invented action can be done 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.
Such a process takes place in the head of every person before he performs any action. You should not think that children, due to their undeveloped intellect, do not carry out such work in their heads. Even our primitive ancestors - monkeys, make strong-willed efforts in order to commit this or that act.
How is an emotional-volitional disorder diagnosed? The spheres of application of the human will are varied. A person must move to take something or to eat. If the child is apathetic and does not want anything, then he has some kind of deviation. The same goes for overly active children who take action without having time to consider the consequences of their decisions.
Main problems
Depending on the degree of violation 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 degree of the child's problems and prescribe treatment for him. What is the classification of persons with disorders of the emotional-volitional sphere?
- Aggressiveness. Personas behave inappropriately, bully others and enjoy 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 cannot fight back, and therefore, it can be humiliated.
- Inhibited reaction. Children may not 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 their own food.
- 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, then too loudly, if they laugh, then they do it for an unnaturally long time.
- Excessive anxiety. Downtrodden children of too active parents become quiet. They are afraid to talk about their desires and problems. They fail to draw attention to themselves due to the weakness of character.
Groups of violations
The classification of violations of the emotional-volitional sphere is necessary in order to correctly prescribe therapeutic measures. All children are different, and their problems cannot be the same either. Even children who grow up in the same family can suffer from various ailments. The main groups of violations of the emotional-volitional sphere:
- Mood disorder. Violation of the emotional-volitional sphere in children often manifests itself in uncontrolled emotions. The child cannot control himself, and therefore his feelings are always on edge. If the baby is happy about something, then soon his state reaches euphoria. If the child is sad, it can easily become depressed. And often one state in an hour passes into another, polar to the original.
- Non-standard behavior. Considering in children, it is impossible not to mention the deviation 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 lack of initiative, and the second situation threatens that the child has problems with attention.
- Psychomotor problems. The child suffers from strange tides 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 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 behavior of the baby.
- Strong dependence on parents. A child who, at the age of five, cannot trust the people around him, causes a strange reaction. The kid hides behind his mother's skirt all the time and tries to close himself from the world. It's one thing - normal childish embarrassment. And quite another - distrust, lack of sociability and intractability.
- A child who is neglected in the family will feel lonely. The baby will not be able to form relationships normally, as the parents will inspire the child that he is stupid, crooked and unworthy of love. The loneliness that such a child will exude will be strongly felt.
- Aggression. Toddlers who lack attention or who want to relieve tension may not withdraw into themselves, but, on the contrary, behave too liberated. Such children will not restrain their emotions and will try their best to draw attention to their person.
Methods
Emotional-volitional disorders in the sphere of personality can be subject to correction. What methods do specialists resort to to correct what parents incorrectly laid in their child?
- Game therapy. With the help of the game, the rules of adequate behavior in the group are explained to the baby. The child forms new neural connections that help transform what he sees in the game and shift examples to life situations.
- Art therapy. With the help of a picture, you can learn a lot about the personality of a child. A creative work will show the specialist how the baby feels in the garden, in the family and in this world. Drawing helps to relax and feel self-confidence. Other types of art work in the same way: modeling, embroidery, designing.
- Psychoanalysis. An experienced psychotherapist can help a child reconsider their 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 revise their habits and form new ones based on the old ones.
Psychoanalytic Therapy
Correction of violations of the emotional-volitional sphere occurs by various methods. One of them is psychoanalytic therapy. Such therapy can be carried out both individually and in a group. If the kid is engaged in loneliness, the psychotherapist in the form of a game talks to the child about feelings. He asks to portray in turn anger, joy, love, etc. 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 - to feel like a loved and welcome guest in the doctor's office.
In group therapy, the therapist does not have time to play with each child. Therefore, the procedure for restoring the emotional-volitional sphere goes through the drawing. Children splash out their emotions, and then tell why they feel anger, joy, etc. Telling themselves and listening to others, the children begin to realize in what cases what to feel and how to correctly express their emotions.
Behavioral Therapy
Such 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 in this situation should experience. After conducting a game situation, in order to consolidate the material, the facilitator should once again explain what exactly was being modeled and how the patient should behave in such a situation. Be sure to get feedback from the child. The child must explain the learned material. Moreover, it is necessary to get the child not only to tell him how to behave in a situation, but also to explain why such behavior would be considered acceptable.
Such therapy should be carried out once a week. And for the remaining 7 days, the child must consolidate the material received in the lesson. Since the child will have little interest in his own development, parents should observe the behavior of the baby. And if the child does something differently than in the training, mom or dad should repeat the recently completed lesson with their child.
Cognitive Behavioral Psychotherapy
Persons with a violation of the emotional-volitional sphere, who have reached the age of majority, also need help, 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 of its development. The teenager must tell what awaits a person who has passed each of the fictional paths. In this 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 habits of behavior will not happen immediately. It is one thing to theoretically lose the situation, and quite another to change the character.
The older a person is, the less likely he is to make an internal restructuring. Therefore, the professional who conducts sessions with an adolescent should positively reinforce the patient's progress and focus on any positive changes. People who suffer from a disorder of the emotional-volitional sphere are prone to self-criticism and it is very important for them to hear words of approval from adults and respected people.
Gestalt therapy
Such therapy allows the child to expand their feelings, or rather develop them. The specialist's task is to transform the baby's inadequate reactions to those that will be acceptable to society. How is the transformation process going? The specialist raises a problem, such as excessive aggression, which the child expresses by beating his opponent. The doctor should tell the kid 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 one's dissatisfaction. Then you need to play the situation with the child. After the baby loses his temper, you should remind him of a 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 the new strategy for expressing aggression. And in order for the learned material to fit better, the child needs to be constantly reminded of the lesson passed. And it is desirable that the kid saw similar ways in adults. For example, when dad and mom swear, they should not yell at each other, but calmly and measuredly express dissatisfaction with one or another misconduct of the spouse.
Emotions are one of the most important mechanisms of mental activity. It is emotions that produce a sensually colored total assessment of 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, inaccessible to direct observation. But even this deeply subjective form of manifestation can have disorders called emotional-volitional disorders.
Emotional-volitional disorders
The peculiarity of these disorders is that they combine two psychological mechanisms: emotions and will.
Emotions have an external expression: facial expressions, gestures, intonation, etc. According to the external manifestation of emotions, doctors judge the internal state of a person. A prolonged emotional state is characterized by the term "mood". The mood of a person is quite mobile and depends on several factors:
- external: luck, defeat, obstacle, conflicts, etc.;
- internal: health, manifestation of activity.
Will is a mechanism for regulating behavior, which allows you to plan activities, satisfy needs, and overcome difficulties. Needs that promote adaptation are called "drive". Attraction is a special state of human need in certain conditions. Conscious desires are called desires. A person always has several urgent and competing needs. If a person does not have the opportunity to realize his needs, then an unpleasant state occurs, called frustration.
Directly, emotional disorders are an excessive manifestation of natural emotions:
Disorders of the will and desires
In clinical practice, disorders of the will and drives are manifested by behavioral disorders:
Emotional-volitional disorders need treatment. Drug therapy in combination with psychotherapy is often effective. For effective treatment, the choice of a specialist plays a decisive role. Trust only true professionals.
Emotions - this is one of the most important mechanisms of mental activity, producing a sensually colored subjective total assessment of incoming signals, the well-being of the internal state of a person and the current external situation.
The general favorable assessment of the present situation and the available prospects is expressed in positive emotions - joy, pleasure, peace, love, comfort. The general perception of the situation as unfavorable or dangerous is manifested by negative emotions - sadness, longing, fear, anxiety, hatred, anger, discomfort. Thus, the quantitative characteristic of emotions should be carried out not along one, but along two axes: strong - weak, positive - negative. For example, the term "depression" means strong negative emotions, and the term "apathy" indicates weakness or complete absence of emotions (indifference). In some cases, a person does not have enough information to evaluate a particular stimulus - this can cause vague emotions of surprise, bewilderment. Healthy people rarely, but have conflicting feelings: love and hate at the same time.
Emotion (feeling) is an internally subjective experience, inaccessible to direct observation. The doctor judges the emotional state of a person by affect (in the broadest sense of the term), i.e. according to the 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 facial expression, tone of expression. Facial expressions and intonation in this case allow us to assess the true attitude to what was said. The statements of patients about love for relatives, the desire to get a job, combined with the monotony of speech, the lack of proper affect, testify to the unsubstantiated 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 mobile and depends on a combination of many circumstances - external (luck or defeat, 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 the joyful news against the background of sad experiences cannot evoke an immediate response in us. Along with stable emotional states, there are also short-term violent emotional reactions - a state of passion (in the narrow sense of the word).
There are several main emotion functions. The first one, signal, allows you to quickly assess the situation - before a detailed logical analysis is carried out. Such an assessment based on the general impression is not completely perfect, but it allows us not to waste too much time on the logical analysis of irrelevant stimuli. Emotions generally signal us about the presence of any need: we learn about the desire to eat by feeling hungry; about the thirst for entertainment - from 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 such emotions as sympathy, empathy (mutual understanding), distrust. Violation of the emotional sphere in mental illness naturally entails a violation of contacts with others, isolation, misunderstanding. Finally, one of the most important functions of emotions is shaping behavior person. It is emotions that allow us to assess the significance of a particular human need and serve as an impetus for its implementation. So, the feeling of hunger prompts us to look for food, suffocation - to open the window, shame - to hide from the audience, fear Ha- flee. It is important to bear in mind that emotion does not always accurately reflect the true state of internal homeostasis and the features of the external situation. Therefore, a person, when hungry, can eat more than is necessary for the body, feeling fear, he avoids a situation that is not really dangerous. On the other hand, the 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. The loss of the ability to experience emotions in a mental illness naturally leads to inaction. Such a person does not read books and does not watch TV, because he does not feel bored, does not take care of clothes and cleanliness of the body, because he does not feel shame.
According to the influence on behavior, emotions are divided into sthenic(prompting to action, activating, exciting) and asthenic(depriving activity and strength, paralyzing the will). The same traumatic situation can cause excitement, flight, frenzy, or, conversely, numbness in different people (“legs buckled from fear”). So, emotions give the necessary impetus to take action. The direct conscious planning of behavior and the implementation of behavioral acts are performed by the will.
Will is the main regulatory mechanism of behavior that allows you to consciously plan activities, overcome obstacles, satisfy needs (drives) in a form that promotes greater adaptation.
Attraction is a state of a specific human need, a need for certain conditions of existence, dependence on their presence. Conscious drives we call desires. It is practically impossible to list all the possible types of needs: their set is unique and subjective for each person, but several needs that are most important for most people should be indicated. These are physiological needs for food, safety (self-preservation instinct), sexual desire. In addition, a person as a social being often needs to communicate (affiliative need), and also seeks to take care of loved ones (parental instinct).
A person always has several competing needs that are relevant to him at the same time. 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 an individual scale of values - hierarchy of motives. Suppressing a need does not mean reducing its relevance. The inability to realize the actual need 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 (for example, an alcoholic does when he receives a long-awaited salary), or to make an attempt to change his attitude to the need, i.e. apply psychological defense mechanisms(see section 1.1.4).
Weakness of will as a property of a person or as a manifestation of a 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 fulfillment of any desire that has arisen in a form that is contrary to the norms of society and causes maladaptation.
Although in most cases it is not possible to associate mental functions with any particular nervous structure, it should be mentioned that experiments indicate the presence in the brain of certain centers of pleasure (a number of regions of the limbic system and septal area) and avoidance. In addition, it has been noted that damage to the frontal cortex and pathways leading to the frontal lobes (for example, during a lobotomy operation) 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, 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). It is necessary to speak about the pathology of the emotional sphere when emotional manifestations deform the behavior of the patient as a whole, cause serious maladaptation.
Hypothymia - persistent painful lowering of mood. The concept of hypothymia corresponds to sadness, melancholy, depression. Unlike the natural feeling of sadness due to an unfavorable situation, hypothymia in mental illness is remarkably persistent. Regardless of the current situation, patients are extremely pessimistic about their current condition and available prospects. It is important to note that this is not only a strong feeling of longing, but also an inability to experience joy. Therefore, a person in such a state cannot be amused by either a witty anecdote or pleasant 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", "chest tightness", "a stone in the heart". This feeling is called vital (precordial) longing, it is accompanied by a sense of catastrophe, hopelessness, collapse.
Hypothymia as a manifestation of strong emotions is classified as a productive psychopathological disorder. This symptom is not specific and can be observed during exacerbation of any mental illness, it often occurs in severe somatic pathology (for example, in malignant tumors), and is also included in the structure of obsessive-phobic, hypochondriacal and dysmorphomanic syndromes. However, this symptom is primarily associated with the concept depressive syndrome, for which hyothymia is the main syndrome-forming disorder.
Hyperthymia - persistent painful elevation of mood. Bright positive emotions are associated with this term - joy, fun, delight. In contrast to situationally determined joy, hyperthymia is characterized by persistence. For weeks and months, patients constantly maintain an amazing optimism, a feeling of happiness. They are full of energy, show initiative and interest in everything. Neither the sad news, nor the obstacles to the implementation of plans do not violate their general joyful mood. Hyperthymia is a characteristic manifestation manic syndrome. The most acute psychoses are expressed by particularly strong exalted feelings, reaching a degree ecstasy. Such a condition may indicate the formation of oneiroid clouding of consciousness (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 complacently careless affect. Patients do not show initiative, are inactive, prone to empty talk. Euphoria is a sign of a wide variety of exogenous and somatogenic brain lesions (intoxication, hypoxia, brain tumors and extensive decaying extracerebral neoplasms, severe damage to the liver and kidney function, myocardial infarction, etc.) and may be accompanied by delusional ideas of grandeur (with paraphrenic syndrome, in patients with progressive paralysis).
term moriya denote foolish careless babbling, laughter, unproductive excitement in deeply mentally ill patients.
Dysphoria They call suddenly arising bouts of anger, anger, irritation, dissatisfaction with others and with themselves. In this state, patients are capable of cruel, aggressive actions, cynical insults, rude 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 included in the structure of the aura and twilight stupefaction. Dysphoria is one of the manifestations of the psycho-organic syndrome (see section 13.3.2). Dysphoric episodes are often also observed in explosive (excitable) psychopathy and in patients with alcoholism and drug addiction during the period of withdrawal.
Anxiety - the most important human emotion, closely related to the need for security, expressed by a sense of an impending vague threat, internal unrest. Anxiety - sthenic emotion: accompanied by throwing, restlessness, anxiety, muscle tension. As an important signal of trouble, it can occur in the initial period of any mental illness. In obsessive-compulsive disorder and psychasthenia, anxiety is one of the main manifestations of the disease. In recent years, sudden onset (often against the background of a traumatic situation) panic attacks, manifested by acute anxiety attacks, have been isolated as an independent disorder. A powerful, unfounded feeling of anxiety is one of the early symptoms of an incipient acute delusional psychosis.
In acute delusional psychoses (syndrome of acute sensual delirium), anxiety is extremely pronounced and often reaches a degree confusion, in which it is combined with uncertainty, misunderstanding of the situation, a violation of the perception of the world around (derealization and depersonalization). Patients are looking for support and explanations, their look expresses surprise ( bewilderment effect). Like the state of ecstasy, such a disorder indicates the formation of a oneiroid.
Ambivalence - simultaneous coexistence of 2 mutually exclusive emotions (love and hate, affection and disgust). In mental illness, ambivalence causes significant suffering to patients, disorganizes their behavior, leads to contradictory, inconsistent actions ( ambivalence). The 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 non-specific 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 a sharp decrease in the severity of emotions, indifference, indifference. Patients lose interest in relatives and friends, are indifferent to events in the world, indifferent to their health and appearance. The speech of patients becomes boring and monotonous, they do not show any interest in conversation, facial expressions are monotonous. The words of others do not cause them any resentment, embarrassment, or surprise. They may claim to 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?”). The absence of feelings does not allow them to express any preference.
Apathy refers to negative (deficit) symptoms. Often it serves as a manifestation of the end states in schizophrenia. It should be borne in mind that apathy in patients with schizophrenia is constantly increasing, passing 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).
Symptom to be distinguished from apathy painful mental insensitivity (anaesthesiapsychicadorosa, mournful insensitivity). The main manifestation of this symptom is not the absence of emotions as such, but a painful sense of one's own immersion in selfish experiences, a consciousness of the inability to think about anyone else, often combined with delusions of self-blame. Often there is a phenomenon of hypesthesia (see section 4.1). Patients complain / that they have become “like a piece of wood”, that they have “not a heart, but an empty tin can”; lament that they do not feel anxiety for young children, are not interested in their success 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 a depressive syndrome.
Symptoms of impaired emotional dynamics 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 nonchalant 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 clouding of consciousness (delirium, oneiroid).
One of the options for emotional lability is weakness (emotional weakness). This symptom is characterized not only by a rapid change in mood, but also by the inability to control external manifestations of emotions. This leads to the fact that each (even insignificant) event is experienced vividly, often causing tears that arise not only during sad experiences, but also express tenderness and delight. Weakness is a typical manifestation of vascular diseases of the brain (cerebral atherosclerosis), but it can also occur as a personality 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 sourdough sourdough. Whatever my daughter says, I don’t remember anything, I have to write everything down. My legs do not walk at all, I can hardly crawl around the apartment ... ". All this the patient says, constantly wiping her eyes. When asked by the doctor who else lives with her in the apartment, she answers: “Oh, our house is full of people! It is a pity that the deceased husband did not live. My brother-in-law is a hardworking, caring person. The granddaughter is intelligent: she dances, and draws, and she has English ... And her grandson will go to college next year - he has such a special school! 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, a tendency to long-term experience of feelings (especially emotionally unpleasant ones). Expressions of emotional rigidity are vindictiveness, stubbornness, perseverance. In speech, emotional rigidity is manifested by thoroughness (viscosity). The patient cannot move on to a discussion of another topic until he fully speaks out about the issue of interest to 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 the will and inclinations
Disorders of the will and drives are manifested in clinical practice as behavioral disorders. It must be taken into account that the statements of patients do not always accurately reflect the nature of existing disorders, since patients often hide their pathological inclinations, are ashamed to admit to others, for example, that they are lazy. Therefore, the conclusion about the presence of violations of the will and inclinations should be made not on the basis of declared intentions, but based on an analysis of the actions performed. So, the statement of the patient about the desire to get a job looks unfounded if he has not been working for several years and does not attempt to find employment. It should not be taken as an adequate statement of the patient that he likes to read if he read the last book several years ago.
Allocate quantitative changes and perversions of drives.
Hyperbulia - a general increase in the will and inclinations, affecting all the main inclinations 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 bedside table. Hypersexuality is manifested by increased attention to the opposite sex, courtship, immodest compliments. Patients try to draw attention to themselves with bright cosmetics, catchy clothes, stand at the Mirror for a long time, putting their hair in order, and may engage in numerous casual sexual intercourse. There is a pronounced craving for communication: any 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 belongings and money, make expensive gifts, get into a fight, wanting to protect the weak (in their opinion). It is important to bear in mind that the simultaneous increase in inclination and will, as a rule, does not allow patients to commit obviously dangerous and gross illegal acts, sexual violence. Although such people usually do not pose a danger, they can interfere with others with their obsession, fussiness, behave carelessly, and mismanage property. Hyperbulia is a characteristic manifestation manic syndrome.
Typobulia - general decrease in will and inclinations. It should be borne in mind that in patients with hypobulia, all the main drives, including physiological ones, are suppressed. There is a decrease in appetite. The doctor may convince the patient to eat, but he takes food reluctantly and in small quantities. A decrease in sexual desire is manifested not only by a decrease in interest in the opposite sex, but also by a lack of attention to one's own appearance. Patients do not feel the need for communication, they are burdened by the presence of strangers and the need to maintain a conversation, they ask to be left alone. Patients are immersed in the world of their own suffering and cannot take care of their loved ones (especially surprising is the behavior of a mother with postpartum depression, who is unable to bring herself to take care of a newborn). Suppression of the instinct of self-preservation is expressed in suicidal attempts. A sense of shame for one's inaction and helplessness is characteristic. Hypobulia is a manifestation depressive syndrome. The suppression of drives in depression is a temporary, transient disorder. The relief of an attack of depression leads to a resumption of interest in life, activity.
At abulia usually there is no suppression of physiological drives, the disorder is limited to a sharp decrease in will. Laziness and lack of initiative of persons with aboulia is combined with a normal need for food, a distinct sexual desire, which are satisfied in the simplest, not always socially acceptable ways. So, a patient who is hungry, instead of going to the store and buying the products he needs, asks his neighbors to feed him. The patient's sexual desire is satisfied by incessant masturbation or makes absurd demands on his mother and sister. In patients suffering from aboulia, higher social needs disappear, they do not need communication, entertainment, they can spend all their days inactive, they are not interested in events in the family and in the world. In the department, they do not communicate with their neighbors in the ward for months, they do not know their names, the names of doctors and nurses.
Abulia is a persistent negative disorder, together with apathy it is a single apathico-abulic syndrome, characteristic of end states in schizophrenia. With progredient 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 take him as a photographer in the city newspaper, as he used to do a lot of photography. Once, on behalf of the editorial office, he had to compile a report on 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 took only a few pictures from the car. He was fired from the editorial office for laziness and lack of initiative. Didn't apply for another job. At home he refused to do any household chores. He stopped caring for the aquarium, which he made with his own hands before the illness. For days on end I lay in bed dressed and dreamed of moving to America, where everything is easy and affordable. He did not mind when relatives turned to psychiatrists with a request to issue him a disability.
Many symptoms described perversions of instincts (parabulia). Manifestations of mental disorders can be a perversion of appetite, sexual desire, the desire for antisocial acts (theft, alcoholism, vagrancy), self-harm. Table 8.1 shows the main terms for ICD-10 drive disorders.
Parabulia are not considered as independent diseases, but are only a symptom. The reasons for the
Table 8.1. Clinical Variants of Attraction Disorders
|
ICD-10 code |
Name of the disorder |
The nature of the manifestation |
|
Pathological | ||
|
passion for gambling | ||
|
games | ||
|
Pyromania |
Intention to commit arson |
|
|
Kleptomania |
Pathological theft |
|
|
Trichotillomania |
Attraction to pull out at myself |
|
|
Picacism (pika) |
The desire to eat inedible |
|
|
» in children |
(as a variety copropha- |
|
|
gia- eating excrement) |
||
|
dipsomania |
Craving for alcohol |
|
|
Dromomania |
The pursuit of wanderlust |
|
|
Homicidomania |
A senseless pursuit |
|
|
commit murder |
||
|
Suicide mania |
Attraction to suicide |
|
|
Oniomania |
The urge to shop (often |
|
|
unnecessary) |
||
|
Anorexia nervosa |
The desire to limit oneself in |
|
|
food, lose weight |
||
|
bulimia |
Binge eating |
|
|
Transsexualism |
Desire to change gender |
|
|
Transvestism |
The urge to wear clothes |
|
|
opposite sex |
||
|
paraphilia, |
Disorders of the sexual |
|
|
including: |
reverence |
|
|
fetishism |
Getting sexual oud |
|
|
allowance from contemplation before |
||
|
methods of intimate wardrobe |
||
|
exhibitionism |
Passion for exposure |
|
|
voyeurism |
Passion for peeping |
|
|
naked |
||
|
pedophilia |
Attraction to minors |
|
|
in adults |
||
|
sadomasochism |
Achieving Sexual Pleasure |
|
|
infliction by causing |
||
|
pain or mental suffering |
||
|
homosexuality |
Attraction to the faces of one's own |
|
Note. Terms for which no code is given are not included in ICD-10.
There are gross violations of the intellect (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, craving disorders are a manifestation of metabolic disorders (for example, eating inedible during anemia or pregnancy), as well as endocrine diseases (increased appetite in diabetes, hyperactivity in hyperthyroidism, aboulia in hypothyroidism, sexual behavior disorders with an imbalance of sex hormones).
Each of the pathological drives can be expressed in varying degrees. There are 3 clinical variants of pathological drives - obsessive and compulsive drives, as well as impulsive actions.
Obsessive (compulsive) attraction involves the emergence of desires that the patient can control in accordance with the situation. Inclinations that are clearly at odds with the requirements of ethics, morality and legality are never realized in this case and are suppressed as unacceptable. However, the refusal to satisfy the desire gives rise to strong feelings in the patient; in addition to the will, thoughts about an unsatisfied need are constantly stored in the head. If it does not have an obvious anti-social character, the patient performs it at the first opportunity. Thus, a person with an obsessive fear of pollution will hold back the urge to wash his hands for a short time, but he will definitely wash them thoroughly when no strangers look at him, because all the time he suffers, he constantly thinks painfully about his need. Obsessional drives are included in the structure of the obsessive-phobic syndrome. In addition, they are a manifestation of mental dependence on psychotropic drugs (alcohol, tobacco, hashish, etc.).
Compulsive attraction - a more powerful feeling, since it is comparable in strength to such vital needs as hunger, thirst, the instinct of self-preservation. Patients are aware of the perverse nature of the attraction, they try to restrain themselves, but with an unsatisfied need, 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 acts and the possibility of subsequent punishment. Compulsive attraction can be the cause of repeated violence and serial killings. A striking example of compulsive craving 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 acts committed by a person immediately, as soon as a painful attraction arises, without a previous struggle of motives and without a stage of decision. 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 the subsequent partial amnesia. Among impulsive acts, absurd ones, devoid of any meaning, predominate. Often, patients subsequently cannot explain the purpose of the deed. Impulsive acts are a frequent manifestation of epileptiform paroxysms. Patients with catatonic syndrome are also inclined to commit impulsive actions.
Disorders of impulses should be distinguished from actions caused by the pathology of other areas of the psyche. So, refusal to eat is 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 gross disorder of the motor sphere - catatonic stupor (see section 9.1). Acts that lead patients to their own death do not always express the desire to commit suicide, but are also due to imperative hallucinations or clouding of consciousness (for example, a patient in a state of delirium, fleeing from imaginary pursuers, jumps out of the window, believing that this is a door).
8.3. Syndromes of emotional-volitional disorders
The most striking manifestations of affective disorders are depressive and manic syndromes (Table 8.2).
8.3.1. depressive syndrome
The clinical picture of a typical depressive syndrome It is customary to describe in the form of a triad of symptoms: decreased mood (hypothymia), slowing down of thinking (associative retardation), and motor retardation. However, it should be borne in mind that it is a decrease in mood that is the main syndrome-forming sign of depression. Hypothymia can be expressed in complaints of melancholy, depression, sadness. In contrast to the natural reaction of sadness in response to a sad event, longing in depression loses its connection with the environment; patients do not show a reaction either to the good news or to new blows of fate. Depending on the severity of the depressive state, hypothymia can be manifested by feelings of varying intensity - from mild pessimism and sadness to a heavy, almost physical feeling of "a stone on the heart" ( vital anguish).
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-accusation, self-abasement, hypochondriacal delusions
Suppression of desires: decreased appetite decreased libido avoidance of contacts, isolation depreciation of life, suicidal tendencies
Sleep disorders: reduced duration early awakening no sense of sleep
Somatic disorders: dry skin, decreased skin turgor, brittle hair and nails, lack of tears, constipation
tachycardia and high 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 the need to help others, altruism
Sleep disorder: reduced sleep duration without causing fatigue
Somatic disorders are not typical. Patients do not show complaints, look young; an increase in blood pressure corresponds to the high activity of patients; body weight decreases with severe psychomotor agitation
Slowing down of thinking in mild cases is expressed by slow monosyllabic speech, long deliberation of the answer. In more severe cases, patients have difficulty comprehending the question asked, unable to cope with the solution of the simplest logical tasks. They are silent, there is no spontaneous speech, but complete mutism (silence) usually does not happen. Motor inhibition is manifested in stiffness, slowness, slowness, in severe depression it can reach the degree of stupor (depressive stupor). The posture of stuporous patients is quite natural: lying on your back with outstretched arms and legs, or sitting with your head bowed, resting your elbows on your knees.
Statements of depressed patients reveal a 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. Pessimistically assess not only their present state, but also the past and future. They declare that they could not do anything in this life, that they brought a lot of trouble to their family, they were not a joy for their parents. They make the saddest predictions; as a rule, do not believe in the possibility of recovery. In severe depression, delusions of self-accusation and self-abasement are not uncommon. Patients consider themselves deeply sinful before God, guilty of the death of their elderly parents, of the cataclysms taking place in the country. Often they blame themselves for the loss of the ability to empathize with others (anaesthesiapsychicadorosa). It is also possible the appearance of hypochondriacal delusions. Patients believe they are terminally ill, perhaps with a shameful illness; afraid of infecting loved ones.
Suppression of desires, as a rule, is expressed by isolation, loss of appetite (less often by bouts of bulimia). The lack of interest in the opposite sex is accompanied by distinct changes in physiological functions. Men often experience impotence and blame it on themselves. In women, frigidity is often accompanied by menstrual irregularities and even prolonged amenorrhea. Patients avoid any communication, among people they feel awkward, out of place, someone else's laughter only emphasizes their suffering. Patients are so immersed in their experiences that they are unable to care for anyone else. Women stop doing housework, cannot take care of young children, do not pay any attention to their appearance. Men do not cope with their favorite work, unable to get out of bed in the morning, get ready and go to work, lie all day without sleep. Patients have no entertainment, they do not read or watch TV.
The greatest danger in depression is a predisposition to suicide. Among mental disorders, depression is the most common cause of suicide. Although thoughts of passing away are inherent in almost all those suffering from depression, the real danger arises when severe depression is combined with sufficient activity of patients. With a pronounced stupor, the implementation of such intentions is difficult. Cases of extended suicide are described, when a person kills his children in order to "save them from future torment."
One of the most painful experiences in depression is persistent insomnia. Patients sleep poorly at night and cannot rest during the day. Particularly characteristic is awakening in the early morning hours (sometimes at 3 or 4 o'clock), after which the patients no longer fall asleep. Sometimes patients insist that they did not sleep for a minute at night, they never closed their eyes, although relatives and medical staff saw them sleeping ( no sense 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 pupil, and constipation ( triad of Protopopov). The appearance of patients is noteworthy. The skin is dry, pale, flaky. A decrease in the secretory function of the glands is expressed in the absence of tears (“she cried out all her eyes”). Hair loss and brittle nails are often noted. A decrease in skin turgor is manifested in the fact that wrinkles deepen and patients look older than their age. An atypical fracture of the eyebrow may be observed. Fluctuations in blood pressure with a tendency to increase are recorded. Disorders of the gastrointestinal tract are manifested not only by constipation, but also by a deterioration in digestion. As a rule, there is a noticeable decrease in body weight. Various pains are frequent (headaches, cardiac, in a stomach, in joints).
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. During the examination, the pathology was not revealed, however, the man assured that he had cancer, and admitted to the doctor that he intended to commit suicide. He did not object to being transferred to a psychiatric hospital. Depressed on admission, answers questions in monosyllables; declares that he "doesn't care anymore!". In the ward, he does not communicate with anyone, most of the time lies in bed, eats almost nothing, constantly complains about the lack of sleep, although the staff reports that the patient sleeps every night, at least until 5 am. Once, during a morning examination, a strangulation furrow was found 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 knitted from 2 handkerchiefs. After treatment with antidepressants, painful thoughts and all unpleasant sensations in the right hypochondrium disappeared.
Somatic symptoms of depression in some patients (especially at the first attack of the disease) may act as the main complaint. This is the reason for their appeal to the therapist and long-term, unsuccessful treatment for "coronary heart disease", "hypertension", "biliary dyskinesia", "vegetovascular dystonia", etc. In this case, they talk about masked (larvated) depression, described in more detail in chapter 12.
The brightness of emotional experiences, the presence of delusional ideas, signs of hyperactivity of the autonomic systems allow us to consider depression as a syndrome of productive disorders (see Table 3.1). This is also confirmed by the characteristic dynamics of depressive states. In most cases, depression lasts for several months. However, it is always reversible. Before the introduction of antidepressants and electroconvulsive therapy into medical practice, doctors often observed a spontaneous exit 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, dreary mood always prevails. An extended depressive syndrome is considered as a disorder of the psychotic level. The severity of the condition is evidenced by the presence of delusional ideas, lack of criticism, active suicidal behavior, severe stupor, suppression of all basic drives. A mild, non-psychotic variant 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 wide variety of mental illnesses: manic-depressive psychosis, schizophrenia, organic brain damage and psychogenia. For depression caused by an endogenous disease (MDP and schizophrenia), pronounced somatovegetative disorders are more characteristic, an important sign of endogenous depression is a special daily dynamics of the state with an increase in melancholy in the morning and some weakening of feelings in the evening. It is the morning hours that are considered as the period associated with the greatest risk of suicide. Another marker of endogenous depression is a positive dexamethasone test (see section 1.1.2).
In addition to the typical depressive syndrome, a number of atypical variants of depression are described.
Anxious (agitated) depression characterized by the absence of pronounced stiffness and passivity. The sthenic affect of anxiety makes patients fuss, constantly turn to others with a request for help or with a demand to stop their torment, to help them die. The premonition of an imminent catastrophe does not allow patients to sleep, they may attempt to commit suicide in front of others. At times, the excitement of patients reaches a degree of frenzy (melancholic raptus, raptus melancholicus), when they tear their clothes, make terrible cries, beat their heads against the wall. Anxiety depression is more often observed in the involutionary age.
depressive-delusional syndrome, in addition to a melancholy mood, it is manifested by such delirium plots as delusions of persecution, staging, influence. Patients are confident in severe punishment for committed misconduct; "notice" the constant observation of themselves. They fear that their guilt will lead to harassment, punishment or even the killing of their relatives. Patients are restless, constantly asking about the fate of their relatives, trying to make excuses, swearing that they will never make a mistake in the future. Such atypical delusional symptoms are more typical not for MDP, but for an acute attack of schizophrenia (schizoaffective psychosis in terms of ICD-10).
Apathetic depression combines the effects of melancholy and apathy. Patients are not interested in their future, they are inactive, do not express any complaints. Their only desire is to be left alone. This condition differs from apathico-abulic syndrome by instability and reversibility. Most often, apathetic depression is observed in those suffering from schizophrenia.
8.3.2. manic syndrome
It is manifested primarily by an increase in mood, acceleration of thinking and psychomotor agitation. Hyperthymia in this state is expressed by constant optimism, neglect of difficulties. Any problems are denied. Patients constantly smile, do not make any complaints, do not consider themselves sick. The acceleration of thinking is noticeable in fast, jumping speech, increased distractibility, superficiality of associations. With severe mania, speech is so disorganized that it resembles a “verbal okroshka”. The speech pressure is so great that patients lose their voice, saliva whipped into foam accumulates in the corners of the mouth. Due to their pronounced distractibility, their activity becomes chaotic, unproductive. They cannot sit still, tend to leave home, ask to be released from the hospital.
There is an overestimation of one's own abilities. Patients consider themselves surprisingly charming and attractive, they constantly boast of their alleged talents. They try to compose poetry, demonstrate their vocal abilities to others. A sign of an extremely pronounced mania is delusions of grandeur.
An increase in all basic drives is characteristic. Appetite sharply increases, sometimes there is a tendency to alcoholism. Patients cannot be alone and are constantly looking for communication. In a conversation with doctors, they do not always keep the necessary distance, turning easily - “brother!”. Patients pay a lot of attention to their appearance, they try to decorate themselves with badges and medals, women use excessively bright cosmetics, clothes try to emphasize their sexuality. Increased interest in the opposite sex is expressed in compliments, immodest offers, 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 squander money, make unnecessary purchases. With excessive activity, it is not possible to complete any of the cases, because each time new ideas arise. Attempts to prevent the realization of their desires cause a reaction of irritation, indignation ( angry mania).
A manic syndrome is characterized by a sharp decrease in the duration of a night's 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, they say that they sleep enough. Such patients usually cause a lot of inconvenience to others, harm their material and social status, but, as a rule, they do not pose a direct threat to the life and health of other people. Mild subpsychotic mood elevation ( hypomania) in contrast to severe mania, it can be accompanied by a consciousness of the unnatural state; delirium is not observed. Patients can make a favorable impression with their ingenuity and wit.
Physically, those suffering from mania appear quite healthy, somewhat rejuvenated. With pronounced psychomotor agitation, they lose weight, despite their wolfish appetite. With hypomania, there may be a significant increase in body weight.
A 42-year-old patient has been suffering from attacks of inappropriately elevated mood since the age of 25, the first of which arose 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, accused her husband of not being affectionate enough towards her. She slept no more than 4 hours a day, ardently engaged in scientific work, paid little attention to her son and household chores. I felt a passionate attraction to my supervisor. She sent him bouquets of flowers in secret. I attended all his lectures for students. Once, in the presence of all the staff of the department, on her knees she asked him to take her as his wife. Was hospitalized. At the end of the attack, she could not finish her dissertation. During the next attack fell in love with a young actor. She went to all his performances, gave flowers, secretly from her husband invited him to her dacha. She bought a lot of wine to drink her lover and thereby overcome his resistance, she herself drank a lot and often. To the bewildered questions of her husband, she confessed everything with fervor. After hospitalization and treatment, she married her lover, went to work for him in the theater. In the interictal period, she is calm, she rarely drinks alcohol. She speaks warmly of her former husband, regrets a little about the divorce.
Manic syndrome is most often a manifestation of MDP and schizophrenia. Occasionally there are manic states caused by organic damage to the brain or intoxication (phenamine, cocaine, cimetidine, corticosteroids, cyclosporine, teturam, hallucinogens, etc.). Mania is a symptom of acute psychosis. The presence of bright productive symptoms allows us to count on a complete reduction of painful disorders. Although individual attacks can be quite long (up to several months), they are still often shorter than depressive episodes.
Along with typical mania, atypical syndromes of a 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, megalomaniac delusions of grandeur ( acute paraphrenia). The patients declare that they are called to “save the whole world”, that they are endowed with incredible abilities, for example, they are “the main weapon against the mafia” and the criminals are trying to destroy them for this. Such a disorder does not occur in MDP and most often indicates an acute attack of schizophrenia. At the height of a manic-delusional attack, oneiroid clouding of consciousness can be observed.
8.3.3. Apatico-abulic syndrome
Manifested by 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 may also spend hours watching TV. At the same time, it turns out that they did not remember a single broadcast they watched. Laziness shows through in all their behavior: they do not wash, do not brush their teeth, refuse to go to the shower and cut their hair. They go to bed dressed because they are too lazy to take off and put on clothes. They cannot be attracted to activities, calling for responsibility and a sense of duty, because they do not feel shame. The conversation does not cause interest in patients. They speak in a monotone, often refusing 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. In the conversation, it turns out that patients do not experience any suffering, do not feel sick, do not make any complaints.
The described symptoms are often combined with the disinhibition of the simplest drives (gluttony, hypersexuality, etc.). At the same time, the lack of shame leads them to try to fulfill 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.
Apatic-abulic syndrome is a manifestation of negative (deficit) symptoms and does not tend to reverse development. Most often, the cause of apathy and abulia are the end states in schizophrenia, in which the emotional-volitional defect grows gradually - from mild indifference and passivity to states of emotional dullness. Another cause of apathy-abulic syndrome is an organic lesion of 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 is surprisingly violent and even dangerous to others. There are well-known cases of the murder of a spouse on the basis of jealousy, violent fights between football fans, violent disputes between political leaders. A psychopathic personality disorder (excitable psychopathy - see section 22.2.4) can contribute to a gross antisocial manifestation of affect. Nevertheless, one has to admit that in most cases such aggressive actions are committed consciously: participants can talk about their feelings at the time of the act, repent of incontinence, 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 subject to legal liability.
Pathological affect called a short-term psychosis that occurs suddenly after the action of a psychotrauma and is accompanied by clouding of consciousness, followed by amnesia of the entire period of psychosis. The paroxysmal nature of the occurrence of a pathological affect indicates that a traumatic event becomes a starting point for the realization of the existing epileptiform activity. It is not uncommon for patients to have a history of severe head trauma or signs of organic dysfunction since childhood. The clouding of consciousness at the moment of psychosis is manifested by fury, the amazing cruelty of the committed violence (dozens of severe wounds, numerous blows, each of which can be fatal). The surrounding people are not able to correct the actions of the patient, because he does not hear them. The psychosis lasts for several minutes and ends with severe exhaustion: the patients suddenly collapse, sometimes falling into a deep sleep. Upon leaving the psychosis, they cannot remember anything that happened, they are extremely surprised when they hear about what they have done, they cannot believe others. It should be recognized that disorders in pathological affect can only conditionally be attributed to the range of emotional disorders, since the most important expression of this psychosis is twilight clouding of consciousness(see section 10.2.4). Pathological affect serves as the basis for recognizing the patient as insane and exempting him from liability for the crime committed.
BIBLIOGRAPHY
Isard K. Human emotions. - M.: Publishing House of Moscow State University, 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. - Kiev: Vyscha school, 1989.
Psychology emotions. Texts / Ed. V.K.Vilyunas, Yu.B.Gippenreiter. - M.: MGU, 1984. - 288 p.
Psychosomatic disorders in cyclothymic and cyclothym-like conditions. - Proceedings of the MIP., T.87. - Rep. ed. S.F. Semenov. - M.: 1979. - 148 p.
Reikovsky Ya. Experimental psychology of emotions. - M.: Progress, 1979.
Sinitsky V.N. Depressive conditions (Pathophysiological characteristics, clinic, treatment, prevention). - Kiev: 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 the will and drives, affecting all the main 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 a manic syndrome.
Hypobulia - a general decrease in will and drives. Patients do not feel the need for communication, they are burdened by the presence of strangers and the need to maintain a conversation, they ask to be left alone. Patients are immersed in the world of their own suffering and cannot take care of their loved ones.
Abulia - a disorder limited to a sharp decrease in will. Abulia is a persistent negative disorder, together with apathy it constitutes a single apathetic-abulic syndrome, characteristic of the end states in schizophrenia.
Obsessive (compulsive) attraction involves the emergence of desires that the patient can control in accordance with the situation. Refusal to satisfy the desire gives rise to strong feelings in the patient, thoughts about an unsatisfied need are constantly stored. Thus, a person with an obsessive fear of pollution will hold back the urge to wash his hands for a short time, but he will definitely wash them thoroughly when no strangers look at him, because all the time he suffers, he constantly thinks painfully about his need. Obsessional drives are included in the structure of the obsessive-phobic syndrome.
Compulsive attraction is a more powerful feeling, since 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 acts and the possibility of subsequent punishment.
What diseases cause a violation of the emotional-volitional sphere:
Schizophrenia
manic syndrome
Depressive syndrome
obsessive phobic syndrome
Psychopathies
Alcoholism
Addiction
Which doctors to contact if there is a violation of the emotional-volitional sphere:
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The concept of emotional regulation and emotional norm, individual psychological features of the manifestation of emotions and feelings. Classification of emotional disturbances. Emotional disorders in various pathological processes and conditions. Methods and techniques for studying emotions (MTSV Luscher, MPV Szondi, questionnaire for assessing the emotional state, drawing projective methods).
Pathopsychological classification of volitional disorders: violations at the level of the motivational component of the volitional act (oppression and strengthening of the motives of activity, perversion of impulses), pathology at the level of realization of the volitional act (oppression and strengthening of motor functions, parakinesia). The study of volitional qualities of personality.
Emotions- this is a mental process of subjective reflection of the most general attitude of a person to objects and phenomena of reality, to other people and to himself in relation to the satisfaction or dissatisfaction of his needs, goals and intentions.
Individual psychological characteristics - depend on the person's age, temperament and personality as a whole. Emotions as complex systemic psychological formations that make up the emotional sphere of a person are characterized by many parameters: sign(positive or negative) and modality(the quality of the 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 arbitrary control.
Classification of emotional disorders:
- emotional lability(weakness) - excessive mobility, ease of changing emotions.
- emotional rigidity(inertia, stiffness) - the experience of emotions persists for a long time, although the event that caused it has long passed.
- emotional excitability It is determined by the minimum strength, intensity of external or internal stimuli that can cause an emotional reaction in a person.
- explosiveness(explosiveness)
- emotional monotony(cold)
- emotional paralysis- acute, short-term shutdown of emotions.
- apathy(indifference)
Emotional instability (emotions are less amenable to conscious control).
Emotional intemperance is the inability to control and own one's 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:
catatim type- usually occurs in stressful situations, pathological emotional reactions are relatively short-lived, changeable, psychogenic (neurosis and reactive psychosis);
holotimic type- characterized by endogenous conditioning (primacy), 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, a violation of unity in the emotional sphere between emotional manifestations and other components of mental activity (schizophrenia);
explosive type- characterized by a combination of inertness of emotional manifestations with their explosiveness, impulsivity (signs of paroxysmal), dominated by an angry-dreary or ecstatically elated mood (epilepsy, organic diseases of the brain);
dement type- combined with increasing signs of dementia, uncriticality, disinhibition of lower drives against the background of complacency, euphoria or apathy, indifference, spontaneity (senile dementia of the Alzheimer's type, atherosclerotic dementia, progressive paralysis, and other diseases).
In pathology, the following are of great practical importance: hypothymia(pathological decrease in mood background), hyperthymia(pathological increase in mood background) and parathymia(perverted emotionality).
Methods for studying emotions MCV Luscher, MPV Szondi, questionnaire for assessing the 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 secondary colors (purple, brown, black, gray). The choice of color in order of preference reflects the focus of the subject on a certain activity, his mood, functional state, as well as the most stable personality traits. It is impossible to apply the Luscher test as an independent technique in the practice of examination, professional selection, and personnel assessment.
Emotional State Assessment Questionnaire- this technique is effective if it is necessary to identify a change in the emotional state of a person over a certain period of time. The following indicators are determined:
I1- "Calmness - anxiety" (individual self-assessment - I1- equals the number of the judgment chosen by the subject from this scale. Similarly, individual values are obtained for indicators I2-I4).
AND 2- "Energy - fatigue."
FROM- "Elevation - depression."
I4“A feeling of self-confidence is a feeling of helplessness.”
I5– Total (on four scales) assessment of the state
Will violations.
Will is a mental process of conscious control and regulation of one's behavior, ensuring the overcoming of 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 a volitional act - three groups: oppression, strengthening and perversion of motives of activity and inclinations.
A) Oppression of the motives of activity
Hypobulia- decrease in intensity and decrease in the number of urges to activity with regression. Extreme severity - aboulimia - complete absence of desires, aspirations and motivations for activity.
B) Strengthening the motives of activity
Hyperbulia- a pathological increase in the intensity and quantity of impulses and motives for activity. Hyperbulia usually gives the patient's behavior an inadequate character. Excessive activity and an increase in the number of impulses are also found in painfully elevated mood (manic states) and intoxication. Very characteristic of hyperbulia is reduced 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 itself in three main forms:
1. They resemble rituals and are more common in neurotic disorders. Usually, only those obsessive actions are performed that do not threaten the life of the patient himself and those around him, and also that do not contradict his moral and ethical principles.
2. Compulsive actions - realized compulsive drives. In most cases, compulsive drives are monothematic and manifest as peculiar recurring insurmountable 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 deeds that last seconds or minutes, are performed by patients without deliberation 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 in addition to 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 diseases of the brain.
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