Violation of the emotional-volitional sphere of a person. Disorders of the emotional-volitional sphere. The main causes of violations are

Characteristics of the emotional-volitional sphere of personality.

For normal life activity and development in society, the emotional-volitional sphere of the individual is of great importance. Emotions and feelings play a very important role in human life.

Will is an ability that manifests itself during the regulation of one’s activities. From birth, a person does not possess it, since, basically, all his actions are based on intuition. As life experience accumulates, volitional actions begin to appear, which become more and more complex. The important thing is that a person not only gets to know the world, but also tries to somehow adapt it to himself. This is precisely what volitional actions are, which are very important indicators in life.

The volitional sphere of personality most often manifests itself when various difficulties and trials are encountered along the path of life. The last stage in the formation of will is the actions that must be taken to overcome external and internal obstacles. If we talk about history, volitional decisions at different times were formed thanks to certain work activities. For example, primitive man performed a certain number of actions to get food.

Characteristics of the volitional sphere of personality

Volitional actions can be divided into two groups:

Simple - actions that do not require the expenditure of certain forces and additional organization.

Complex - actions that require a certain concentration, perseverance and skill.

In order to understand the essence of such actions, it is necessary to understand the structure. An act of will consists of the following elements:

  • pulse;
  • motive;
  • method and means of activity;
  • decision-making;
  • execution of the decision.

Development of the emotional-volitional sphere of personality

This process is quite complex and occurs due to the influence of various factors. External stimuli include certain social conditions, and internal stimuli, for example, heredity. Development occurs from early childhood to adolescence and it can be divided into certain stages:

From birth to 3 years of age, the somato-vegetative type predominates. Any dissatisfaction is manifested by increased emotional excitability.

At the ages of 3 to 7 years, the emotional and volitional sphere of the personality is manifested by a psychomotor type of response. During this period, the child often displays negativism, oppositionality, and also develops reactions such as fear and fright.

The next stage of development is the age from 7 to 11 years. During this period, the child’s affective type of reaction predominates, which manifests itself as impressionability and anxiety. The feeling of anxiety becomes more stable. At this age, the child develops self-esteem and strong-willed traits such as perseverance, determination, independence, etc.

At the age of 12 to 15 years, the volitional sphere of personality in psychology is manifested by the dominance of the emotional-ideational type of behavior. A child at this age is characterized by the following traits: touchiness, imbalance, irritability, mood swings, and conflict. All this makes it difficult to adapt to society. The last stage of will development is the age from 16 to 18 years. During this period, stabilization of the emotional state is observed. Adolescents at this age exhibit the following traits: independence, determination, endurance, determination, perseverance, good concentration, and the ability to get out of difficult situations.

Violations of the emotional-volitional sphere of the personality are manifested:

  • self-doubt;
  • inadequate self-esteem;
  • increased anxiety;
  • problems in interacting with other people;
  • emotional stress;
  • reluctance to do anything;
  • increased impulsiveness.

Emotions and feelings.
Emotions represent the subject’s biased attitude towards the environment and what happens to him. The mechanism by which emotions arise is closely related to the needs and motives of a person. Conditions, objects and phenomena that contribute to the satisfaction of needs and the achievement of goals evoke positive emotions: pleasure, joy, interest, excitement. On the contrary, situations perceived by the subject as preventing the realization of needs and goals cause negative emotions and experiences: displeasure, grief, sadness, fear, sadness, anxiety, etc.

Consequently, we can state the double conditionality of emotions, on the one hand, by our needs, on the other hand. the other - features situations. Emotions establish connections and relationships between these two series of events and signal to the subject about the possibility or impossibility of satisfying his needs under given conditions.

Thus, emotions are a special class of mental processes and states associated with needs and motives and reflecting in the form of experiences the significance of phenomena and situations affecting the subject.

When talking about a person’s experiences, as a rule, two terms are used - “feelings” and “emotions”. In everyday speech, the concepts of “feelings” and “emotions” are practically the same. Some psychologists are also inclined to identify them. At the same time, there is a point of view according to which feelings and emotions are different and in many ways opposite subjective states in relation to each other.

According to the traditions of Russian psychology, it is customary to distinguish feelings as a special subclass of emotional processes. Unlike emotions, which reflect short-term experiences, feelings are long-term and can last a lifetime. For example, you can get pleasure (satisfaction) from a completed task, that is, experience a positive emotion, or you can be satisfied with your profession, have a positive attitude towards it, that is, experience a feeling of satisfaction.

Feelings arise as a generalization of many emotions aimed at a specific object. Feelings are expressed through emotions depending on the situation in which the object of their expression is located. For example, a mother, loving her child, experiences different emotions towards him in different situations: she can be angry with him, feel proud of him, tenderness for him, etc. This example shows that:

  • firstly, emotions and feelings are not the same thing;
  • secondly, there is no direct correspondence between feelings and emotions: the same emotion can express different feelings and the same feeling can be expressed in different emotions.

Proof of the non-identity of emotions and feelings is the later appearance of feelings in ontogenesis compared to emotions.

Possible disturbances in the emotional sphere of the individual.

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

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

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

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

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

The main causes of violations are:

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

With various mental illnesses, a disturbance in the emotional state of the patient is often observed. This manifests itself in the form of depression, euphoria, dysphoria, weakness, emotional dullness, etc.

Depression is expressed by persistent depression of mood, despondency, melancholy. The surrounding reality is perceived by the patient with a feeling of hopelessness. This gives rise to thoughts of suicide. Similar symptoms can be observed in manic-depressive psychosis, involutional and reactive depression, as well as in hepatitis, hypertension.

Euphoria is expressed by a complacent, blissful mood with shades of cloudless joy and excellent well-being. The distress in such patients is short-lived. Euphoria can occur with brain tumors (frontal and temporal areas), with severe forms of somatic diseases (tuberculosis, diseases of the cardiovascular system, progressive paralysis). In some cases, the most difficult physical condition, even on the eve of death, is accompanied by carelessness, cheerfulness, and the construction of a mass of rosy plans.

A persistent increase in mood, accompanied by the motor activity of patients and acceleration of their thought process, is observed in a manic state (mania). It is characteristic of the manic phase of manic-depressive psychosis.

Dysphoria is characterized by a sad, angry, grumpy mood. It usually occurs in patients with epilepsy. Lasts from several minutes to several days. In this case, the patient is gloomy, irritable, depressed, and aggressive.

Weakness accompanied by incontinence of emotions, slight emotion or tearfulness for various minor reasons. Emotional weakness is more common in older people. For example, a patient suffering from cerebral atherosclerosis cries while reading a work of art or listening to a story with tragic content. He also easily gets into a cheerful mood.

Emotional dullness is characterized by a state of indifference to the environment. The patient does not care, does not care, does not care. He is absolutely inactive and strives for solitude. This condition is typical of schizophrenia, and also occurs with brain tumors and atrophic processes (Alzheimer's and Pick's diseases).

Affect- a state that a person experiences during an extremely strong sensory shock. There are states of physiological and pathological affect.

Violent emotional outbursts (resentment, insult, anger, despair, joy) with a clear awareness of one’s behavior refer to states of physiological affect. In this case, emotional disturbances reach an extreme degree of tension, but do not go beyond physiological boundaries. People who are in such a state when committing a crime must be held accountable for their actions, that is, they are recognized as sane. Memory during physiological affect is preserved.

Will, volitional effort, structure of a volitional act.

Will- one of the most complex concepts in psychology. Will is considered both as an independent mental process and as an aspect of other important psychic phenomena, and as a unique ability of an individual to voluntarily control his behavior.

Will is a mental function that literally permeates all aspects of human life. The content of a volitional action usually has three main features:

  1. Will provides purposefulness and orderliness human activity. But the definition of S.R. Rubinstein, “Volitional action is a conscious, purposeful action through which a person achieves the goal set for him, subordinating his impulses to conscious control and changing the surrounding reality in accordance with his plan.”
  2. Will, as a person’s ability for self-regulation, makes him relatively free from external circumstances, truly turns him into an active subject.
  3. Will is a person’s conscious overcoming of difficulties on the way to his goal. When faced with obstacles, a person either refuses to act in the chosen direction or increases his efforts. to overcome the difficulties encountered.

Functions of the will

Thus, volitional processes perform three main functions:

  • initiating, or incentive, ensuring the beginning of one or another action in order to overcome emerging obstacles;
  • stabilizing associated with volitional efforts to maintain activity at the proper level when external and internal interference occurs;
  • brake, which consists of restraining other, often strong desires that are not consistent with the main goals of the activity.

Volitional act

The most important place in the problem of will is occupied by the concept of “volitional act”. Each volitional act has a certain content, the most important components of which are decision-making and its execution. These elements of a volitional act often cause significant mental stress, similar in nature to the state of stress.

The structure of a volitional act has the following main components:

  • an impulse to perform a volitional action caused by a particular need. Moreover, the degree of awareness of this need can vary: from a vaguely realized attraction to a clearly realized goal;
  • the presence of one or more motives and the establishment of the order of their implementation:
  • “struggle of motives” in the process of choosing one or another of the conflicting motives;
  • decision making in the process of choosing one or another behavior option. At this stage, either a feeling of relief or a state of anxiety associated with uncertainty about the correctness of the decision may arise;
  • implementation of a decision, implementation of one or another course of action.

At each of these stages of the volitional act, a person shows will, controls and corrects his actions. At each of these moments, he compares the result obtained with the ideal image of the goal, which was created in advance.

In volitional actions, a person’s personality and its main features are clearly manifested.

Will manifests itself in such personality traits as:

  • determination;
  • independence;
  • determination;
  • persistence;
  • excerpt;
  • self-control;

Each of these properties is opposed by opposite character traits, in which lack of will is expressed, i.e. lack of one's own will and submission to someone else's will.

The most important volitional property of a person is determination as a person’s ability to achieve his life goals.

Independence manifests itself in the ability to take actions and make decisions based on internal motivation and one’s knowledge, skills and abilities. A person who is not independent is focused on subordinating to another, shifting responsibility onto him for his actions.

Determination is expressed in the ability to make a thoughtful decision in a timely manner and without hesitation and implement it. The actions of a decisive person are characterized by thoughtfulness and speed, courage, and confidence in their actions. The opposite of decisiveness is indecisiveness. A person characterized by indecision constantly doubts, hesitates in making decisions and using the chosen decision methods. An indecisive person, even having made a decision, begins to doubt again and waits to see what others will do.

Endurance and self-control there is the ability to control oneself, one’s actions and the external manifestation of emotions, to constantly control them, even in the event of failures and major setbacks. The opposite of self-control is the inability to restrain oneself, which is caused by the lack of special education and self-education.

Perseverance is expressed in the ability to achieve a goal, overcoming difficulties on the way to achieving it. A persistent person does not deviate from his decision, and in case of failure he acts with renewed energy. A person lacking persistence retreats from his decision at the first failure.

Discipline means conscious subordination of one’s behavior to certain norms and requirements. Discipline comes in different forms in both behavior and thinking, and is the opposite of indiscipline.

Courage and courage are manifested in the readiness and ability to fight, overcome difficulties and dangers on the way to achieving a goal, and in the readiness to defend one’s position in life. The opposite quality to courage is cowardice, which is usually caused by fear.

The formation of the listed volitional properties of a person is determined mainly by the purposeful education of the will, which should be inseparable from the education of feelings.

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

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

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

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

8.1. Symptoms of Emotional Disorders

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

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

Hypotymia as a manifestation of strong emotions is classified as a productive psychopathological disorder. This symptom is not specific and can be observed during an exacerbation of any mental illness; it is often found in severe somatic pathology (for example, with malignant tumors), and is also 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 is a characteristic manifestation manic syndrome. The most acute psychoses are expressed by especially strong exalted feelings, reaching the degree ecstasy. This condition may indicate the formation of oneiric stupefaction (see section 10.2.3).

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

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

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

Anxiety - the most important human emotion, closely related to the need for security, expressed by a feeling of an impending uncertain threat, internal excitement. Anxiety is a sthenic emotion: accompanied by tossing, restlessness, restlessness, and muscle tension. As an important signal of trouble, it can arise in the initial period of any mental illness. In obsessive-compulsive neurosis and psychasthenia, anxiety is one of the main manifestations of the disease. In recent years, suddenly occurring (often against the backdrop of a traumatic situation) panic attacks, manifested by acute attacks of anxiety, have been identified as an independent disorder. 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). For this symptom 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 - general increase will and drives, affecting all the basic drives of a person. An increase in appetite leads to the fact that patients, while in the department, immediately eat the food brought to them and sometimes cannot resist taking food from someone else’s nightstand. Hypersexuality is manifested by increased attention to the opposite sex, courtship, and immodest compliments. Patients try to attract attention with bright cosmetics, flashy clothes, stand for a long time in front of the Mirror, tidying up their hair, and can engage in numerous casual sexual relationships. There is a pronounced desire to communicate: every conversation of others becomes interesting for patients, they try to join in the conversations of strangers. Such people strive to provide patronage to any person, give away their things and money, make expensive gifts, get involved in a fight, wanting to protect the weak (in their opinion). It is important to take into account that the simultaneous increase in drives and will, as a rule, does not allow patients to commit obviously dangerous and grossly illegal actions, sexual violence. Although such people usually do not pose a danger, they can disturb others with their intrusiveness, fussiness, behave carelessly, and misuse property. Hyperbulia is a characteristic manifestation manic syndrome.

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

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

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

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

Many symptoms described perversions of drives (parabulia). Manifestations mental disorders There may be a perversion of appetite, sexual desire, a 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.

In cases of pathological drives there are gross intellectual impairments (mental retardation, 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 syndromes

Depressive syndrome

Depressive triad: decreased mood, ideational retardation, motor retardation

Low self-esteem

pessimism

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

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

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

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

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

Manic triad: increased mood, accelerated thinking, psychomotor agitation

High self-esteem, optimism

Delusions of grandeur

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

Sleep disorder: reduced sleep duration without causing tiredness

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

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

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

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

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

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

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

Depression, as a rule, is accompanied by a variety of somatovegetative symptoms. As a reflection of the severity of the condition, peripheral sympathicotonia is more often observed. A characteristic triad of symptoms is described: tachycardia, dilated pupils and constipation ( Protopopov's triad). The appearance of the patients is noteworthy. 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 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 does not communicate with anyone in the department, lies in bed most of the time, eats almost nothing, constantly complains of lack of sleep, although the staff reports that the patient sleeps every night, according to at least until 5 o'clock in the morning. One day, during a morning examination, a strangulation groove was discovered on the patient’s neck. Upon persistent questioning, he admitted that in the morning, when the staff fell asleep, he tried, while lying in bed, to strangle himself with a noose tied from 2 handkerchiefs. After treatment with antidepressants, painful thoughts and all unpleasant sensations in the right hypochondrium disappeared.

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

Vividness of emotional experiences, presence of delusional ideas, signs of hyperactivity vegetative 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 wide variety of mental illnesses: manic-depressive psychosis, schizophrenia, organic brain damage and psychogenic disorders. For depression caused by an endogenous disease (MDP and schizophrenia), pronounced somatovegetative disorders are more typical; an important sign of endogenous depression is the special daily dynamics of the state with increased melancholy in the morning and some weakening of feelings in the evening. It is the morning hours that are considered to be the period associated with the greatest risk of suicide. Another marker of endogenous depression is a positive dexamethasone test (see section 1.1.2).

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

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

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

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

8.3.2. Manic syndrome

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

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

An increase in all basic drives is characteristic. Appetite increases sharply, and sometimes there is a tendency to alcoholism. Patients cannot be alone and are constantly looking for communication. When talking with doctors, they do not always maintain the necessary distance, calling simply “brother!” Patients pay a lot of attention to their appearance, try to decorate themselves with badges and medals, women use excessively bright cosmetics, and try to emphasize their sexuality with clothes. Increased interest in the opposite sex is expressed in compliments, immodest proposals, and declarations of love. Patients are ready to help and patronize everyone around them. At the same time, it often turns out that there is simply not enough time for one’s own family. They waste money and make unnecessary purchases. 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. The presence of bright productive symptoms allows us to count on a complete reduction of painful disorders. Although individual attacks can be quite long (up to several months), they are still often shorter than attacks of depression.

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

8.3.3. Apathetic-abulic syndrome

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

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

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

8.4. Physiological and pathological affect

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

Pathological affect is called short-term psychosis, which occurs suddenly after the action of psychological trauma and is accompanied by clouding of consciousness with subsequent amnesia for the entire period of psychosis. The paroxysmal nature of the onset of pathological affect indicates that a psychotraumatic event becomes a trigger for the implementation of existing epileptiform activity. It is not uncommon for patients to have a history of severe head trauma or signs of organic dysfunction from 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 darkness consciousness(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.

MENTAL DEVELOPMENT DURING ASYNCHRONIES WITH PREMIUM

Among children with disabilities health, i.e. Those who have various deviations in psychophysical and social-personal development and need special help, children are singled out for whom disorders in the emotional-volitional sphere come to the fore. The category of children with disorders of the emotional-volitional sphere is extremely heterogeneous. The main feature of such children is a violation or delay in the development of higher socialized forms of behavior, which involve interaction with another person, taking into account his thoughts, feelings, and behavioral reactions. At the same time, activities that are not mediated by social interaction (play, construction, fantasy, solving intellectual problems alone, etc.) can occur at a high level.

According to the widespread classification of behavioral disorders in children and adolescents by R. Jenkins, the following types of behavioral disorders are distinguished: hyperkenetic reaction, anxiety, autistic-type withdrawal, escape, unsocialized aggressiveness, group delinquency.

Children with early childhood autism syndrome (ECA) make up the bulk of children who have the most severe disorders in social and personal development that require special psychological, pedagogical, and sometimes medical assistance.

Chapter 1.

PSYCHOLOGY OF CHILDREN WITH EARLY CHILDHOOD AUTISM SYNDROME

SUBJECT AND TASKS OF PSYCHOLOGY OF CHILDREN WITH RDA

The focus of this area is the development of a system of comprehensive psychological support for children and adolescents experiencing difficulties in adaptation and socialization due to disorders in the emotional and personal sphere.

The tasks of primary importance in this section of special psychology include:

1) development of principles and methods for early detection of RDA;

2) issues of differential diagnosis, differentiation from similar conditions, development of principles and methods of psychological correction;

3) development of psychological foundations for eliminating the imbalance between the processes of learning and development of children.

Vivid external manifestations of RDA syndrome are: autism as such, i.e. extreme “extreme” loneliness of the child, decreased ability to establish emotional contact, communication and social development. Characterized by difficulties in establishing eye contact, interaction with gaze, facial expressions, gestures, and intonation. There are difficulties in the child expressing his emotional states and their understanding of the states of other people. Difficulties in establishing emotional connections are manifested even in relationships with loved ones, but to the greatest extent autism disrupts the development of relationships with strangers;

stereotypy in behavior associated with an intense desire to maintain constant, familiar living conditions. The child resists the slightest changes in the environment and order of life. Absorption in monotonous actions is observed: rocking, shaking and waving arms, jumping; addiction to various manipulations of the same object: Shaking, tapping, spinning; being caught up in the same topic of conversation, drawing, etc. and constant return to it (text 1);

“Stereotypes permeate everything mental manifestations autistic child in the first years of life, clearly appear when analyzing the formation of his affective, sensory, motor, speech spheres, play activities... this was manifested in the use of rhythmically clear music for stereotypical swinging, twisting, spinning, shaking objects, and by the age of 2 - special attraction to the rhythm of poetry. By the end of the second year of life, there was also a desire for a rhythmic organization of space - laying out monotonous rows of cubes, an ornament of circles, and sticks. Very typical are stereotypical manipulations with a book: fast and rhythmic turning of pages, which often captivates a two-year-old child more than any other toy. Obviously, a number of properties of the book are important here: the convenience of stereotypical rhythmic movements (the leafing itself), the stimulating sensory rhythm (the flickering and rustling of pages), as well as the obvious absence in its appearance of any communicative qualities suggesting interaction.”

“Perhaps the most common type of motor patterns seen in autism are: symmetrical flapping of both arms, elbows at maximum speed, finger tapping, body rocking, head shaking, or spinning and clapping. various types...many autistic people live with strict routines and unchanging rituals. They may enter and leave the bathroom 10 times before entering it to perform routine procedures or, for example, spin around themselves before agreeing to get dressed.” characteristic delay and disturbance of speech development, namely its communicative function. In at least one third of cases, this can manifest itself in the form of mutism (lack of purposeful use of speech for communication, while maintaining the possibility of accidentally pronouncing individual words and even phrases). A child with RDA may also have formally well-developed speech with great vocabulary, an expanded “adult” phrase. However, such speech has the character of cliched, “parrot-like”, “photographic”. The child does not ask questions and may not respond to speech addressed to him; he may enthusiastically recite the same poems, but not use speech even in the most necessary cases, i.e. there is an avoidance of verbal interaction as such. A child with RDA is characterized by speech echolalia (stereotypical meaningless repetition of heard words, phrases, questions), a long lag in the correct use of personal pronouns in speech, in particular, the child continues to call himself “you”, “he” for a long time, and indicates his needs with impersonal orders: “give me something to drink”, “cover”, etc. The unusual tempo, rhythm, and melody of the child’s speech is noteworthy;

early manifestation of the above disorders (before the age of 2.5 years).

The greatest severity of behavioral problems (self-isolation, excessive stereotypical behavior, fears, aggression and self-injury) is observed in pre- school age, from 3 to 5-6 years (an example of the development of a child with RDA is given in the appendix).

HISTORICAL EXCURSION

The term “autism” (from the Greek autos - itself) was introduced by E. Bleuler to designate a special type of thinking characterized by “separation of associations from given experience, ignoring actual relationships.” Defining the autistic type of thinking, E. Bleuler emphasized its independence from reality, freedom from logical laws, and being captured by one’s own experiences.

The syndrome of early childhood autism was first described in 1943 by the American clinician L. Kanner in his work “Autistic disorders of affective contact,” written on the basis of a generalization of 11 cases. He concluded that there was a special clinical syndrome of “extreme loneliness,” which he called early childhood autism syndrome and which later became known as Kanner syndrome after the scientist who discovered it.

G. Asperger (1944) described children of a slightly different category, he called it “autistic psychopathy.” The psychological picture of this disorder is different from Kanner’s. The first difference is that signs of autistic psychopathy, unlike RDA, appear after the age of three. Autistic psychopaths clearly exhibit behavioral disorders, they are devoid of childishness, there is something senile in their entire appearance, they are original in their opinions and original in their behavior. Games with peers do not attract them; their play gives the impression of being mechanical. Asperger talks about the impression of floating in a dream world, poor facial expressions, monotonous “booming” speech, disrespect for adults, rejection of affection, and the lack of necessary connection with reality. There is a lack of intuition and insufficient ability to empathize. On the other hand, Asperger noted a desperate commitment to home and love for animals.

S. S. Mnukhin described similar conditions in 1947.

Autism occurs in all countries of the world, on average in 4-5 cases per 10 thousand children. However, this figure only covers so-called classic autism, or Kanner syndrome, and will be significantly higher if other types of behavior disorders with autistic-like manifestations are taken into account. Moreover, early autism occurs in boys 3-4 times more often than in girls.

In Russia, issues of psychological and pedagogical assistance to children with RDA began to be developed most intensively from the late 70s. Subsequently, the result of research was an original psychological classification (K.S. Lebedinskaya, V.V. Lebedinsky, O.S. Nikolskaya, 1985, 1987).

REASONS AND MECHANISMS OF RDA.

PSYCHOLOGICAL ESSENCE OF RDA. CLASSIFICATION OF CONDITIONS BY DEGREE OF SEVERITY

According to the concept being developed, according to the level of emotional regulation, autism can manifest itself in different forms:

1) as complete detachment from what is happening;

2) as active rejection;

3) as being caught up in autistic interests;

4) as an extreme difficulty in organizing communication and interaction with other people.

Thus, four groups of children with RDA are distinguished, which represent different stages of interaction with the environment and people.

With successful correctional work, the child climbs these kind of steps of socialized interaction. In the same way, if educational conditions deteriorate or do not correspond to the child’s condition, a transition to more unsocialized forms of life will occur.

Children of the 1st group are characterized by manifestations of a state of severe discomfort and a lack of social activity at an early age. It is impossible even for loved ones to get a return smile from the child, to catch his gaze, to receive a response to the call. The main thing for such a child is not to have any points of contact with the world.

The establishment and development of emotional connections with such a child helps to increase his selective activity, to develop certain stable forms of behavior and activity, i.e. make a transition to a higher level of relations with the world.

Children of the 2nd group are initially more active and slightly less vulnerable in contacts with the environment, and their autism itself is more “active”. It manifests itself not as detachment, but as increased selectivity in relations with the world. Parents usually indicate a delay mental development for such children, first of all, speech; They note increased selectivity in food and clothing, fixed walking routes, and special rituals in various aspects of life, the failure of which leads to violent affective reactions. Compared to children of other groups, they are most burdened with fears and display a lot of speech and motor stereotypies. They may experience unexpected violent manifestations of aggression and self-injury. However, despite the severity various manifestations, these children are much more adapted to life than the children of the first group.

Children of the 3rd group are distinguished by a slightly different way of autistic defense from the world - this is not a desperate rejection of the world around them, but an over-preoccupation with their own persistent interests, manifested in a stereotypical form. Parents, as a rule, complain not about developmental delays, but about increased conflict in children and lack of consideration for the interests of others. For years, a child can talk on the same topic, draw or act out the same story. Often the themes of his interests and fantasies are frightening, mystical, and aggressive in nature. The main problem of such a child is that the behavior program he has created cannot be adapted to flexibly changing circumstances.

In children of the 4th group, autism manifests itself in its mildest form. The increased vulnerability of such children and inhibition in contacts (interaction stops when the child senses the slightest obstacle or opposition) comes to the fore. This child is too dependent on emotional support from adults, so the main direction of helping these children should be to develop in them other ways of obtaining pleasure, in particular from the experience of realizing their own interests and preferences. To do this, the main thing is to provide the child with an atmosphere of safety and acceptance. It is important to create a clear, calm rhythm of classes, periodically including emotional impressions.

The pathogenetic mechanisms of childhood autism remain unclear. At different times in the development of this issue, attention was paid to very different causes and mechanisms of occurrence of this disorder.

L. Kanner, who identified “extreme loneliness” with a desire for ritual forms of behavior, disturbances or absence of speech, mannerisms of movements and inadequate reactions to sensory stimuli as the main symptom of autism, considered it an independent developmental anomaly of constitutional genesis.

Regarding the nature of RDA long time B. Bittelheim's (1967) hypothesis about its psychogenic nature dominated. It was that such conditions of a child’s development, such as the suppression of his mental activity and affective sphere by an “authoritarian” mother, lead to the pathological formation of personality.

Statistically, RDA is most often described in the pathology of the schizophrenic circle (L. Bender, G. Faretra, 1979; M.Sh. Vrono, V.M. Bashina, 1975; V.M. Bashina, 1980, 1986; K.S. Lebedinskaya, I.D. Lukashova, S.V. Nemirovskaya, 1981), less often - with organic pathology of the brain (congenital toxoplasmosis, syphilis, rubeolar encephalopathy, other residual failure nervous system, lead intoxication, etc. (S.S. Mnukhin, D.N. Isaev, 1969).

When analyzing the early symptoms of RDA, an assumption arises about special damage to the ethological mechanisms of development, which is manifested in a polar attitude towards the mother, in great difficulties in the formation of the most basic communicative signals (smile, eye contact, emotional syntony1), weakness of the self-preservation instinct and affective defense mechanisms.

At the same time, children exhibit inadequate, atavistic2 forms of cognition of the surrounding world, such as licking and sniffing an object. In connection with the latter, there are speculations about a breakdown biological mechanisms affectivity, primary weakness of instincts, information blockade associated with a disorder of perception, underdevelopment of internal speech, central disturbance of auditory impressions, which leads to blockade of needs for contacts, disruption of the activating influences of the reticular formation, and many others. etc. (V. M. Bashina, 1993).

V.V. Lebedinsky and O.N. Nikolskaya (1981, 1985) when addressing the issue of the pathogenesis of RDA, proceed from the position of L.S. Vygotsky about primary and secondary developmental disorders.

Primary disorders in RDA include increased sensory and emotional sensitivity (hypersthesia) and weakness energy potential; to the secondary ones - autism itself, as a withdrawal from the surrounding world, which hurts with the intensity of its stimuli, as well as stereotypies, overvalued interests, fantasies, disinhibition of drives - as pseudo-compensatory autostimulatory formations that arise in conditions of self-isolation, replenishing the deficit of sensations and impressions from the outside and thereby perpetuating the autistic barrier. They have a weakened emotional reaction to loved ones, up to a complete absence of external reaction, the so-called “affective blockade”; insufficient response to visual and auditory stimuli, which gives such children a resemblance to the blind and deaf.

Clinical differentiation of RDA is of great importance for determining the specifics of treatment and pedagogical work, as well as for school and social prognosis.

To date, there has been an understanding of two types of autism: classical Kanner autism (KKA) and variants of autism, which include autistic conditions of different genesis, which can be seen in various types of classifications. The Asperger's variant is usually milder, and the “core personality” is not affected. Many authors refer to this variant as autistic psychopathy. The literature contains descriptions of various clinical

1 Syntony is the ability to respond emotionally to the emotional state of another person.

2 Atavisms are outdated signs or forms of behavior that are biologically inappropriate at the present stage of development of the organism.

manifestations in these two variants of abnormal mental development.

If Kanner's RDA is usually detected early - in the first months of life or during the first year, then with Asperger's syndrome, developmental features and strange behavior, as a rule, begin to appear in the 2nd -3rd years and more clearly - by primary school age. With Kanner's syndrome, the child begins to walk before speaking; with Asperger's syndrome, speech appears before walking. Kanner syndrome occurs in both boys and girls, while Asperger's syndrome is considered "an extreme expression of male character." With Kanner syndrome, there is a cognitive defect and a more severe social prognosis; speech, as a rule, does not have a communicative function. With Asperger's syndrome, intelligence is more preserved, social prognosis is much better, and the child usually uses speech as a means of communication. Eye contact is also better with Asperger's syndrome, although the child avoids other people's gaze; general and special abilities are also better in this syndrome.

Autism can arise as a unique developmental anomaly of genetic origin, and can also be observed as a complicating syndrome in various neurological diseases, including metabolic defects.

Currently, ICD-10 has been adopted (see appendix to section I), in which autism is considered in the group “general disorders of psychological development” (F 84):

F84.0 Childhood autism

F84.01 Childhood autism caused by organic brain disease

F84.02 Childhood autism due to other causes

F84.1 Atypical autism

F84.ll Atypical autism with mental retardation

F84.12 Atypical autism without mental retardation

F84.2 Rett syndrome

F84.3 Other disintegrative disorder of childhood

F84.4 Hyperactive disorder associated with mental retardation and stereotypic movements

F84.5 Asperger's syndrome

F84.8 Other pervasive developmental disorders

F84.9 Pervasive developmental disorder, unspecified

Conditions associated with psychosis, in particular schizophrenia-like, are not classified as RDA.

All classifications are based on etiological or pathogenic principles. But the picture of autistic manifestations is characterized by great polymorphism, which determines the presence of variants with different clinical and psychological pictures, different social adaptation and different social prognosis. These options require a different correctional approach, both therapeutic and psychological-pedagogical.

For milder manifestations of autism, the term parautism is often used. Thus, parautism syndrome can often be observed in Down syndrome. In addition, it can occur in diseases of the central nervous system such as mucopolysaccharidosis, or gargoilism. This disease involves a complex of disorders, including pathology of the connective tissue, central nervous system, visual organs, musculoskeletal system and internal organs. The name “Gargoilism” was given to the disease due to the external resemblance of patients to sculptural images of chimeras. The disease predominates in males. The first signs of the disease appear soon after birth: Trits' rough features, a large skull, a forehead hanging over the face, a wide nose with a sunken bridge of the nose, deformed ears, a high palate, and a large tongue are noteworthy. Characterized by a short neck, torso and limbs, a deformed chest, changes in internal organs: heart defects, enlargement of the abdomen and internal organs - liver and spleen, umbilical and inguinal hernias. Mental retardation of varying severity is combined with defects in vision, hearing and communication disorders such as early childhood autism. Signs of RDA appear selectively and inconsistently and do not determine the main specifics of abnormal development;

Lesch-Nyhan syndrome is a hereditary disease that includes mental retardation, motor disorders in the form of violent movements - choreoathetosis, auto-aggression, spastic cerebral palsy. A characteristic sign of the disease is pronounced behavioral disorders - auto-aggression, when a child can cause serious harm to himself, as well as impaired communication with others;

Ullrich-Noonan syndrome. The syndrome is hereditary and is transmitted as a Mendelian autosomal dominant trait. Manifests itself in the form of a characteristic appearance: anti-Mongoloid eye shape, narrow upper jaw, small lower jaw, low-lying ears, drooping upper eyelids (ptosis). A characteristic feature is the cervical pterygoid fold, short neck, and low stature. The incidence of congenital heart defects and visual defects is characteristic. Changes in the limbs, skeleton, dystrophic, flat nails, pigment spots on the skin are also observed. Intellectual disabilities do not appear in all cases. Despite the fact that children at first glance seem sociable, their behavior can be quite disordered, many of them experience obsessive fears and persistent difficulties in social adaptation;

Rett syndrome is a neuropsychiatric disease that occurs exclusively in girls with a frequency of 1:12500. The disease manifests itself from 12-18 months, when the girl, who had previously developed normally, begins to lose her newly formed speech, motor and object-manipulative skills. A characteristic sign of this condition is the appearance of stereotypical (monotonous) hand movements in the form of rubbing, wringing, and “washing” against the background of loss of purposeful manual skills. The girl’s appearance gradually changes: a peculiar “lifeless” facial expression (“unhappy” face) appears, her gaze is often motionless, directed at one point in front of her. Against the background of general lethargy, attacks of violent laughter are observed, sometimes occurring at night and combined with attacks of impulsive behavior. Seizures may also occur. All these behavioral features of girls resemble behavior with RDA. Most of them have difficulty engaging in verbal communication; their answers are monosyllabic and echolalic. At times, they may experience periods of partial or total loss of verbal communication (mutism). They are also characterized by extremely low mental tone, the responses are impulsive and inadequate, which also resembles children with RDA;

early childhood schizophrenia. In early childhood schizophrenia, the type of continuous course of the disease predominates. However, it is often difficult to determine its onset, since schizophrenia usually occurs against the background of autism. As the disease progresses, the child’s psyche becomes increasingly disordered, the dissociation of all mental processes, and above all thinking, is more clearly manifested, personality changes such as autism and emotional decline and disturbances in mental activity increase. Stereotypic behavior increases, peculiar delusional depersonalizations arise when the child transforms into images of his overvalued fantasies and hobbies, pathological fantasizing arises;

autism in children with cerebral palsy, visually impaired and blind, with a complex defect - deaf-blindness and other developmental disabilities. Manifestations of autism in children with organic damage to the central nervous system are less pronounced and unstable. They retain the need to communicate with others, they do not avoid eye contact, in all cases the most late-forming neuropsychic functions are more insufficient.

With RDA, there is an asynchronous variant of mental development: a child, without mastering basic everyday skills, can demonstrate a sufficient level of psychomotor development in activities that are significant to him.

It is necessary to note the main differences between RDA as a special form of mental dysontogenesis and autism syndrome in the psychoneurological diseases described above and childhood schizophrenia. In the first case, there is a peculiar asynchronous type of mental development, the clinical symptoms of which vary depending on age. In the second case, the characteristics of the child’s mental development are determined by the nature of the underlying disorder; autistic manifestations are often temporary and vary depending on the underlying disease.

FEATURES OF COGNITIVE SPHERE DEVELOPMENT

In general, mental development in RDA is characterized by unevenness. Thus, increased abilities in certain limited areas, such as music, mathematics, painting, can be combined with a profound violation of ordinary life skills. One of the main pathogenic factors determining the development of personality according to the autistic type is a decrease in general vitality. This manifests itself primarily in situations requiring active, selective behavior.

Attention

Lack of general, including mental, tone, combined with increased sensory and emotional sensitivity, causes an extremely low level of active attention. From a very early age, there is a negative reaction or no reaction at all when trying to attract the child’s attention to objects in the surrounding reality. Children suffering from RDA experience severe impairments in the purposefulness and voluntary attention, which interferes with the normal formation of higher mental functions. However, individual bright visual or auditory impressions coming from objects in the surrounding reality can literally fascinate children, which can be used to concentrate the child’s attention. This could be some sound or melody, a shiny object, etc.

Characteristic feature is the strongest mental satiety. The attention of a child with RDA is stable for literally several minutes, and sometimes even seconds. In some cases, satiation can be so strong that the child does not simply

disconnects from the situation, but shows pronounced aggression and tries to destroy what he was just doing with pleasure.

Sensations and perception

Children with RDA are characterized by unique responses to sensory stimuli. This is expressed in increased sensory vulnerability, and at the same time, as a consequence of increased vulnerability, they are characterized by ignoring influences, as well as a significant discrepancy in the nature of reactions caused by social and physical stimuli.

If normally the human face is the most powerful and attractive stimulus, then children with RDA give preference to a variety of objects, while the human face almost instantly causes satiety and a desire to avoid contact.

Peculiarities of perception are observed in 71% of children diagnosed as having RDA (according to K.S. Lebedinskaya, 1992). The first signs of “unusual” behavior in children with RDA that are noticed by parents include paradoxical reactions to sensory stimuli that appear already in the first year of life. Great polarity is found in reactions to objects. Some children have an unusually strong reaction to “novelty,” such as a change in lighting. It is expressed in an extremely sharp form and continues for a long time after the cessation of the stimulus. Many children, on the contrary, were weakly interested in bright objects, they also did not have a reaction of fear or crying to sudden and strong sound stimuli, and at the same time they noted increased sensitivity to weak stimuli: children woke up from a barely audible rustling, fear reactions easily occurred , fear of indifferent and habitual stimuli, for example, working household appliances in the house.

In the perception of a child with RDA, there is also a violation of orientation in space, a distortion of the holistic picture of the real objective world. For them, it is not the object as a whole that is important, but its individual sensory qualities: sounds, shape and texture of objects, their color. Most children have an increased love for music. They are hypersensitive to odors; they examine surrounding objects by sniffing and licking.

Tactile and muscle sensations coming from their own body are of great importance for children. Thus, against the background of constant sensory discomfort, children strive to receive certain activating impressions (swinging their whole body, making monotonous jumps or spinning, enjoying tearing paper or fabric, pouring water or pouring sand, watching fire). With often reduced pain sensitivity, they have a tendency to inflict various injuries on themselves.

Memory and Imagination

From a very early age, children with RDA have good mechanical memory, which creates conditions for preserving traces of emotional experiences. It is emotional memory that stereotypes the perception of the environment: information enters the consciousness of children in whole blocks, is stored without being processed, and is applied in a stereotyped manner, in the context in which it was perceived. Children may repeat the same sounds, words, or ask the same question over and over again. They easily memorize poems, while strictly ensuring that the person reading the poem does not miss a single word or line; the rhythm of the verse, children can begin to sway or compose their own text. Children in this category memorize well, and then monotonously repeat various movements, play actions, sounds, entire stories, and strive to receive familiar sensations coming through all sensory channels: vision, hearing, taste, smell, skin.

Regarding imagination, there are two opposing points of view: according to one of them, defended by L. Kanner, children with RDA have a rich imagination, according to the other, the imagination of these children, if not reduced, is bizarre, has the character of pathological fantasy. The content of autistic fantasies intertwines fairy tales, stories, films and radio programs accidentally heard by the child, fictional and real events. Pathological fantasies of children are characterized by increased brightness and imagery. Often the content of fantasies can have an aggressive connotation. Children can spend hours, every day, for several months, and sometimes several years, telling stories about the dead, skeletons, murders, arson, call themselves a “bandit,” and attribute various vices to themselves.

Pathological fantasy serves as a good basis for the emergence and consolidation of various inadequate fears. This could be, for example, fears of fur hats, certain objects and toys, stairs, withered flowers, strangers. Many children are afraid to walk the streets, fearing, for example, that a car will run into them, they experience a hostile feeling if they happen to get their hands dirty, and they get irritated if water gets on their clothes. They exhibit more pronounced than normal fears of the dark and fear of being left alone in the apartment.

Some children are overly sentimental and often cry when watching certain cartoons.

Speech

Children with RDA have a peculiar attitude towards speech reality and, at the same time, a peculiarity in the development of the expressive side of speech.

When perceiving speech, there is a noticeably reduced (or completely absent) reaction to the speaker. By “ignoring” simple instructions addressed to him, the child may interfere in a conversation that is not addressed to him. The child responds better to quiet, whispered speech.

The first active speech reactions, which manifest themselves in the form of humming in normally developing children, may be delayed, absent, or impoverished in children with RDA, lacking intonation. The same applies to babbling: according to the study, in 11% the babbling phase was absent, in 24% it was weakly expressed, and in 31% there was no babbling reaction to an adult.

Children usually develop their first words early. In 63% of observations these are ordinary words: “mom”, “dad”, “grandfather”, but in 51% of cases they were used without correlation with an adult (K.S. Lebedinskaya, O.S. Nikolskaya). Most children develop phrasal speech from the age of two, usually with clear pronunciation. But children practically do not use it to contact people. They rarely ask questions; if they appear, they are of a recurring nature. At the same time, when alone with themselves, children discover rich speech production: they tell something, read poetry, sing songs. Some demonstrate pronounced verbosity, but despite this, it is very difficult to get an answer to a specific question from such children, their speech does not fit the situation and is not addressed to anyone. Children of the most severe, group 1, according to the classification of K.S. Lebedinskaya and O.S. Nikolskaya, may never master spoken language. Children of the 2nd group are characterized by “telegraphic” speech patterns, echolalia, and the absence of the pronoun “I” (referring to oneself by name or in the third person - “he”, “she”).

The desire to avoid communication, especially using speech, has a negative impact on the prospects for the speech development of children in this category.

Thinking

The level of intellectual development is associated, first of all, with the uniqueness of the affective sphere. They focus on perceptually bright rather than functional features of objects. The emotional component of perception retains its leading importance in RDA even throughout school age. As a result, only part of the signs of the surrounding reality is assimilated, and objective actions are poorly developed.

The development of thinking in such children is associated with overcoming the enormous difficulties of voluntary learning and purposeful resolution of real-life problems. Many experts point to difficulties in symbolization and transfer of skills from one situation to another. It is difficult for such a child to understand the development of a situation over time and to establish cause-and-effect relationships. This is very clearly manifested in the retelling of educational material, when performing tasks related to plot pictures. Within the framework of a stereotypical situation, many autistic children can generalize, use game symbols, and build a program of action. However, they are not able to actively process information, actively use their capabilities in order to adapt to the changing environment, environment, and situation.

At the same time, intellectual disability is not necessary for early childhood autism. Children may show giftedness in certain areas, although the autistic orientation of thinking remains.

When performing intellectual tests, such as the Wechsler test, there is a pronounced disproportion between the level of verbal and non-verbal intelligence in favor of the latter. However low levels performance of tasks related to speech mediation, for the most part, speaks of the child’s reluctance to use speech interaction, and not of a truly low level of development of verbal intelligence.

FEATURES OF PERSONALITY AND EMOTIONAL-VOLITIONAL SPHERE

Violation of the emotional-volitional sphere is the leading symptom of RDA syndrome and can appear soon after birth. Thus, in 100% of observations (K.S. Lebedinskaya) in autism, the earliest system of social interaction with surrounding people, the revitalization complex, sharply lags behind in its formation. This is manifested in the absence of fixation of gaze on a person’s face, a smile and emotional responses in the form of laughter, speech and motor activity to manifestations of attention from an adult. As you grow

The child's weakness of emotional contacts with close adults continues to increase. Children do not ask to be held when in their mother’s arms, do not take an appropriate position, do not cuddle, and remain lethargic and passive. Usually the child distinguishes his parents from other adults, but does not express much affection. They may even experience fear of one of the parents, they may hit or bite, they do everything out of spite. These children lack the characteristic desire for this age to please adults, to earn praise and approval. The words “mom” and “dad” appear later than others and may not correspond to parents. All of the above symptoms are manifestations of one of the primary pathogenic factors of autism, namely a decrease in the threshold of emotional discomfort in contacts with the world. A child with RDA has extremely low endurance in communicating with the world. He gets tired quickly even from have a nice chat, prone to fixation on unpleasant impressions and the formation of fears. K. S. Lebedinskaya and O. S. Nikolskaya identify three groups of fears:

1) typical for childhood in general (fear of losing a mother, as well as situationally determined fears after experiencing a fright);

2) caused by increased sensory and emotional sensitivity of children (fear of household and natural noises, strangers, unfamiliar places);

Fears occupy one of the leading places in the formation of autistic behavior in these children. When establishing contact, it is discovered that many ordinary objects and phenomena (certain toys, household items, the sound of water, wind, etc.), as well as some people, cause a constant feeling of fear in the child. The feeling of fear, which sometimes persists for years, determines the desire of children to preserve their familiar environment and produce various defensive movements and actions that are in the nature of rituals. The slightest changes in the form of rearranging furniture or daily routine cause violent emotional reactions. This phenomenon is called the “identity phenomenon.”

Speaking about the characteristics of behavior with RDA of varying degrees of severity, O. S. Nikolskaya characterizes children of group I as not allowing themselves to experience fear, reacting with care to any impact of great intensity. In contrast, children of the 2nd group are almost constantly in a state of fear. This is reflected in their appearance and behavior: their movements are tense, frozen facial expressions, a sudden cry. Some local fears can be provoked by individual signs of a situation or object that are too intense for the child in terms of their sensory characteristics. Also, local fears can be caused by some kind of danger. The peculiarity of these fears is their rigid fixation - they remain relevant for many years and the specific cause of fears is not always determined. In children of the 3rd group, the causes of fears are determined quite easily; they seem to lie on the surface. Such a child constantly talks about them and includes them in his verbal fantasies. The tendency to master a dangerous situation often manifests itself in such children in the recording of negative experiences from their own experience, the books they read, especially fairy tales. At the same time, the child gets stuck not only on some scary images, but also on individual affective details that slip through the text. Children of the 4th group are fearful, inhibited, and unsure of themselves. They are characterized by generalized anxiety, especially increasing in new situations, when it is necessary to go beyond the usual stereotypical forms of contact, when the level of demands of others in relation to them increases. The most characteristic are fears that grow out of the fear of a negative emotional assessment by others, especially loved ones. Such a child is afraid of doing something wrong, of being “bad,” of not living up to his mother’s expectations.

Along with the above, children with RDA experience a violation of the sense of self-preservation with elements of self-aggression. They can unexpectedly run out onto the roadway, they lack a “sense of edges”, and the experience of dangerous contact with sharp and hot things is poorly consolidated.

All children, without exception, lack a craving for peers and the children's group. When contacting children, they usually experience passive ignoring or active rejection of communication, and lack of response to the name. The child is extremely selective in his social interactions. The constant immersion in internal experiences and the isolation of an autistic child from the outside world hinder the development of his personality. Such a child has extremely limited experience of emotional interaction with other people, he does not know how to empathize, or become infected by the mood of the people around him. All this does not contribute to the formation of adequate moral guidelines in children, in particular the concepts of “good” and “bad” in relation to a communication situation.

FEATURES OF ACTIVITY

Active forms of cognition begin to clearly manifest themselves in normally developing children from the second half of the first year of life. It is from this time that the characteristics of children with RDA become most noticeable, while some of them show general lethargy and inactivity, while others show increased activity: they are attracted by the sensory perceived properties of objects (sound, color, movement), manipulations with them have a stereotypically repetitive nature. Children, grasping objects they come across, do not try to study them by feeling, looking, etc. Actions aimed at mastering specific socially developed ways of using objects do not attract them. In this regard, self-service actions are formed in them slowly and, even when formed, can cause protest in children when trying to stimulate their use.

A game

Children with RDA from an early age are characterized by ignoring toys. Children examine new toys without any desire to manipulate them, or they manipulate selectively, with only one. The greatest pleasure is obtained when manipulating non-game objects that provide a sensory effect (tactile, visual, olfactory). The play of such children is non-communicative; children play alone, in a separate place. The presence of other children is ignored; in rare cases, the child can demonstrate the results of his play. Role play is unstable and can be interrupted by erratic actions, impulsive role changes, which also do not receive their development (V.V. Lebedinsky, A.S. Spivakovskaya, O.L. Ramenskaya). The game is full of auto-dialogues (talking to oneself). There may be fantasy games when the child transforms into other people, animals, or objects. In spontaneous play, a child with RDA, despite being stuck on the same plots and a large number of simply manipulative actions with objects, is able to act purposefully and interestedly. Manipulative games in children of this category persist into older age.

Educational activities

Any voluntary activity in accordance with a set goal poorly regulates the behavior of children. It is difficult for them to distract themselves from immediate impressions, from the positive and negative “valence” of objects, i.e. on what makes them attractive to the child or makes them unpleasant. In addition, autistic attitudes and fears of a child with RDA are the second reason preventing the formation of educational activities

in all its integral components. Depending on the severity of the disorder, a child with RDA can be educated either in an individual education program or in a mass school program. At school there is still isolation from the community; these children do not know how to communicate and have no friends. They are characterized by mood swings and the presence of new fears already associated with school. School activities cause great difficulties; teachers note passivity and inattention in lessons. At home, children perform tasks only under the supervision of their parents, satiety quickly sets in, and interest in the subject is lost. At school age, these children are characterized by an increased desire for “creativity.” They write poems, stories, compose stories in which they are the heroes. A selective attachment appears to those adults who listen to them and do not interfere with their fantasies. Often these are random, unfamiliar people. But there is still no need for active life together with adults, for productive communication with them. Studying at school is not going well educational activities. In any case, special correctional work is required to shape the educational behavior of an autistic child, to develop a kind of “learning stereotype.”

PSYCHOLOGICAL DIAGNOSTICS AND CORRECTION FOR EARLY CHILDHOOD AUTISM

In 1978, M. Rutter formulated the diagnostic criteria for RDA, these are:

special deep violations in social development, manifesting itself without connection with the intellectual level;

delay and disturbances in the development of speech not related to the intellectual level;

the desire for constancy, manifested as stereotypical activities with objects, over-predilection for objects of the surrounding reality, or as resistance to changes in the environment; manifestation of pathology up to 48 months of age. Since children in this category are very selective in communication, the possibility of using experimental psychological techniques limited. The main emphasis should be placed on the analysis of anamnestic data on the characteristics of the child’s development, obtained through a survey of parents and other representatives of the immediate social environment, as well as on monitoring the child in various situations of communication and activity.

Observations of a child according to certain parameters can provide information about his capabilities both in spontaneous behavior and in created interaction situations.

These parameters are:

a more acceptable communication distance for the child;

favorite activities when he is left to his own devices;

methods of examining surrounding objects;

the presence of any stereotypes of everyday skills;

whether speech is used and for what purposes;

behavior in situations of discomfort, fear;

the child’s attitude towards the inclusion of an adult in his activities.

Without determining the level of interaction with the environment that is accessible to a child with RDA, it is impossible to correctly construct the methodology and content of a comprehensive correctional and developmental intervention (Text 2).

An approach to solving the problems of restoring affective connections for such children can be expressed by the following rules.

"!. Initially, in contacts with the child there should be not only pressure, pressure, but even just direct treatment. A child who has a negative experience in contacts should not understand that he is again being drawn into a situation that is habitually unpleasant for him.

2. The first contacts are organized at a level adequate for the child within the framework of the activities in which he is engaged himself.

3. It is necessary, if possible, to include elements of contact in the usual moments of autostimulation of the child with pleasant impressions and thereby create and maintain one’s own positive valence.

4. It is necessary to gradually diversify the child’s usual pleasures, strengthen them with affective contamination of one’s own joy - to prove to the child that it is better to be with a person than without him.

5. The work to restore the child’s need for affective contact can be very long, but it cannot be forced.

6. Only after the child’s need for contact has been consolidated, when an adult becomes for him the positive affective center of the situation, when the child’s spontaneous, explicit appeal to another appears, can one begin to try to complicate the forms of contact.

7. The complication of forms of contact should occur gradually, based on the existing stereotype of interaction. The child must be sure that the forms he has learned will not be destroyed and he will not remain “unarmed” in communication.

8. The complication of contact forms follows the path not so much of offering new variants of it, but of carefully introducing new details into the structure of existing forms.

9. It is necessary to strictly dose affective contacts with the child. Continuing interaction in conditions of mental satiety, when even a pleasant situation becomes uncomfortable for the child, can again extinguish his affective attention to the adult and destroy what has already been achieved.

10. It must be remembered that when an affective connection is achieved with a child, his autistic attitudes are softened, he becomes more vulnerable in contacts and must be especially protected from situations of conflict with loved ones.

11. When establishing affective contact, it is necessary to take into account that this is not the end in itself of all correctional work. The task is to establish affective interaction for joint mastery of the surrounding world. Therefore, as contact with the child is established, his affective attention begins to gradually be directed to the process and result of joint contact with the environment.”

Since most autistic children are characterized by fears, the system of correctional work, as a rule, includes special work to overcome fears. For this purpose, play therapy is used, in particular in the “desensitization” version, i.e. gradual “getting used to” the frightening object (text 3).

“...Establishing contact. Despite the individuality of each child, in the behavior of all children who have undergone play therapy, something common stands out in the first sessions. Children are united by a lack of directed interest in toys, refusal to contact the experimenter, weakening of orientation activity, and fear of a new environment. In this regard, in order to establish contact, it was first of all necessary to create conditions to weaken or relieve anxiety and fear, to instill a sense of security, and to produce stable spontaneous activity at a level accessible to the child. It is necessary to establish contact with the child only in accessible activities.

Methodological techniques used at the first stage of play therapy. Primary importance was attached to the fact that sick children, being unable to communicate at a level normal for their age, showed the preservation of early forms of influence. Therefore, at the first stage of correctional work, these preserved forms of contact were identified, and communication with the child was built on their basis.

Methodological techniques used at the second stage of play therapy. Solving the problems of play therapy at the second stage required the use of different tactics. Now the experimenter, remaining attentive and friendly to the child, was actively involved in his activities, making it clear in every possible way that the best form of behavior in the playroom is joint play with an adult. The experimenter’s efforts at this point in therapy are aimed at trying to reduce disordered active activity, eliminate obsessions, limit egocentric speech production or, conversely, stimulate speech activity. It is especially important to emphasize that the formation of sustainable joint activity was carried out not in a neutral, but in a motivated (even pathological) game. In some cases, the simultaneous use of unstructured material and a personally meaningful toy was effective in creating collaborative and purposeful play with the experimenter. In this case, sand or water stabilized the child's erratic activity, and the plot of the game was built around the child's favorite object. Subsequently, new objects were added to play with attractive toys, and the experimenter encouraged the child to act with them. Thus, the range of objects with which children consistently played expanded. At the same time, a transition was made to more advanced methods of interaction, and verbal contacts were formed.

As a result of play activities, in a number of cases it was possible to significantly change the behavior of children. First of all, this was expressed in the absence of any fear or fear. The children felt natural and free, became active and emotional.”

A specific method that has proven itself to be an effective technique for overcoming the main emotional problems in autism is the so-called “holding therapy” method (from English, hold), developed by the American doctor M. Welsh. The essence of the method is that the mother attracts the child to her, hugs him and holds him tightly, being face to face with him, until the child stops resisting, relaxes and looks into her eyes. The procedure can take up to 1 hour. This method is a kind of impetus to begin interaction with the outside world, reduce anxiety, strengthen the emotional connection between the child and the mother, which is why a psychologist (psychotherapist) should not carry out the holding procedure.

With RDA, to a greater extent than with other deviations, the circle of communication is limited to the family, the influence of which can be both positive and negative. In this regard, one of the central tasks of the psychologist is to assist the family in accepting and understanding the child’s problems, developing approaches to “home correction” as an integral component of the overall plan for the implementation of the correctional and educational program. At the same time, parents of autistic children themselves often need psychotherapeutic help. Thus, the child’s lack of a pronounced desire to communicate, avoidance of eye, tactile and speech contacts can create in the mother a feeling of guilt and uncertainty about the ability to fulfill her maternal role. At the same time, the mother usually acts as the only person through whom the interaction of an autistic child with the outside world is organized. This leads to the formation of increased dependence of the child on the mother, which causes the latter to worry about the possibility of the child’s inclusion in the wider society. Hence the need for special work with parents to develop an adequate, future-oriented strategy for interacting with their own child, taking into account the problems he has at the moment.

An autistic child has to be taught almost everything. The content of classes may include teaching communication and everyday adaptation, school skills, expanding knowledge about the world around us and other people. IN primary school this is reading, natural history, history, then subjects of the humanities and natural sciences. Particularly important for such a child is the study of literature, first children’s, and then classical. What is needed is a slow, careful, emotionally rich mastery of the artistic images of people, circumstances, and logic of their lives contained in these books, awareness of their internal complexity, the ambiguity of internal and external manifestations, and relationships between people. This helps to improve understanding of oneself and others, and reduces the one-dimensionality of autistic children’s perception of the world. The more such a child masters various skills, the more adequate and structurally developed his social role becomes, including school behavior. Despite the importance of all school subjects, educational material delivery programs must be individualized. This is due to the individual and often unusual interests of such children, in some cases their selective talent.

Physical exercise can increase a child's activity and relieve pathological stress. Such a child needs a special individual program of physical development, combining work techniques in a free, playful and clearly structured form. Labor lessons, drawing, singing in younger age They can also do a lot to adapt such a child to school. First of all, it is in these lessons autistic child can get the first impressions that he works together with everyone, understand that his actions have a real result.

American and Belgian specialists have developed a special program for “forming a stereotype of independent activity.” As part of this program, the child learns to organize his activities by receiving hints: using a specially structured educational environment - cards with symbols of a particular type of activity, a schedule of activities in visual and symbolic execution. Experience using similar programs

in different types of educational institutions shows their effectiveness for the development of purposeful activity and independence not only of children with RDA, but also those with other types of dysontogenesis.


Lebedinskaya K. S., Nikolskaya O. S. Diagnosis of early childhood autism. - M., 1991. - P. 39 - 40.

Gilberg K., Peters T. Autism: medical and pedagogical aspects. - St. Petersburg, 1998. - P. 31.

Ethological mechanisms of development are innate, genetically fixed forms of species behavior that provide the necessary basis for survival.

As noted by O.S. Nikolskaya, E.R. Baenskaya, M.M. Liebling, one should not talk about the absence of certain abilities in RDA, for example, the ability to generalize and plan.

For more details, see: Liblipg M.M. Preparation for teaching children with early childhood autism // Defectology. - 1997. - No. 4.

The section uses the experience of GOU No. 1831 in Moscow for children suffering from early childhood autism.

Lebedinsky V.V. Nikolskaya O.V. et al. Emotional disorders in childhood and their correction. - M., 1990. - P. 89-90.

Spivakovskaya A. S. Violations of gaming activity. - M., 1980. - P. 87 - 99.

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 psychotraumatic situation can cause excitement, flight, frenzy or, conversely, numbness (“my legs gave way from fear”) in different people. So, emotions provide the necessary impetus for taking action. Direct conscious planning of behavior and the implementation of behavioral acts is performed by the will.

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

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

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

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

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

8.1. Symptoms of Emotional Disorders

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

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

Hypotymia as a manifestation of strong emotions is classified as a productive psychopathological disorder. This symptom is not specific and can be observed during an exacerbation of any mental illness; it is often found in severe somatic pathology (for example, with malignant tumors), and is also 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 is a characteristic manifestation manic syndrome. The most acute psychoses are expressed by especially strong exalted feelings, reaching the degree ecstasy. This condition may indicate the formation of oneiric stupefaction (see section 10.2.3).

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

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

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

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

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

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

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

Apathy refers to negative (deficit) symptoms. It often serves as a manifestation of final states in schizophrenia. It should be taken into account that apathy in patients with schizophrenia is constantly increasing, going through a number of stages that differ in the degree of severity of the emotional defect: smoothness (leveling) of emotional reactions, emotional coldness, emotional dullness. Another 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 the simultaneous increase in drives and will, as a rule, does not allow patients to commit obviously dangerous and grossly illegal actions, sexual violence. Although such people usually do not pose a danger, they can disturb others with their intrusiveness, fussiness, behave carelessly, and misuse property. Hyperbulia is a characteristic manifestation manic syndrome.

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

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

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

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

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

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

Table 8.1. Clinical variants of impulse disorders

Code according to ICD-10

Name of disorder

Nature of manifestation

Pathological

passion for gambling

games

Pyromania

The desire to commit arson

Kleptomania

Pathological theft

Trichotillomania

The urge to snatch at myself

Pica (pica)

The desire to eat inedible things

» in children

(as a variety, coprofa-

Gia- eating excrement)

Dipsomania

Craving for alcohol

Dromomania

The desire to wander

Homicidomania

A senseless desire to

commit murder

Suicidemania

Suicidal impulse

Oniomania

The urge to shop (often

unnecessary)

Anorexia nervosa

The desire to limit oneself

food, lose weight

Bulimia

Binges of overeating

Transsexualism

The desire to change gender

Transvestism

The desire to wear clothes

opposite sex

Paraphilias,

Sexual predilection disorders

including:

respects

fetishism

Getting sexual pleasure

joy from contemplating before

intimate wardrobe items

exhibitionism

Passion for nudity

voyeurism

Passion for peeping

married

pedophilia

Attraction to minors

in adults

sadomasochism

Achieving sexual pleasure

creation by causing

pain or mental distress

homosexuality

Attraction to one's own person

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

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

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

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

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

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

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

8.3. Syndromes of emotional-volitional disorders

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

8.3.1. Depressive syndrome

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

Manic syndrome

Table 8.2. Symptoms of manic and depressive syndromes

Depressive syndrome

Depressive triad: decreased mood, ideational retardation, motor retardation

Low self-esteem

pessimism

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

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

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

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

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

Manic triad: increased mood, accelerated thinking, psychomotor agitation

High self-esteem, optimism

Delusions of grandeur

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

Sleep disorder: reduced sleep duration without causing tiredness

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

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

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

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

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

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

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

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

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

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

The intensity of emotional experiences, the presence of delusional ideas, and signs of hyperactivity of the autonomic systems allow us to consider depression as a syndrome of productive disorders (see Table 3.1). This is confirmed by the characteristic dynamics 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 wide variety of mental illnesses: manic-depressive psychosis, schizophrenia, organic brain damage and psychogenic disorders. For depression caused by an endogenous disease (MDP and schizophrenia), pronounced somatovegetative disorders are more typical; an important sign of endogenous depression is the special daily dynamics of the state with increased melancholy in the morning and some weakening of feelings in the evening. It is the morning hours that are considered to be the period associated with the greatest risk of suicide. Another marker of endogenous depression is a positive dexamethasone test (see section 1.1.2).

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

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

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

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

8.3.2. Manic syndrome

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

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

An increase in all basic drives is characteristic. Appetite increases sharply, and sometimes there is a tendency to alcoholism. Patients cannot be alone and are constantly looking for communication. When talking with doctors, they do not always maintain the necessary distance, calling simply “brother!” Patients pay a lot of attention to their appearance, try to decorate themselves with badges and medals, women use excessively bright cosmetics, and try to emphasize their sexuality with clothes. Increased interest in the opposite sex is expressed in compliments, immodest proposals, and declarations of love. Patients are ready to help and patronize everyone around them. At the same time, it often turns out that there is simply not enough time for one’s own family. They waste money and make unnecessary purchases. 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. The presence of bright productive symptoms allows us to count on a complete reduction of painful disorders. Although individual attacks can be quite long (up to several months), they are still often shorter than attacks of depression.

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

8.3.3. Apathetic-abulic syndrome

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

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

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

8.4. Physiological and pathological affect

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

Pathological affect is called short-term psychosis, which occurs suddenly after the action of psychological trauma and is accompanied by clouding of consciousness with subsequent amnesia for the entire period of psychosis. The paroxysmal nature of the onset of pathological affect indicates that a psychotraumatic event becomes a trigger for the implementation of existing epileptiform activity. It is not uncommon for patients to have a history of severe head trauma or signs of organic dysfunction from 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.

Emotions are one of the most important aspects of mental activity that characterizes a person’s experience of reality. Lebedinsky and Myasishchev, pointing out that what is essential in defining emotions is their connection with a person’s attitude towards the environment and himself, see in them “an integral expression of the altered tone of neuropsychic activity, affecting all aspects of the human psyche and body.”

One of the leading foreign researchers of emotions, Izard, emphasizes that a holistic definition of emotions requires taking into account three components that characterize this phenomenon: a) the experienced or conscious sensation of emotions; b) processes occurring in the nervous, endocrine, respiratory, digestive and other systems of the body; c) observable expressive complexes of emotions, in particular those reflected on the face. The above emphasizes the interdisciplinary nature of the field that studies emotions, which has attracted the attention of psychologists, neurophysiologists, doctors and other specialists.

A branch of psychology - general and special - that contributed to the intensification of a number of areas in the study of emotions was the area of ​​human expressive manifestations, the relationship between emotions and expression, with access to the study of emotional communication between people (Bodalev et al.). When describing the characteristics of emotional disorders, the consideration of which is important for medical practice, it is advisable to proceed from the grouping of emotions proposed by Myasishchev. In this case, the following are considered separately: 1) emotional reactions, which are characterized by a clear connection between the experiences that have arisen and the sudden circumstances that caused them, 2) emotional states characterized by changes in neuropsychic tone and 3) emotional relationships (feelings) with emotional selectivity or connection of emotions of a certain type with certain persons, objects or processes.

Disorders of the emotional sphere are characteristic of patients with neuroses (F40-F48). Typical for the modern clinic of neuroses are painful emotional and affective reactions and states of fear, decreased mood, etc.

States of fear in neuroses (F40-F48) can be conditionally considered in the form of three main clinical variants: neurotic anxiety, neurotic fear and neurotic phobia. They studied (Nemchin) the reactions of patients to stimuli - words and photographic scenes - of varying degrees of emotional significance for the patient. According to the degree of emotional significance, words and photographs were conditionally divided into three groups: 1) indifferent, the content of which was not included in the system of pathogenic experiences; 2) reflecting the pathogenic experiences of patients and the characteristics of painful symptoms; 3) reflecting the features of a traumatic situation. EEG reactions and GSR were recorded. In a study of patients with neurotic anxiety, electrophysiological reactions were significantly more pronounced to stimuli related to the content of pathogenic experiences and a traumatic situation. Moreover, reactions to stimuli reflecting the content of pathogenic experiences associated with the disease turned out to be especially pronounced. In neurotic fear, similar changes in EEG and GSR were noted. However, changes caused by stimuli related to the content of the fear itself were more pronounced. In patients of the third group with neurotic phobias, the most pronounced and lasting changes were caused by words and photographic scenes reflecting the characteristics of a traumatic situation.

In general, patients with neuroses are characterized by fairly high levels of sensitivity, anxiety, lability of emotions, impulsivity and low levels of frustration tolerance. In accordance with clinical concepts, sensitivity and anxiety are relatively higher in patients with obsessive-compulsive neurosis (F42), lability of emotions and impulsivity - in the group of patients with hysteria (F44).

To an even greater extent to emotional and affective reactions, including pathological nature, prone to persons suffering from psychopathy (F60-F69) (especially hysterical (F60.4), explosive (F60.3), epileptoid (F60.30) clinical forms psychopathy).

In recent decades, numerous studies have been devoted to the study of such emotional states, which are called situations of tension, or stressful situations.

Here we will focus only on frustration, since the number of publications in the domestic literature on this problem is very small.

Frustration is considered as one of the types of mental states, expressed in the characteristic features of experiences and behavior and caused by objectively insurmountable (or subjectively understood) difficulties that arise on the way to achieving a goal or solving a problem (Levitov).

Indicators of frustration in patients with neuroses (F40-F48), with the exception of the intrapunitive direction and the type of reaction “with fixation on self-defense,” are statistically significantly different from those in the control group of healthy individuals (Tarabrina). In patients, the extrapunitive direction of frustration reactions predominates with a lower frequency of impunitive ones, and the type of reactions “with a fixation on meeting needs” dominates, that is, for a patient with neurosis, in a situation of frustration, it is more typical to demand help from another person to resolve it. At the same time, significant differences were observed in the GCR indicator, which was statistically significantly lower in patients with neuroses compared to the healthy control group (48.9 and 64.3, respectively).

Of great importance in diagnostic, treatment and rehabilitation plans is the reduction and dulling of emotionality. In this case, a more or less pronounced indifference towards all phenomena of life is revealed. State of apathy - general emotional decline- occurs in many diseases, but emotional dullness is especially pronounced in schizophrenia (F20-F29). The patient, whose attitude towards family members before the onset of the disease was characterized by love and affection, becomes indifferent to them, loses interest in the environment; the differentiation of emotional reactions is lost, and inadequacy in experiences appears.

Bleicher presents the results of a study of patients with schizophrenia using the “pictogram” method, which makes it possible to clearly characterize the characteristics of their emotionality. The images chosen by patients for indirect memorization turn out to be devoid of emotional content, and their connection with the stimulus word is motivated by patients rationally, taking into account not so much significant as “weak” signs. The author gives the following examples of pictograms of patients with schizophrenia: for the word “sadness” - an expanded book (“In Rockwell Kent’s book there is sadness, doubt, world sorrow”), “heroic deed” - an arrow (“I think about the warriors of antiquity”), etc. d.

When studying patients with schizophrenia using the TAT method, it was noted that they lack a subjective attitude to the content of the drawing, they do not highlight its emotional overtones, there is no experience of the special intimacy of the examination, usually associated with involuntary identification with the characters of the compiled stories, reflecting, for example, in patients with neuroses, conflicts and significant for them situations and relationships. The description of humorous drawings by patients with schizophrenia is of the same nature - humor is either inaccessible to them, or in the plot of the drawing humor is transferred to other, completely inadequate objects. A manifestation of pronounced emotional changes and emotional dullness in an experiment using the Rorschach method is a decrease in color interpretations in patients with schizophrenia.

Using the audit analysis technique, Bazhin and Korneva studied the features of recognition of emotional states by patients with schizophrenia. Patients with schizophrenia with clinically detectable symptoms of emotional decline retain the ability to perceive and correctly interpret the expressive signs of the speaker’s emotional state. In apathetic, lethargic and indifferent patients, sensitivity to emotional stimuli is not only preserved, but in some cases even worsens. The data obtained using the audit analysis technique were confirmed in another work in which the perception of speech and facial expression was simultaneously studied in patients with schizophrenia (F20-F29). The correlation coefficient between the accuracy of recognizing the emotional state of the speaker and identifying facial expressions was 0.5.

Bespalko's work also highlights the limitations of widely held ideas about emotional disorders in schizophrenia and the need for greater differentiation, in particular for the purposes of rehabilitation therapy. The author suggests that of the three types of emotions: emotional reactions, states and relationships - at the onset of the disease, schizophrenia suffers mainly from the phylogenetically most new system emotions - involved in the formation of emotional relationships. It is as a result of this that previously unusual inclinations for the patient appear, distortions of higher ethical feelings, attitudes towards loved ones change, etc. Emotional reactions and emotional states can be considered as less specific in schizophrenia, although they occupy a significant place in their clinical manifestations. To confirm these assumptions, the author cites the results of studies, the purpose of which was to identify the characteristics of the perception of facial expressions by healthy people and patients with schizophrenia. A sharp increase in extreme ratings of facial expressions (based on photographs of different faces) in patients with schizophrenia was accompanied by a parallel increase in extreme ratings in the semantic differential. Since the semantic differential reflects emotional relationships, the characteristics of facial expressions, the author notes, are probably affected by a pathological distortion of emotional relationships, and this secondarily affects the evaluation of facial expressions.

The significance of these works goes beyond the study of the characteristics of emotional disorders in schizophrenia. Covering more general problems of the relationship between expression and emotions, emotional communication, and indirectly the empathic potential of the patient’s personality, they are of interest for the development of psychological and socio-psychological foundations of psychotherapy and rehabilitation.

The studies conducted by Bogatskaya on patients with schizophrenia (F20-F29) with apatho-abulic defect are noteworthy. Using a specially developed psychophysiological technique and the technique of “unfinished sentences,” even in this group of patients with so-called emotional dullness, “emotional islands” were identified in the form of one or more emotionally significant relationships (to work, family, one’s future). It was on these “emotional islands” that psychotherapeutic and sociotherapeutic influences were focused.

An example of a disease in which striking changes in the emotional state are detected is manic-depressive psychosis (F31). During the manic phase, a pathologically elevated, joyful mood is noted - euphoria. The environment is perceived by patients in rainbow, light colors. During the depressive phase, on the contrary, the change in the emotional state has the opposite direction and is characterized as melancholic (depressive). He is characterized by gloomy assessments of what is happening and pessimistic views of the future. In both phases of the disease, changes are also noted cognitive processes, in particular thinking (delusional ideas of revaluation of personality in one phase and ideas of self-accusation, self-abasement, sinfulness in another).

In order to study the influence of the auditor's own affective state on the recognition of emotional characteristics of speech, patients who were in the depressive phase of manic-depressive psychosis were studied. It turned out that the greatest difficulties arose in identifying the condition low mood, while recognition of other emotional states did not change significantly.

Emotional and affective disorders are common in patients with organic brain diseases (F00-F09). Increased irritability and explosiveness are characteristic of persons who have suffered brain injuries (S06); emotional hyperaesthetic weakness and “incontinence of emotions” - with cerebral vascular diseases (I00-I99); irritability, incontinence of affect, euphoria, anxious-fearful or indifferent-depressive mood are observed in various organic diseases of the brain.

Disorders of the emotional-affective sphere in patients with temporal lobe epilepsy (G40) are described. The changes are either paroxysmal or permanent in nature and manifest themselves in the form of fear, anxiety, decreased mood, anger, less often - in the form of pleasant sensations in various organs, a feeling of “insight”, “being in paradise”. In patients with Jacksonian epilepsy (G40), emotional disorders were significantly less pronounced than in patients with lesions of the mediobasal parts of the temporal lobes.

Emotional disturbances in temporal lobe tumors (D43) are similar to those noted in temporal lobe epilepsy. In the vast majority of patients, they were also observed when the tumor was localized in the mediobasal parts of the temporal lobes and, as a rule, were absent when the tumor was located in the superficial parts of the temporal lobe.

Thus, the presented data confirm the known ideas about the role of the mediobasal parts of the temporal lobes in the genesis of emotional disorders.

As an example of adequate planning and conduct of experimental psychological studies of the emotional and affective sphere of patients in a somatic clinic, aimed at studying the internal picture of the disease, increasing the effectiveness of psychotherapeutic and psychohygienic measures, we can cite the works of Zaitsev and his colleagues, in which an associative experiment was used. Using the technique of free verbal associations, in some patients with myocardial infarction (I21), associative complexes were identified, indicating the presence of a psychological dominant, reflecting ideas about the disease and its possible unfavorable outcome. Disorders in the emotional and affective sphere characteristic of patients with myocardial infarction were reflected in emotionally rich associations and in the readiness to produce verbal associative complexes with affective overtones. Thus, from the words “wounded, dead, grave,” associated with the theme of the war years, the patient moved to the complex “morgue, hospital, heart attack, death.” This complex indicated his existing psychological dominant, reflecting the characteristics of the internal picture of the disease. It is of interest that in all patients with myocardial infarction, in whom similar associative complexes were identified before treatment, they disappeared under the influence of therapeutic and rehabilitation interventions. In the healthy control group, during the same experiment, semantic associations of ordinary content were noted.

The pathology of the volitional sphere is represented by strengthening, weakening, absence and distortion of volitional activity.

1. Hyperbulia– painfully increased volitional activity. Patients exhibit a painfully relieved determination in which any idea is immediately implemented, the possibility of proper discussion is reduced, and actions are hasty. Hyperbulia is a characteristic symptom of manic syndrome. In addition, delusional patients can detect hyperbulia when realizing their delusional ideas.

2. Hypobulia– a painful decrease in will, in which the strength of motives and drives is reduced, and it is difficult to determine and maintain any goal. Patients do nothing, are lethargic, passive, sit for a long time or lie in one position with an indifferent expression on their face. The extreme degree of hypobulia is called abulia(lack of will) and is manifested by a lack of motivation, loss of desires, complete indifference and inactivity, an almost complete limitation of communication.. Decreased will is often combined with impoverishment of emotions (up to apathy) and determines the clinic apatoabulic syndrome (for example, schizophrenia). Abulia also occurs when senile psychoses, depression, asthenia.

3. Parabulia– perversion of the will, represented by various catatonic symptoms:

· stupor– general motor retardation, numbness, accompanied by loss of any contact with others;

· mutism– loss of speech contact with others while maintaining the speech apparatus, unmotivated refusal to speak;

· negativism– senseless opposition, an unmotivated refusal of the patient to perform any action, sometimes in the form of the opposite action (active negativism);

· stereotypies- constant, monotonous, monotonous repetition of any action (motor stereotypies) or rhythmic, monotonous repetition of any word, phrase, sometimes meaningless name of similar-sounding phrases, words or syllables (speech stereotypies - verbigeration);

· passive submission– the patient cannot resist the orders of others and completely carries them out, regardless of the content;

· echopraxia– the patient completely repeats all the actions of another person;

· echolalia– repetition in whole or in part of the speech of others, while the patient answers a question addressed to him by repeating the question or last words question;

· catalepsy(waxy flexibility) - manifests itself in an increase in muscle tone (this phenomenon develops gradually, starting with the muscles of the neck, shoulders and then covers the whole body), as a result of which the patient’s body can maintain its given position for a long time, even if the position is extremely uncomfortable. The patient himself does not make any movements, but does not resist changing his position and freezes in it for a long time.

Syndromes of impaired will.

Catatonia– a symptom complex of mental disorders in which movement disorders predominate in the form akinesis(catatonic stupor) or in the form hyperkinesis(catatonic excitement).

For catatonic stupor characterized by the presence of increased muscle tone, which develops as if from top to bottom (masticatory muscles, cervical and occipital muscles, then the muscles of the shoulders, forearms, hands and, last of all, the muscles of the legs). Hypertonicity may appear as stupor or in the form waxy flexibility (catalepsy). In addition, with catatonic stupor, negativism, mutism, passive submission.

In accordance with the severity and predominance of certain movement disorders There are several types of catatonic stupor, which can replace each other:

A) stupor with waxy flexibility;

b) negativistic stupor;

V) stupor with muscle numbness.

For catatonic excitement characteristically, devoid of internal unity and purposefulness, increased motor activity, with a desire for movement(as opposed to the desire for action with manic syndrome), against the background of which symptoms such as stereotypies, echo symptoms, paramimia, negativism, passing speech. May be accompanied by pathos, ecstasy, anger, rage, indifference. As a type of psychomotor agitation, it poses a danger both to oneself and to others (including medical staff).

Depending on the predominance of certain disorders, several varieties are distinguished, which represent successive stages of the development of catatonic excitation:

1. confused-pathetic excitement with exaltation, delight, pathos in behavior and speech;

2. hebephrenic-catatonic with antics, grimacing, ridiculous antics, rude and cynical jokes, mood swings (from gaiety to anger);

3. impulsively e excitement in the form of sudden active actions, often aggressive (they beat others, tear clothes, break objects, expose themselves, smear themselves with feces, etc.). It may be “mute” or with shouts and swearing;

4. frantic catatonic excitement is accompanied by continuous disorderly and chaotic throwing. More often “mute”.

Stupor and excitement can appear in isolation, but they can also replace each other.

In cases where consciousness remains unclouded, catatonia is called lucid. With this option, catatonia can be in the form of a monosyndrome, or it can be combined with delusions (catatonic-delusional syndrome), hallucinations (catatonic-hallucinatory syndrome), and affective (catatonic-depressive syndrome) disorders. Among states of stupefaction, catatonia is usually accompanied by oneiric stupor ( oneiric catatonia).Catatonic syndrome most often occurs in schizophrenia.

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