The classification of emotional disorders is presented in table. 2.5.
Feeling tone disorders:
- emotional hyperesthesia - a violation of the sensory tone, in which sensations and perceptions of ordinary strength are accompanied by an inappropriately heightened emotional coloring. Occurs when the threshold of emotional response is lowered and is usually combined with sensory hyperesthesia;
- emotional hypesthesia - a violation of the sensory tone, in which sensations and perceptions of normal strength are accompanied by an inadequately weakened emotional coloring. Occurs when the threshold of emotional response increases. It is observed in derealization and depersonalization disorders.
Table 25
Classification of emotional disorders
|
Feeling tone disorders |
Emotional hyperesthesia. |
|
|
Emotional hypesthesia |
||
|
Hypotymia |
||
|
Hyperthymia |
||
|
Complacency. |
||
|
Anger |
||
|
Parathymia |
Ambivalence. |
|
|
Emotional inadequacy. |
||
|
Wood and glass syndrome |
||
|
Negative emotional |
Emotional dullness. |
|
|
disorders |
Mental anesthesia |
|
|
Disturbances in the dynamics of emotions |
Emotional lability. |
|
|
Weakness. |
||
|
Inertia (rigidity) of emotions |
||
Hypotymia- decreased mood of various shades.
Types of hypothymia:
- yearning - emotional state with a predominance of depression and depression. Melancholy, accompanied by characteristic painful sensations of compression, painful tightness behind the sternum, in the region of the heart, is called precordial (vital). Included in the structure of depressive, neurotic syndromes, dysphoria, etc.;
- anxiety- an emotional state or reaction characterized by internal excitement, anxiety, tension, localized in the chest. Accompanied by a premonition and fearful expectation of impending disaster, pessimistic fears directed towards the future. Unlike melancholy, anxiety is an activating affect. Included in the structure of neurotic, anxious-depressive, delusional syndromes and clouding of consciousness;
- fear - an emotional state or reaction of high intensity, the content of which is concerns about one’s well-being or life. Included in the structure of phobic, delusional syndromes, acute hallucinosis, clouding of consciousness, etc.
Hyperthymia- elevated mood of various shades.
Types of hyperthymia:
- euphoria- an emotional state with a predominant feeling of joy, “radiance,” “sunshine” of being with an increased desire for activity. Included in the structure of manic syndromes, alcohol intoxication, etc.;
- complacency - an emotional state with a tinge of contentment, carelessness without the desire for activity. In pathology, it can be observed in mental disorders associated with organic diseases of the brain;
- ecstasy - an emotional state with the highest elation, exaltation, often with a mystical tinge of experience. Included in the structure of the syndrome special conditions consciousness, atypical manic syndrome, etc.;
- anger - the highest degree of irritability, anger, dissatisfaction with others with a tendency to aggression and destructive actions. Included in the structure of dysphoria, psychoorganic, atypical manic syndromes.
Parathymia- paradoxical, perverted emotionality, meaningful discrepancy between affective reactions and their stimuli.
Types of parathymia:
- ambivalence- the coexistence of two opposing emotional assessments in relation to the same fact, object, event, emotional ambiguity, internal splitting of attitudes towards something or someone, the experience of antagonistic emotional reactions;
- emotional inadequacy- paradoxicality, inconsistency of the emotional reaction with the stimulus (for example, negative emotions to events that are usually considered as joyful, favorable);
- symptom « wood and glass" - combination of emotional impoverishment and dullness with selective hypersensitivity, vulnerability, “fragility” of feelings.
Negative emotional disorders:
- mental anesthesia - a decrease or complete loss of emotional response to the environment, accompanied by a feeling of mental emptiness, a painful experience of lack of emotional responsiveness, inner emptiness, and insensitivity. Occurs mainly when depressive disorders;
- emotional dullness - insensitivity, indifference, complete emotional devastation (“paralysis of emotions”) with the disappearance of adequate emotional reactions.
Disturbances in the dynamics of emotions:
- emotional lability - emotional instability, rapid and frequent changes in the polarity of emotions that arise without sufficient reason, sometimes for no reason. Characteristic of asthenic, hysterical, withdrawal syndromes;
- weakness - emotional incontinence, difficulties in controlling external manifestations of emotional reactions. Marked when neurotic disorders, asthenia, organic brain lesions;
- emotional inertia (rigidity) - a tendency towards a protracted emotional reaction, manifested by affective stuckness, “viscosity” of emotions. Included in the structure of personality changes in epilepsy and organic brain lesions.
8. Emotional disorders (apathy, euphoria, dysphoria, weakness, inadequacy of emotions, ambivalence, pathological effect).
Emotions- sensual coloring of all mental acts, people’s experience of their relationship to the environment and themselves.
1. Euphoria– elevated mood with endless self-satisfaction, serenity, slowing down of thinking. Ecstasy- an experience of delight and unusual happiness.
2. Dysphoria- sad-angry mood with increased sensitivity to external stimuli, with bitterness, explosiveness, and a tendency to violence.
3. Incontinence of emotions (weakness)- decreased ability to correct external manifestations of emotions (patients are touched, cry, even if it is unpleasant for them, characteristic of cerebral atherosclerosis)
4. Apathy (emotional dullness)– complete indifference to everything, nothing arouses interest or emotional response (with dementia, schizophrenia).
5. Inadequacy of emotions- inadequate affect, paradoxical emotions; the emotional reaction does not correspond to the occasion that caused it (the patient laughs when talking about the death of a relative)
6. Emotional ambivalence- duality, dissociation of emotions (in schizophrenia)
7. Pathological affect - occurs in connection with mental trauma; accompanied by twilight gloom consciousness, delusional, hallucinatory disorders, inappropriate behavior appear, serious offenses are possible; lasts minutes, ends with sleep, complete prostration, expressed by vegetation; the period of impaired consciousness is amnesic.
9. Depressed and manic syndromes. Somatic symptoms affective disorders.
Manic syndrome - characterized by a triad of symptoms: 1) sharply elevated mood with increased positive emotions, 2) increased motor activity, 3) accelerated thinking. Patients are animated, carefree, laugh, sing, dance, are full of bright hopes, overestimate their abilities, dress pretentiously, and make jokes. It is observed during the manic phase of manic-depressive psychosis.
Basic diagnostic symptoms in a manic state:
A) elevated (expansive) mood: a state of high spirits, often contagious, and an exaggerated sense of physical and emotional well-being, disproportionate to the circumstances of the individual's life
b) increased physical activity : manifests itself in restlessness, moving around, aimless movements, inability to sit or stand still.
V) increased talkativeness: the patient speaks too much, quickly, often in a loud voice, and there are unnecessary words in his speech.
G) distractibility: Trivial events and stimuli that do not normally attract attention capture the individual's attention and render him/her unable to sustain attention on anything.
d) decreased need for sleep: some patients go to bed in the early hours of midnight, wake up early, feeling rested after short nap, and are eager to start the next day full of activity.
e) sexual incontinence: behavior in which an individual makes sexual overtures or acts out of line social restrictions or taking into account prevailing social conventions.
and) reckless, reckless or irresponsible behavior: behavior in which an individual engages in extravagant or impractical ventures, spends money recklessly, or undertakes questionable ventures without realizing their riskiness.
h) increased sociability and familiarity: loss of a sense of distance and loss of normal social restrictions, expressed in increased sociability and extreme familiarity.
And) leap of ideas: a disordered form of thinking, subjectively manifested as a “pressure of thoughts.” Speech is fast, without pauses, loses its purpose and wanders far from the original topic. Often uses rhymes and puns.
To) hypertrophied self-esteem: exaggerated ideas of one's own capabilities, possessions, greatness, superiority, or self-worth.
Depressive syndrome - a pronounced decrease in mood with increased negative emotions, slowness of motor activity and slower thinking. The patient's health is poor, he is overcome by sadness, sadness, and melancholy. The patient lies or sits in one position all day long, does not spontaneously engage in conversation, associations are slow, answers are monosyllabic, and are often given very late. The thoughts are gloomy, heavy, there is no hope for the future. Melancholy is experienced as an extremely painful, physical sensation in the heart area. Facial expressions are mournful, inhibited. Thoughts about worthlessness and inferiority are typical; overvalued ideas of self-blame or delusions of guilt and sinfulness may arise with the appearance of suicidal thoughts and tendencies. It may be accompanied by the phenomenon of painful mental anesthesia - painful insensibility, internal devastation, disappearance of the emotional response to the environment. For depressive syndrome characterized by pronounced somatovegetative disorders in the form of sleep disturbances, appetite, constipation, tachycardia, mydriasis; patients lose weight, endocrine functions are upset. Depression within reactive psychoses and neuroses, with some infectious and vascular psychoses.
Main diagnostic symptoms of depression:
1) depressed mood: low mood, expressed by sadness, suffering, discouragement, inability to enjoy anything, gloominess, depression, a feeling of despondency, etc.
2) loss of interests: Decreased or lost interests or feelings of pleasure in normally enjoyable activities.
3) loss of energy: feeling tired, weak or exhausted; a feeling of loss of ability to get up and walk or loss of energy. Starting a business, physical or intellectual, seems especially difficult or even impossible.
4) loss of self-confidence and self-esteem: loss of faith in one's own abilities and qualifications, a feeling of embarrassment and failure in matters that depend on self-confidence, especially in social relationships, a feeling of inferiority in relation to others and even of little value.
5) unreasonable self-reproach or guilt: excessive preoccupation with some past action that causes painful sensation, inadequate and uncontrollable. An individual may curse himself for some minor failure or mistake that most people would not take seriously. He realizes that the guilt is exaggerated or that this feeling lasts too long, but he cannot do anything about it.
6) suicidal thoughts or behavior: Persistent thoughts about harming oneself, with persistent thinking or planning of ways to do so.
7) difficulty thinking or concentrating: inability to think clearly. The patient is worried and complains that his/her brain is less efficient than normal. He/she is unable to make easy decisions even on simple issues, being unable to simultaneously hold the necessary pieces of information in his/her mind. Difficulty concentrating is the inability to focus thoughts or pay attention to those objects that require it.
8) sleep disorders: sleep pattern disturbances that may manifest as:
periods of awakening between the initial and final periods of sleep,
early awakening after a period of night sleep, i.e. the individual does not fall asleep again after this,
disturbance of the sleep-wake cycle - the individual stays awake almost all night and sleeps during the day,
Hypersomnia is a condition in which the duration of sleep is at least two hours longer than usual, representing a certain change in the usual sleep pattern.
10) loss of the ability to experience pleasure (anhedonia): Loss of the ability to derive pleasure from previously enjoyable activities. Often the individual is not capable of anticipating pleasure.
11) worsening depression in the morning: Low or depressed mood that is more pronounced earlier in the day. As the day progresses, depression decreases.
12) frequent crying: Frequent periods of crying for no apparent reason.
13) pessimism about the future: A bleak view of the future regardless of actual circumstances.
Triad of depression : decreased mood, intelligence, motor skills.
Cognitive triad of depression: 1) destructive assessment of one’s own personality 2) negative assessment of the outside world 3) negative assessment of the future.
10. Impaired attention function.
Attention- orientation and concentration of the psyche on certain objects and phenomena, ensuring their clear reflection.
A) hyperprosexia- strengthening, sharpening attention; a person concentrates quickly, works quickly; attention span does not change or decreases (in hypomanic state)
b) aprosexia - various options reduced attention:
1. attention fatigue- at the beginning of the activity, the patient mobilizes attention, begins to work productively, but performance quickly decreases, attention is depleted due to fatigue, and is distracted; patients often complain of poor memory (with asthenic syndrome)
2. distractibility- excessive mobility, constant transition from one object and type of activity to another (in a manic state, in this case combined with accelerated thinking)
3. one-sided attentional fixation (pathological fixation)- possible with overvalued obsessive delusional ideas, accompanied by emotional involvement or due to inertia of mental functions in patients with epilepsy, organic brain lesions; patients often seem absent-minded, do not notice what is happening around them, being in the sphere of ideas that are relevant to them
4. dulling of attention- characterized by an increase in passive attention and a decrease in active attention, but is combined with a volitional defect and is part of the structure of the apathetic-abulic syndrome (with schizophrenia in the defect stage, deep degrees of dementia). connection with inertia of mental functions in patients with epilepsy, organic lesions
11. Memory impairment. Amnestic (Korsakovsky) syndrome.
Memory - mental process, which consists in remembering, storing and subsequently reproducing or recognizing what was previously perceived, experienced or done.
Hypermnesia- strengthening of memory in a painful state for events of the past (for example, in a hypomanic state, a person can remember events that seem to have been long forgotten).
Memory loss is manifested by deterioration in the registration, storage and reproduction of new information.
Hypomnesia- weakening of memory.
Amnesia- loss of a more or less significant number of memories from memory.
A) retrograde– amnesia extends to events preceding the disease, which at one time were well learned
b) anterograde– amnesia extends to events related to the period of illness that caused memory impairment.
V) anterograde
G) fixation amnesia- memory impairment mainly for current events, inability to learn
Paramnesia- qualitative memory disorders:
A) polysests– the impossibility of fully reproducing in consciousness the details associated with alcohol intoxication, differ from amnesia by forgetting the final scenes of alcoholic excesses (with amnesia, everything falls out)
b) pseudoreminiscence– a really existing episode is shifted and a recent event is filled with it
V) confabulation– a person invents something and fills a gap in memory (with severe dementia)
G) cryptomnesia- a memory disorder in which a person, having read or heard something interesting, forgets about the origin and source of this information and, over time, gives out this information as coming from him personally
d) progressive amnesia– loss of the ability to remember and gradual depletion of memory (the first to be forgotten are latest events, and events relating to a distant period of time remain relatively intact in memory - Ribot's law)
Korsakov's amnestic syndrome- a combination of fixation amnesia with paramnesia, impaired concentration. May be observed with cerebral atherosclerosis, consequences of trauma, or as a leading syndrome within the framework of Korsakov psychosis (alcoholic encephalopathy, in which memory and intelligence impairments are combined with peripheral polyneuritis).
Clinical characteristics of Korsakoff syndrome:
Severe memory impairment for recent events, the ability to assimilate is severely affected new information and operate with it (fixation amnesia), direct reproduction is preserved
Long-term memory is usually relatively well retained
Confabulation
Difficulty concentrating, time disorientation
12. Pathology of drives and instincts.
Will- purposeful mental activity to overcome obstacles. The source of volitional activity is higher and lower needs.
1. Abulia- lack of will, almost complete absence motivation to activity, passivity, reduction of needs, especially higher ones. Usually combined with apathy (with schizophrenia, dementia).
2. Hypobulia- decreased will (with depression, schizophrenia)
3. Hyperbulia - increased activity, excessive activity (with mania)
4. Parabulia– perversion of volitional activity, which accompanies:
A) stupor- immobility, numbness; accompanied by changes in muscle tone, mutism (speech failure); can be psychogenic, with catatonic form of schizophrenia, exogenous hazards
b) catalepsy- waxy flexibility; often combined with stupor; the patient freezes for a long time in an uncomfortable position assigned to him or independently adopted (for example, a mental air cushion)
V) negativism- causeless negative attitude to something; can be active (the patient actively resists the instructions, for example, clenching his mouth when trying to look at the tongue) and passive (does not follow the instructions without offering active resistance).
G) impulsiveness- unmotivated unexpected actions, often with aggression; occur without conscious control when deep violations mental activity; sudden, senseless, take over the mind and subordinate all the patient’s behavior.
d) mannerism- peculiar pretentiousness, unnaturalness voluntary movements, speech, writing, clothing (for schizophrenia)
5. Excitement syndromes
A) manic excitement- manic triad (acceleration of thinking and speech, physical activity, elevated mood). Speech and motor skills are expressive and directed towards a common goal.
b) catatonic agitation- a large number of stereotypies of speech and movements, dissociation between speech and motor skills, purposeful activity
V) epileptiform agitation- accompanied by twilight disorder consciousness, saturated with negative affect, anger, fear, hallucinatory and delusional experiences, a tendency to destructive and aggressive actions
6. Sexual instinct disorders (increase, decrease, perversion)
A) transsexualism: desire to live and be accepted as a member of the opposite sex
b) double role transvestism: wearing clothes of the opposite sex for the temporary experience of belonging to the opposite sex in the absence of any sexual motivation for cross-dressing
V) fetishism– a fetish (some non-living object) is the most important source of sexual stimulation or is necessary for a satisfactory sexual response
G) exhibitionism- an intermittent or constant tendency to suddenly show one's genitals strangers(usually of the opposite sex), which is usually accompanied by sexual arousal and masturbation.
d) voyeurism- an occasional or persistent tendency to peek at people during sexual or intimate activities, such as dressing, which is combined with sexual arousal and masturbation.
e) pedophilia- preference for sexual activity with a child or children of puberty.
and) sadomasochism- preference for sexual activity as a recipient (masochism) or vice versa (sadism), or both, which includes pain, humiliation, and the establishment of dependence.
And) sadomy- sexual attraction to animals
To) gerantophilia- sexual attraction to elderly and senile people
k) necrophilia- the role of the fetish is played by a dead human body
m) excrementophilia- human excretions play the role of a fetish
7.Disturbance of the food instinct
A) bulimia (polyphagia)- insatiable appetite
b) anorexia– decreased food instinct, sometimes nervous – desire to lose weight, mental – loss of hunger
V) polydipsia- unquenchable thirst
G) perversions of the food instinct(geophagy, coprophagy)
8. Violation of the instinct of self-preservation:
A) promotion- anxiety for one’s life, fear of death, often manifested obsessive fears, overvalued and delusional hypochondriacal ideas
b) demotion- indifference, indifference when life is threatened, apathy, loss of a sense of the value of life, expressed in suicidal thoughts and actions
V) perversions(self-harm, suicidal tendencies)
9. Other pathological desires:
A) dipsomania– binge drinking, an irresistible desire to drink, in between there is no desire for alcohol
b) dromomania– periodically arising desire to wander
V) kleptomania- to theft
G) pyromania– to arson (without the desire to cause evil and damage)
13. Speech disorders.
Speech disorders are divided into 2 groups:
a) speech disorders associated with gross organic brain lesions (alalia, aphasia, scanned speech, slurred speech, explosive speech, dysarthria)
b) speech disorders caused by primary mental disorders
1. Oligophasia- reduction in vocabulary in speech
2. Mutism- speech failure
3. Torn Speech- violation of semantic connections between members of a sentence while maintaining the grammatical structure of the phrase; at earlier stages of the disease, it may manifest itself in a violation of semantic connections not within a sentence, but in the process of narration between phrases that individually have a complete semantic content.
4. Neologisms- words that are not in the usual dictionary, created by the patient himself and do not have a generally accepted meaning
5. Perseveration
6. Stuttering(can be organic)
14. Thinking disorders (accelerated and slow, reasoning, thoroughness, ambivalence, autistic thinking, fragmented thinking).
Thinking- the process of learning the general properties of objects and phenomena, connections and relationships between them; knowledge of reality in a generalized form, in movement and variability. Closely related to speech pathology.
1. Violations of the pace of the associative process.
A) acceleration of thinking- speech production concisely reflects the content of thinking, logical constructions bypass intermediate links, the narrative deviates along the side chain, a jump of ideas (in manic states) or mentism (an influx of thoughts that occurs against the will of the patient) is characteristic (in schizophrenia).
b) slow thinking- for depressive, apathetic, asthenic conditions and mild degrees of clouding of consciousness.
2. Violation of the associative process for harmony .
A) fragmentation– violation of semantic connections between members of a sentence while maintaining the grammatical structure of the phrase.
b) stopping, blocking thoughts (sperrung)- sudden loss of thoughts (in schizophrenia).
V) incoherent thinking- a disorder of speech and thinking, in which the main features are a violation of the grammatical structure of speech, inexplicable transitions from topic to topic and loss of logical connection between parts of speech.
G) incoherence- manifests itself not only in a violation of the semantic aspect of speech, but also in the collapse of the syntactic structure of a sentence (with disorders of consciousness in the structure of amentia syndrome).
d) verbigeration- peculiar stereotypies in speech, reaching in some cases to the point of meaningless stringing together of words that are similar in consonance.
e). paralogical thinking– the emergence of a different system, peculiar only to this patient logical constructions. Combined with neologisms- words that are not in the usual dictionary, created by the patient himself and do not have a generally accepted meaning.
3. Violation of purposeful thinking.
A) pathological thoroughness - when narrating events, the patient gets stuck in the details, which occupy an increasing place in the main line of the narrative, distracting the patient from a consistent chain of presentation, making his story excessively long.
b) perseveration- painful repetition of one word or group of words, despite the patient’s desire to move on to another topic and the doctor’s attempts to introduce new stimuli.
V) reasoning- tendency to fruitless reasoning. The patient uses declarative statements and provides unsubstantiated evidence.
G) symbolism– the patient puts a special meaning into certain signs, drawings, colors, understandable only to him.
d) autistic thinking- characterized by a separation from the surrounding reality, immersion in the world of imagination, fantastic experiences.
e) ambivalence- simultaneous emergence and coexistence of directly opposite, mutually exclusive thoughts.
Pathology of judgments:
A) obsessions - intrusive thoughts, doubts, memories, ideas, desires, fears, actions that arise in the human mind involuntarily and interfere with the normal flow thought process. Patients understand their uselessness, painfulness and try to get rid of them.
1) abstract - not causing a strong emotional coloring
2) figurative - with painful, emotionally negatively colored experiences
3) phobic - obsessive fears.
b) super valuable ideas- affectively rich, persistent beliefs and ideas that capture consciousness entirely and for a long time. They are closely related to reality and reflect the patient’s personal assessments and his aspirations; their content is not absurd, and they are not alien to the individual. The pathological nature of overvalued ideas lies not in their content, but in the exorbitant big place, which they occupy in mental life, the excessive importance given to them.
V) dominant ideas– thoughts related to the real situation, prevailing in a person’s consciousness for a certain period of time and preventing concentration on the current activity.
G) delusional ideas- false conclusions associated with disorders of the will, drives, emotional disturbances. They are characterized by a lack of tendency to systematize, a short duration of existence and the possibility of partial correction through dissuade.
Emotions(from Latin emoveo, emotum - excite, excite) - reactions in the form of subjectively colored experiences of the individual, reflecting the significance for him of the influencing stimulus or the result of his own action (pleasure, displeasure).
Highlight epicritic emotions, cortical, inherent only to humans, phylogenetically younger (these include aesthetic, ethical, moral) and protopathic emotions, subcortical, thalamic, phylogenetically more ancient, elementary (satisfaction of hunger, thirst, sexual feelings).
Exist positive emotions, that arise when needs are met are the experience of joy, inspiration, satisfaction and negative emotions, in which difficulty in achieving a goal, grief, anxiety, irritation, and anger are experienced.
In addition, they were identified (E. Kant) sthenic emotions, aimed at vigorous activity, struggle, promoting the mobilization of forces to achieve the goal, and asthenic, causing decreased activity, uncertainty, doubt, inactivity.
Affect is usually understood as a short-term strong emotional disturbance, which is accompanied not only by an emotional reaction, but also by the excitement of all mental activity.
Highlight physiological affect, for example, anger or joy, not accompanied by confusion, automatisms and amnesia. Asthenic affect- quickly depleted affect, accompanied by depressed mood, decreased mental activity, well-being and vitality.
Thenic affect characterized by increased well-being, mental activity, and a sense of personal strength.
Pathological affect- a short-term mental disorder that occurs in response to intense, sudden mental trauma and is expressed in the concentration of consciousness on traumatic experiences, followed by an affective discharge, followed by general relaxation, indifference and often deep sleep; characterized by partial or complete amnesia.
In some cases, pathological affect is preceded by a long-term psychotraumatic situation and the pathological affect itself arises as a reaction to some kind of “last straw”.
Mood is a more or less prolonged emotional state.
The phylogeny of feelings (according to Ribot) is characterized by the following stages:
Stage 1 - protoplasmic (pre-conscious), at this stage feelings are expressed in changes in tissue irritability;
Stage 2 - needs; during this period, the first signs of experiencing pleasure and displeasure appear;
3rd stage - so-called primitive emotions; these include emotions of an organic nature; pain, anger, sexual feeling;
Stage 4 - abstract emotions (moral, intellectual, ethical, aesthetic).
Emotional response disorders
Emotional response - acute emotional reactions that arise in response to various situations. Unlike changes in mood, emotional forms of response are short-term and do not always correspond to the main background of the mood.
Emotional disorders are characterized by an inappropriate emotional response to external events. Emotional reactions may be inadequate in terms of strength and severity, duration and significance of the situation that caused them.
Explosiveness- increased emotional excitability, a tendency to violent manifestations of affect, an inadequate reaction in strength. A reaction of anger with aggression can arise over a minor issue.
Emotionally Stuck- a state in which the emerging affective reaction is fixed for a long time and affects thoughts and behavior. The resentment experienced “sticks” for a long time with a vindictive person. A person who has internalized certain dogmas that are emotionally significant to him cannot accept new attitudes, despite the changed situation.
Ambivalence- the emergence of simultaneously opposite feelings towards the same person.
Feeling lost- loss of the ability to react to current events, painful insensibility, for example, with psychogenic “emotional paralysis.”
Symptoms of Mood Disorders
Mood is understood as the prevailing emotional state for a certain period, influencing all mental activity.
Mood disorders are characterized by two variants: symptoms with increased and decreased emotionality. Disorders with increased emotionality include hyperthymia, euphoria, hypothymia, dysphoria, anxiety, and emotional weakness.
Hyperthymia- an increased cheerful, joyful mood, accompanied by a surge of vigor, good, even excellent physical well-being, ease in solving all issues, and overestimation of one’s own capabilities.
Euphoria- a complacent, carefree, carefree mood, the experience of complete satisfaction with one’s condition, insufficient assessment of current events.
Hypotymia- low mood, feelings of depression, melancholy, hopelessness. Attention is fixed only on negative events; the present, past and future are perceived in gloomy tones.
Dysphoria- an angry-sad mood with a feeling of dissatisfaction with oneself and others. Often accompanied by pronounced affective reactions of anger, rage with aggression, despair with suicidal tendencies.
Anxiety- experiencing internal anxiety, expecting trouble, misfortune, catastrophe. Feelings of anxiety may be accompanied motor restlessness, vegetative reactions. Anxiety can develop into panic, in which patients rush around, do not find a place for themselves, or freeze in horror, expecting a catastrophe.
Emotional weakness- lability, instability of mood, its change under the influence of minor events. Patients can easily experience states of tenderness, sentimentality with the appearance of tearfulness (weakness). For example, when seeing pioneers walking, a person cannot hold back tears of tenderness.
Painful mental insensibility(anaesthesia psychica dolorosa). Patients painfully experience the loss of all human feelings - love for loved ones, compassion, grief, melancholy. They say that they have become “like a tree, like a stone”, they suffer from this, they claim that melancholy is easier, since it contains human experiences.
All of these symptoms indicate an increased emotional state, regardless of whether these emotions are positive or negative.
Mood disorders with decreased emotionality include conditions such as apathy, emotional monotony, emotional coarseness, and emotional dullness.
Apathy(from the Greek apatia - insensibility; synonyms: anormia, antinormia, painful indifference) - a disorder of the emotional-volitional sphere, manifested by indifference to oneself, surrounding persons and events, lack of desires, motives and complete inactivity. Patients in this state do not show any interests, do not express any desires, are not interested in those around them, often do not know the names of their roommates or the attending physician - not because of memory impairment, but because of indifference. On dates with loved ones, they silently take gifts and leave.
Emotional monotony- emotional coldness. The patient has an even, cold attitude towards all events, regardless of their emotional significance.
Emotional rawness. It manifests itself in the loss of the most subtle differentiated emotional reactions: delicacy and empathy disappear, disinhibition, importunity, and unceremoniousness appear. Such conditions can be observed in alcoholism and atherosclerotic personality changes.
Emotional or affective stupidity- a disorder characterized by weakness of emotional reactions and contacts, impoverishment of feelings, emotional coldness, turning into complete indifference and indifference. Such patients are indifferent and cold towards close people, they are not touched by the illness or death of their parents, and sometimes grossly selfish interests remain.
Hypermia- a disorder accompanied by lively, rapidly changing facial expressions, reflecting a picture of quickly appearing and disappearing affects. The manifestation of facial reactions is often exaggerated, excessively violent and bright. Expressive actions are intensified, accelerated, and quickly change, reaching in some cases manic excitement.
Amimia, hypomimia- weakening, impoverishment of facial expressions, monotonous frozen facial expressions of grief, despair, characteristic of depressive states. There is a frozen mournful expression on the face, the lips are tightly compressed, the corners of the mouth are lowered, the eyebrows are knitted, and there are folds between them. Characteristic fold of Veragut: skin fold upper eyelid at the border of the inner third it is pulled upward and backward, due to which the arc turns into an angle in this place.
Expressive movements are weakened, slowed down, blurred. Sometimes motor activity is completely lost, patients become immobilized, but mournful facial expressions remain. This is a picture of a depressive stupor.
Paramimia- inadequacy of facial expressions and expressive actions of the situation. In some cases, this is expressed in the appearance of a smile at a funeral, tears and grimaces, crying during solemn and pleasant events. In other cases, facial reactions do not correspond to any experiences - these are various grimaces. For example, the patient closes his eyes and opens his mouth, wrinkles his forehead, puffs out his cheeks, etc.
Emotions- these are physiological states of the body that have a pronounced subjective coloring and cover all types of human feelings and experiences - from deeply traumatic suffering to high forms of joy and social sense of life.
Highlight:
epicritic, cortical, inherent only to humans, phylogenetically younger (these include aesthetic, ethical, moral).
protopathic emotions, subcortical, thalamic, phylogenetically more ancient, elementary (satisfaction of hunger, thirst, sexual feelings).
positive emotions that arise when needs are met are the experience of joy, inspiration, and satisfaction.
negative emotions in which difficulty in achieving a goal, grief, anxiety, irritation, and anger are experienced.
sthenic emotions aimed at vigorous activity, struggle, promoting the mobilization of forces to achieve a goal.
asthenic, causing decreased activity, uncertainty, doubt, inactivity.
Affect - short-term strong emotional excitement, which is accompanied not only by an emotional reaction, but also by the excitement of all mental activity. In some cases, pathological affect is preceded by a long-term psychotraumatic situation and the pathological affect itself arises as a reaction to some kind of “last straw”.
Highlight:
physiological affect - in response to an adequate stimulus, a violent emotional and motor reaction develops, not accompanied by a disturbance of consciousness and subsequent amnesia.
pathological affect - in response to an inadequate, weak stimulus, a violent emotional and motor reaction develops, accompanied by a disturbance of consciousness with subsequent amnesia. Affect may be followed by general relaxation and often deep sleep, upon awakening from which the deed is perceived as alien.
Clinical example: “A man who had suffered a head injury in the past, in response to a harmless remark from his boss about the fact that he smoked too much, suddenly jumped up, threw chairs with such force that one of them literally fell apart, and then rushed with his face twisted with anger at the person who made the remark and began to choke him. The employees who ran up with great difficulty pulled him away from the boss. After this pathological condition passed, I didn’t remember anything that happened to him during this period.”
Mood- a more or less prolonged emotional state.
Pathology of emotions.
Mania- mental disorder, accompanied by a feeling of joy, lightness, high mood and an affect of anger.
increased mood with a feeling of joy that patients infect others with, and an affect of anger.
acceleration of thinking (can reach a “jump of ideas”)
increased speech motor activity
May be accompanied by overvalued ideas of overestimating one’s own personality or delusional ideas of grandeur.
The state of full-blown mania is unproductive. There is absolutely no criticism of one's condition. Mild cases are called hypomania, and we can talk about a rather productive state.
Clinical example: “A 20-year-old patient, barely noticing a group of students, rushes towards them, instantly gets to know everyone, jokes, laughs, offers to sing, teach dancing, and jokingly introduces all the patients around him: “This is a giant of thought, twice two doesn’t know how many, but this one is Baron Munchausen, an extraordinary liar,” etc. He quickly gets distracted to give guidelines to the nannies, who, in his opinion, are doing the cleaning of the premises incorrectly. Then, jumping on one leg and dancing, he returns to the group of students, offering to test their knowledge in all sciences. He speaks very quickly in a hoarse voice, often not finishing his thoughts, jumps to another subject, and sometimes rhymes words.”
There are several variants of manic syndrome.
cheerful mania - most characteristic of manic-depressive psychosis (increased optimistic mood with moderate speech motor agitation)
angry mania (elevated mood, pickiness, dissatisfaction, irritation)
mania with foolishness, in which an elevated mood with motor and speech excitement is accompanied by mannerisms, childishness, and a tendency to make ridiculous jokes
Confused mania (elevated mood, incoherent speech, and erratic motor agitation).
Manic rampage - excitement with anger, rage, destructive tendencies, aggression.
Delusional manic states - development against the background of a manic state of delirium, hallucinations, signs of mental automatism without clouding of consciousness.
Manic states with foolishness - elevated mood, a tendency to make ridiculous and flat jokes, grimaces, a tendency to commit ridiculous acts. Possible crazy ideas, verbal hallucinations, mental automatisms.
Manic states with the development of acute sensory delirium - pathos, exaltation, verbosity. With the development of acute sensory delirium, a staging occurs with a change in the perception of the environment, with the feeling that a performance is being played out, in which the patient plays the main role.
Moria– elevated mood with elements of clowning, foolishness, a tendency to make flat jokes, i.e. motor excitement. Always with elements of reduced criticism and intellectual deficiency (with organic damage to the frontal lobes).
Euphoria- a complacent, carefree, carefree mood, the experience of complete satisfaction with one’s condition, insufficient assessment of current events. Unlike mania, the last 2 components of the triad (states of alcoholic, drug intoxication, organic diseases of the brain, somatic diseases - tuberculosis) are absent.
Explosiveness- increased emotional excitability, a tendency to violent manifestations of affect, an inadequate reaction in strength. A reaction of anger with aggression can arise over a minor issue.
Emotionally Stuck- a state in which the emerging affective reaction is fixed on long time and influences thoughts and behavior. The resentment experienced “sticks” for a long time with a vindictive person. A person who has internalized certain dogmas that are emotionally significant for him cannot accept new attitudes, despite the changed situation (epilepsy).
Ambivalence (double feelings)-simultaneous coexistence of two opposing emotions, combined with ambivalence (in schizophrenia, hysterical disorders: neurosis, psychopathy).
Weakness (incontinence of affect)– slight tenderness, sentimentality, incontinence of emotions, tearfulness (vascular diseases of the brain).
Dysphoria- an angry-sad mood with a feeling of dissatisfaction with oneself and others, often with aggressive tendencies. Often accompanied by pronounced affective reactions of anger, rage with aggression, despair with suicidal tendencies (epilepsy, traumatic brain disease, abstinence in alcoholics, drug addicts).
Anxiety- experiencing internal anxiety, expecting trouble, misfortune, catastrophe. Feelings of anxiety may be accompanied by motor restlessness and autonomic reactions. Anxiety can develop into panic, in which patients rush around, do not find a place for themselves, or freeze in horror, expecting a catastrophe.
Emotional weakness- lability, instability of mood, its change under the influence of minor events. Patients can easily experience states of tenderness, sentimentality with the appearance of tearfulness (weakness).
Painful mental insensibility(anaesthesia psychica dolorosa) - patients painfully experience the loss of all human feelings - love for loved ones, compassion, grief, melancholy.
Apathy(from the Greek apatia - insensibility; synonyms: anormia, antinormia, painful indifference) - a disorder of the emotional-volitional sphere, manifested by indifference to oneself, surrounding persons and events, lack of desires, motivations and complete inactivity (schizophrenia, organic lesions of the brain - trauma, atrophic processes with phenomena of aspontaneity).
Emotional monotony- the patient has an even, cold attitude towards all events, regardless of their emotional significance. There is no adequate emotional resonance.
Emotional coldness– events that are significant in the normal state are perceived as a fact.
Emotional callousness- manifests itself in the loss of the most subtle differentiated emotional reactions: delicacy and empathy disappear, disinhibition, importunity, and impudence appear (organic lesions of the brain, schizophrenia).
Clinical example: “A patient suffering from schizophrenia for many years lies in bed all day, not showing any interest in anything. She remains just as indifferent when her parents visit her, and did not react in any way to the message about the death of her older sister. She perks up only when she hears the clink of dishes being set out from the dining room or sees a bag of food in the hands of visitors, and she no longer reacts to what kind of home-cooked food was brought to her, but in what quantity.”
Depression- a mental disorder accompanied by low mood, feelings of melancholy, anxiety and a pronounced affect of fear.
low mood with a feeling of depression, depression, melancholy and an affect of fear
slow thinking
slower speech activity
Depending on the severity of the components of the triad at the 1st pole there will be depressive stupor with the most pronounced motor, ideational inhibition, and on the 2nd - depressive/melancholic raptus with melancholy, anxiety, suicidal attempts. These states can easily transform into each other.
Clinical example: “The patient sits motionless on the bed, head down, arms dangling helplessly. The expression on his face is sad, his gaze is fixed on one point. He answers questions in monosyllables, after a long pause, in a barely audible voice. She complains that she doesn’t have any thoughts in her head for hours.”
By depth:
Psychotic level - lack of criticism, the presence of delusional ideas of self-accusation, self-deprecation.
Neurotic level – criticism remains, delusional ideas of self-accusation and self-deprecation are absent
By origin:
Endogenous – occurs spontaneously (autochthonous), characterized by seasonality (spring-autumn), daily mood fluctuations (emphasis on the first half of the day). One of the extreme manifestations of severity is mental anesthesia (painful mental insensibility).
Reactive – occurs as a result of a super-strong psychotraumatic factor. The peculiarity is that the structure always contains the situation that led to this disorder.
Involutional – occurs during the period of age-related reverse development, more often in women. According to the clinical picture, this is anxious depression.
Somatogenic – occurs as a result of somatic suffering.
Masked(somatized, larved) – somatovegetative masks of depressive disorders come to the fore.
Emotions - mental processes in which a person experiences his attitude to certain phenomena environment and to yourself. Concepts with which pathological emotions and volitional disorders, include mood, affect, passion, ecstasy.
Mood - a certain emotional background, long-term, that determines the setting for the emergence of certain positive or negative emotions.
Affect - strong short-term emotion, explosion of emotions. Affect within normal limits is called physiological.
Passion - a strong, lasting feeling that directs human activity.
Ecstasy - a strong positive emotion (delight, bliss) that captures the entire personality at the moment of action of a certain stimulus.
Emotional disorders conditionally divided into quantitative and qualitative.
Quantitative violations emotions:
1. sensitivity - emotional hyperesthesia, heightened feelings, emotional vulnerability; found in asthenic conditions, sometimes as a personality trait;
2. weakness - incontinence of emotions in the form of tearfulness and tenderness; often occurs in atherosclerosis of cerebral vessels, in asthenic conditions;
3. lability of emotions - instability of mood, when for a minor reason its polarity changes, for example, with hysteria, with vivid expression ( external manifestation) each transition;
4. explosiveness - emotional explosiveness, when emotions with anger, recklessness, anger and even aggression arise for an insignificant reason; occurs with organic lesions of the temporal lobe, with an explosive form of psychopathy;
5. apathy - indifference, emotional emptiness, “paralysis” of emotions; with a long course and insufficient awareness, it develops into emotional dullness.
Qualitative violations emotions:
1. pathological affect - differs from physiological affect by clouding of consciousness, inadequacy of actions with frequent aggression, pronounced vegetative manifestations, amnesia for what was committed in this state and subsequent severe asthenia. Pathological affect refers to exceptional states - states that exclude sanity.
2. dysphoria – sad-angry mood with excessive irritability, which usually occurs with epilepsy and organic diseases of the brain, is characterized by duration (hours, days), great conflict and often aggressive behavior.
3. depression - pathologically depressed mood, usually for a long time; characterized by sadness, anxiety, suicidal thoughts and actions. There is a “depressive triad”: depression as a symptom, slow thinking with ideas of self-deprecation and psychomotor retardation(to the point of numbness - stupor). Somatic manifestations depression - Protopopov's triad: tachycardia, mydriasis, constipation.
Clinical forms depression:
- Agitated (anxious)
- Delusional with guilt and nihilistic delirium (before the delirium of Qatar)
- Hypochondriacal
- Anergic (lack of strength and energy)
- Anesthetic (before depersonalization)
- Grumpy (sullen)
- Apathetic (with a severe feeling of emptiness)
- Asthenic (tearful)
- Masked (erased).
4.euphoria - inappropriately elevated mood, characterized by good nature, serenity and cheerfulness. Euphoria is typical organic diseases brain with localization in the frontal lobe. A complicated type of euphoria with stupid behavior, foolishness and a penchant for flat jokes, wit is called "moria".
5.mania - the opposite syndrome of depression: elevated mood, accelerated thinking and psychomotor disinhibition. With manic excitement, there is an abundance and rapid change of desires, fussy activity, incompleteness of actions, verbosity to the point of a “jump of ideas,” and increased distractibility.
6.parathymia - perversion of emotions that arise in violation of the patterns of emotional response. These include:
· emotional inadequacy when the patient develops an emotion, the nature of which does not correspond and even is opposite to the psychological situation;
· emotional ambivalence- duality, the simultaneous occurrence of opposing emotions. Both disorders are typical of schizophrenia.
