Psychopathological syndromes
Relevance of the topic: One of the most important stages of diagnosis in psychiatry is the establishment of the leading psychopathological syndrome. The ability to correctly qualify symptoms of mental disorders allows for timely prescription of emergency therapy, as well as further diagnostic and therapeutic measures.
common goal: learn to identify the leading syndrome of mental disorders and provide adequate assistance to patients.
Theoretical questions:
1. Borderline non-psychotic syndromes, asthenic, neurotic (neurasthenic, obsessive-phobic, dysmorphophobic, hysterical), depressive, hypochondriacal, somatoform.
2. Psychotic syndromes: depressive, manic, paranoid, paranoid, dysmorphomanic, catatonic, hebephrenic, delirious, oneiric, amengic, asthenic confusion, twilight state of consciousness, hallucinosis.
3. Defective organic syndromes: psychoorganic, Korsakov amnestic, mental retardation, dementia, mental insanity.
4. Main psychopathological syndromes childhood: neuropathy, childhood autism, hyperdynamic, childhood pathological fears, anorexia nervosa, infantilism.
5. The importance of diagnosing a psychopathological syndrome for choosing a method
emergency treatment and further examination of the patient.
Psychopathological syndrome is a more or less stable set of pathogenetically related symptoms. Definition of the syndrome (syndromological diagnosis) is the initial stage of the diagnostic process, which is of great practical importance.
There are different classifications of syndromes: according to the predominant damage to one or another mental function, according to the depth of damage to the personality.
Classification of psychopathological syndromes according to predominant damage to certain mental functions
1. Syndromes with a predominance of disorders of sensations and perceptions.
Hallucinosis syndrome (verbal, tactile, visual).
Syndromes of derealization and depersonalization.
2. Syndromes with a predominance of mnestic disorders
Korsakoff's amnestic syndrome.
3. Syndromes with a predominance of thinking disorders.
Paranoid syndrome (hallucinatory-paranoid, Kandinsky-Clerambault, hypochondriacal, dysmorphomanic, etc.);
Paranoid;
Paraphrenic;
4. Syndromes with a predominance of intellectual impairment.
Infantilism syndrome;
Psychoorganic (encephalopathic) syndrome;
Oligophrenic syndrome;
Dementia syndrome.
5. Syndromes with a predominance of emotional and effector-volitional disorders.
Neurotic (asthenic and neurasthenic, hysterical, obsession syndrome);
Psychopathic-like;
Apatico-abulic;
Hebephrenic;
Catatonic.
6. Syndromes with a predominance of disturbances of consciousness.
Non-psychotic syndromes (fainting, stupor, stupor, coma)
Psychotic syndromes (delirious; oneiric; amentive; twilight state of consciousness)
Classification of psychopathological syndromes depending on the depth of personality damage.
I. Non-psychotic borderline syndromes:
1. Asthenic (astheno-neurotic, astheno-depressive, astheno-hypochondriacal, astheno-abulic).
2. Apatico-abulic.
3. Neurotic and neurosis-like (neurasthenic, syndrome obsessive states, dysmorphophobic, depressive-hypochondriacal).
4. Psychopathic and psychopath-like.
II. Psychotic syndromes:
1. Syndromes of confusion:
1. asthenic confusion;
2. confusion syndrome;
3. delirious;
4. amentive;
5. oneiroid;
6. twilight state of consciousness.
2. Depressive (psychotic variant);
3. Hallucinosis syndrome (verbal, tactile, visual);
4. Manic;
5. Paranoid (including hallucinatory-paranoid, hypochondriacal, dysmorphomanic, Kandinsky-Clerambault syndrome of mental automatism);
6. Paranoid;
7. Paraphrenic;
8. Hebephrenic;
9. Catatonic.
Sh. Organic defect syndromes:
1. Psychoorganic (explosive, apathetic, euphoric, asthenic options);
2. Korsakovsky amnestic;
3. Mental retardation;
4. Dementia (total and lacunar).
Psychopathological symptom represents a single clinical sign of mental disorder. Psychopathological syndrome is a set of pathogenetically related symptoms.
Asthenic syndrome(Greek a-absence, steno - strength) manifests itself in pronounced physical And mental fatigue that occurs after minor exertion. Patients find it difficult to concentrate and therefore have trouble remembering. Emotional incontinence, lability, and increased sensitivity to sounds, light, and colors appear. The pace of thinking slows down, patients experience difficulty solving complex intellectual problems.
At astheno-neurotic states, the described phenomena of asthenia are accompanied by short temper, increased irritability, tearfulness, and moodiness.
At astheno-depressive states, the phenomena of asthenia are combined with low mood.
At astheno-hypochondriacal - asthenic symptoms are combined with increased attention to their physical health, patients attach great importance various unpleasant sensations coming from the internal organs. They often have thoughts about the presence of some incurable disease.
At astheno-abulic syndrome, patients, starting any work, get tired so quickly that they practically cannot complete even the simplest tasks and become practically inactive.
Asthenic syndrome in various variants it occurs in all somatic, exogenous-organic, and psychogenic diseases.
Neurotic syndrome- a symptom complex that includes phenomena of instability of the emotional, volitional and effector spheres with increased mental and physical exhaustion, with a critical attitude towards one’s condition and behavior
Depending on the personality characteristics, neurotic syndrome can be neurasthenic, hysterical and psychasthenic in nature.
Neurasthenic syndrome(irritable weakness syndrome) is characterized, on the one hand, by increased excitability, incontinence of affect, a tendency to violent affective reactions with volitional instability, on the other hand by increased exhaustion, tearfulness, and lack of will.
Hysterical syndrome- characterized by increased emotional excitability, theatrical behavior, a tendency to fantasize and deceit, to violent affective reactions, hysterical attacks, functional paralysis and paresis, etc.
Obsessive syndrome (obsessive syndrome)- manifested by obsessive thoughts, phobias, obsessive desires and actions. Obsession phenomena usually arise suddenly and do not correspond to the content of the patient’s thoughts at the moment; the patient is critical of them and struggles with them.
Obsession syndrome occurs in neuroses, somatic, exogenous-organic diseases of the brain.
Body dysmorphic syndrome- patients overestimate the importance of their physical disabilities, actively seek help from specialists, and demand cosmetic surgery. Most often it occurs during puberty due to a psychogenic mechanism. For example, if teenagers are convinced that they have overweight, they severely limit themselves in food (mental anorskia).
Depressive-hypochondriacal syndrome- characterized by the appearance of thoughts in the patient O the presence of any serious, even incurable, disease, which is accompanied by a melancholy mood. Such patients persistently seek help from doctors, require various examinations, and prescription of drug therapy.
Psychopathic-like syndrome- a symptom complex of emotional and effector-volitional disorders that are more or less persistent in nature and determine the main type neuropsychic response and behavior that is usually insufficiently adequate to the real situation. Includes increased emotional excitability, inadequacy of voluntary actions and deeds, increased subordination to instinctive drives.
Depending on the characteristics of the type of higher nervous activity and the conditions of upbringing, it can have an asthenic, hysterical, psychasthenic, excitable, paranoid or schizoid character. It is the basis of various forms of psychopathy and psychopathic states of organic and other origin. Often accompanied by sexual and other perversions.
Delirious syndrome(from Latin delirium - madness) - hallucinatory clouding of consciousness with a predominance of true visual hallucinations, visual illusions, figurative delirium, motor excitation while maintaining self-awareness.
Amentive syndrome- severe confusion of consciousness with incoherent thinking, complete inaccessibility to contact, disorientation, abrupt deceptions of perception and signs of severe physical exhaustion.
Oneiric clouding of consciousness. Distinguished by the extreme fantastic nature of psychotic experiences. Characterized by duality, inconsistency of experiences and actions taken, a feeling of global changes in the world, catastrophe and triumph at the same time.
Depressive syndrome characterized depressive triad: depressed, sad, melancholy mood, slow thinking and motor retardation.
Manic syndrome- X characteristic manic triad: euphoria (inappropriately elevated mood), acceleration of associative processes and motor excitation with a desire for activity.
Hallucinatory syndrome (hallucinosis) - an influx of abundant hallucinations (verbal, visual, tactile) against the background of clear consciousness, lasting from 1-2 weeks (acute hallucinosis) to several years (chronic hallucinosis). Hallucinosis may be accompanied by affective disorders (anxiety, fear), as well as delusional ideas. Hallucinosis is observed in alcoholism, schizophrenia, epilepsy, organic brain lesions, including syphilitic etiology.
Paranoid syndrome- characterized by the presence of unsystematized delusional ideas of various contents in combination with hallucinations and pseudohallucinations. Kandinsky-Clerambault syndrome is a type of paranoid syndrome and is characterized by the phenomena mental automatism, i.e. feelings that someone is directing the patient’s thoughts and actions, the presence pseudohallucinations, most often auditory, delusional ideas influence, mentalism, symptoms of openness of thoughts (the feeling that the patient’s thoughts are accessible to people around him) and nesting of thoughts(the feeling that the patient’s thoughts are alien, transmitted to him).
Paranoid syndrome characterized by the presence of a systematic delirium, in the absence of disturbances of perception and mental automatisms. Delusional ideas are based on real facts, but the ability of patients to explain logical connections between the phenomena of reality suffers; facts are selected one-sidedly, in accordance with the plot of the delusion.
Paraphrenic syndrome - combination of systematized or unsystematized delirium with mental automatisms, verbal hallucinations, confabulatory experiences of fantastic content, and a tendency to increase mood.
Body dysmorphomania syndrome characterized by a triad of symptoms: delusional ideas of physical disability, delusional attitude, low mood. Patients actively strive to correct their shortcomings. When they are denied surgery, they sometimes try to change the shape of their ugly body parts. It is observed in schizophrenia.
Catatonic syndrome- manifests itself in the form of catatonic, absurd and senseless excitement or stupor, or periodic changes in these states. It is observed in schizophrenia, infectious and other psychoses.
Hebephrenic syndrome- a combination of hebephrenic excitement with foolishness and fragmented thinking. It is observed mainly in schizophrenia.
Apathetic-abulic syndrome- a combination of indifference, indifference (apathy) and absence or weakening of incentives to activity (abulia). It is observed in debilitating somatic diseases, after traumatic brain injuries, intoxication, and schizophrenia.
Psychoorganic syndrome- characterized by mild intellectual impairments. Patients have reduced attention and fixation memory, they have difficulty remembering events about their lives and well-known historical events. The pace of thinking slows down. Patients experience difficulties in acquiring new knowledge and skills. There is either a leveling of personality or a sharpening of character traits. Depending on which emotional reactions predominate, there are explosive version - patients exhibit explosiveness, rudeness, and aggressiveness; euphoric version (inappropriate cheerfulness, carelessness), apathetic option (indifference). Partial reversibility is possible, more often there is a gradual worsening and development of dementia syndrome. Characteristic of exogenous organic brain lesions.
Korsakov's amnestic syndrome-includes memory impairment for current events (fixational amnesia), retro- and anterograde amnesia, pseudoreminiscences, confabulations, and amnestic disorientation.
Dementia - persistent decline in intelligence level. There are two types of dementia - congenital (oligophrenia) and acquired (dementia).
Acquired dementia is caused by schizophrenia, epilepsy, as well as organic diseases in which atrophic processes occur in the brain (syphilitic and senile psychoses, vascular or inflammatory diseases of the brain, severe traumatic brain injury).
Confusion syndrome characterized by a misunderstanding of what is happening, underthinking of the questions asked, and not always adequate answers. The expression on the patients' faces is confused and perplexed. They often ask questions: “what is this?”, “why?”, “why?”. Occurs when coming out of a coma, as well as when paranoid syndrome.
Frontal syndrome - a combination of signs of total dementia with spontaneity, or vice versa - with general disinhibition. It is observed in organic diseases of the brain with predominant damage to the frontal parts of the brain - tumors, head injury, Pick's disease.
APATHY (indifference). At the initial stages of the development of apathy, there is a slight weakening of hobbies; the patient reads or watches TV mechanically. In case of psycho-affective indifference, during questioning he expresses relevant complaints. With a shallow emotional decline, for example in schizophrenia, the patient calmly reacts to events of an exciting, unpleasant nature, although in general the patient is not indifferent to external events.
In a number of cases, the patient’s facial expressions are impoverished, he is not interested in events that do not concern him personally, and almost does not participate in entertainment. Some patients are little affected even by their own situation and family affairs. Sometimes there are complaints about “stupidity”, “indifference”. The extreme degree of apathy is characterized by complete indifference. The patient's facial expression is indifferent, there is indifference to everything, including his appearance and cleanliness of his body, to his stay in the hospital, to the appearance of relatives.
ASTHENIA (increased fatigue). With minor symptoms, fatigue occurs more often with increased load, usually in the afternoon. In more pronounced cases, even with relatively simple types of activity, a feeling of fatigue, weakness, and an objective deterioration in the quality and pace of work quickly appear; rest doesn't help much. Asthenia is noticeable at the end of a conversation with a doctor (for example, the patient talks sluggishly, tries to quickly lie down or lean on something). Among vegetative disorders, excessive sweating and pallor of the face predominate. Extreme degrees of asthenia are characterized by severe weakness up to prostration. Any activity, movement, short-term conversation is tiring. Rest doesn't help.
AFFECTIVE DISORDERS characterized by instability (lability) of mood, a change in affect towards depression (depression) or elevation (manic state). At the same time, the level of intellectual and motor activity changes, and various somatic equivalents of the condition are observed.
Affective lability (increased emotional reactivity). With unexpressed disorders, the range of situations and reasons in connection with which affect arises or mood changes are somewhat expanded compared to the individual norm, but these are still quite intense emotiogenic factors (for example, actual failures). Typically, affect (anger, despair, resentment) occurs rarely and its intensity largely corresponds to the situation that caused it. With more severe affective disorders, mood often changes for minor and varied reasons. The intensity of the disorders does not correspond to the real significance of psychogenicity. In this case, affects can become significant, arise for completely insignificant reasons or without a perceptible external reason, change several times within a short time, which makes goal-directed activity extremely difficult.
Depression. With minor depressive disorders, the patient sometimes develops a noticeably sad expression on his face and sad intonations in conversation, but at the same time his facial expressions are quite varied and his speech is modulated. The patient manages to be distracted and cheered up. There are complaints of “feeling sad” or “lack of cheerfulness” and “boredom.” Most often, the patient is aware of the connection between his condition and traumatic influences. Pessimistic experiences are usually limited conflict situation. There is some overestimation of real difficulties, but the patient hopes for a favorable resolution of the situation. A critical attitude towards the disease has been maintained. With a decrease in psycho-traumatic influences, the mood normalizes.
As depressive symptoms worsen, facial expressions become more monotonous: not only the face, but also the posture expresses despondency (shoulders are often slumped, the gaze is directed into space or down). There may be sad sighs, tearfulness, a pitiful, guilty smile. The patient complains of a depressed, “decadent” mood, lethargy, and unpleasant sensations in the body. He considers his situation gloomy and does not notice anything positive in it. It is almost impossible to distract and cheer up the patient.
With severe depression, a “mask of grief” is observed on the patient’s face; the face is elongated, grayish-cyanotic in color, the lips and tongue are dry, the gaze is suffering, expressive, there are usually no tears, blinking is rare, sometimes the eyes are half-closed, the corners of the mouth are downturned, the lips are often compressed. Speech is not modulated, up to an unintelligible whisper or silent lip movements. The pose is hunched over, with head down, knees together. Raptoid states are also possible: the patient groans, sobs, rushes about, tends to self-harm, and breaks his arms. Complaints of “unbearable melancholy” or “despair” predominate. He considers his situation hopeless, hopeless, hopeless, his existence unbearable.
A special type of depression is the so-called hidden (masked, larved) or somatized depression. With its development in patients observed primarily in general somatic institutions, against the background of a slight change in affect, various somatovegetative (viscerovegetative) disorders develop, simulating various diseases of organs and systems. At the same time, depressive disorders themselves fade into the background, and the patients themselves, in most cases, object to the assessment of their condition as " depression". A somatic examination in these cases does not reveal significant disorders that could explain the patient’s persistent and massive complaints. By excluding one or another prolonged somatic suffering, taking into account the phasic course of somatovegetative disorders (including diurnal fluctuations with a significant deterioration in the condition in the morning ), by identifying hidden, atypical anxiety and depression using clinical and psychodiagnostic studies, and most importantly, by observing the effect when prescribing an antidepressant, one can make a final conclusion about the presence of hidden depression.
Manic state. With the development of a manic state, a barely noticeable elation of mood appears at first, in particular the revival of facial expressions. The patient notes vigor, tirelessness, wellness, “is in excellent shape,” somewhat underestimates the real difficulties. Subsequently, there is a clear revival of facial expressions, the patient smiles, his eyes sparkle, he is often prone to humor and witticisms, in some cases he states that he feels a “special surge of strength”, “rejuvenated”, is unreasonably optimistic, considers events with an unfavorable meaning to be trivial, all difficulties - easily overcome. The pose is relaxed, there are excessively sweeping gestures, and sometimes a raised tone slips into the conversation.
In a pronounced manic state, generalized, non-targeted motor and ideational excitation occurs, with extreme expression of affect - to the point of frenzy. The face often turns red and the voice becomes hoarse, but the patient notes “unusually good health.”
DELUSIONAL SYNDROMES. Rave- a false, but not amenable to logical correction, belief or judgment that does not correspond to reality, as well as to the social and cultural attitudes of the patient. Delusions must be differentiated from delusional ideas that characterize erroneous judgments expressed with excessive persistence. Delusional disorders are characteristic of many mental illnesses; as a rule, they are combined with other mental disorders, forming complex psychopathological syndromes. Depending on the plot, delusions of relation and persecution are distinguished (the patient’s pathological belief that he is a victim of persecution), grandeur (the belief in a high, divine purpose and special personal importance), changes in one’s own body (the belief in physical, often bizarre changes in body parts ), appearance serious illness(hypochondriacal delusion, in which, on the basis of real somatic sensations or without them, concern develops, and then a belief in the development of a particular disease in the absence of its obvious signs), jealousy (usually a painful conviction of a spouse’s infidelity is formed on the basis of a complex emotional state). There are also primary delusion, the content of which and the patient’s actions resulting from it cannot be associated with the history of his life and personality characteristics, and secondary delusions, conditionally “arising” from other mental disorders (for example, from hallucinations, affective disorders and etc.). From the point of view of dynamics, relative specificity of signs of mental illness and prognosis, three main types of delusions are distinguished - paranoid, paranoid and paraphrenic.
With paranoid delusions, the content of pathological experiences follows from ordinary life situations; it is, as a rule, logically constructed, reasoned and not of an absurd or fantastic nature. Delusions of reformation and invention, jealousy, etc. are typical. In some cases, there is a tendency to constantly expand delusional constructions, when new real life circumstances seem to be “strung” onto the pathological “core” of a painful idea. This helps to systematize delirium.
Paranoid rave less logical. More often, ideas of persecution and influence are characteristic, often combined with pseudohallucinations and phenomena of mental automatism.
Paraphrenic delusions are usually fantastic and completely absurd. More often it is delusions of grandeur. Patients consider themselves the rulers of enormous wealth, the creators of civilization. They are usually in high spirits and often have false memories (confabulation).
ATTRACTION, DISORDERS. The pathology of desire reflects a weakening as a result of various reasons(hypothalamic disorders, organic disorders of the central nervous system, states of intoxication, etc.) volitional, motivated mental activity. The consequence of this is a “deep sensory need” for the realization of impulses and the strengthening of various drives. To the number clinical manifestations Desire disorders include bulimia (a sharp increase in the food instinct), dromomania (an attraction to vagrancy), pyromania (an attraction to arson), kleptomania (an attraction to theft), dipsomania (alcoholic binges), hypersexuality, various types of perversion of sexual desire, etc. Pathological attraction may have the nature of obsessive thoughts and actions, be determined by mental and physical discomfort (dependence), and also occur acutely as impulsive reactions. Unlike other options, in the latter case there is often a complete lack of critical assessment of the situation in which the patient is trying to implement an action determined by pathological attraction.
Violation of desire can be observed in various mental disorders; their differential diagnostic assessment is based, as in other cases, taking into account the entire complex of painful manifestations and the personality-typological characteristics of the patient.
HALLUCINATIVE SYNDROMES. Hallucinations are a truly felt sensory perception that occurs in the absence of an external object or stimulus, displaces actual stimuli and occurs without phenomena of impaired consciousness. There are auditory, visual, olfactory, tactile (the sensation of insects crawling under the skin) and others. hallucinations. A special place belongs to verbal hallucinations, which can be commentary or imperative, manifesting themselves in the form of a monologue or dialogue. Hallucinations can appear in healthy people in a state of half-sleep (hypnagogic hallucinations). Hallucinations are not specific psychopathological manifestations of endogenous or other mental illnesses. They are observed in schizophrenia, epilepsy, intoxication, organic and other psychoses, and can be both acute and chronic. As a rule, hallucinations are combined with other mental disorders; most often various variants of hallucinatory-paranoid syndrome are formed.
DELIRIUM- a nonspecific syndrome characterized by a combined disorder of consciousness, perception, thinking, memory, sleep-wakefulness rhythm, and motor agitation. The delirious state is transient and fluctuating in intensity. Observed against the background of various intoxicating effects caused by alcohol, psychoactive substances, as well as liver diseases, infectious diseases, bacterial endocarditis and other somatic disorders.
DEMENTIA- a condition caused by a disease, usually of a chronic or progressive nature, in which there are disturbances in higher cortical functions, including memory, thinking, orientation, understanding of what is happening around, and the ability to learn. At the same time, consciousness is not changed, disturbances in behavior, motivation, and emotional response are observed. Characteristic of Alzheimer's disease, cerebrovascular and other diseases that primarily or secondary affect the brain.
HYPOCHONDRIC SYNDROME characterized by unjustifiably increased attention to one’s health, extreme preoccupation with even minor ailments, and the belief in the presence of a serious illness in the absence of its objective signs. Hypochondria is usually integral part more complex senestopathic-hypochondriacal, anxiety-hypochondriacal and other syndromes, and is also combined with obsessions, depression, and paranoid delusions. THINKING, VIOLATION. Characteristic symptoms are thoroughness of thinking, mentalism, reasoning, obsessions, and increased distractibility. At first, these symptoms are almost invisible and have little effect on the productivity of communication and social contacts. However, as the disease progresses, they become more pronounced and permanent, which makes it difficult to communicate with the patient. When they are most severe, productive contact with patients is practically impossible due to the development of significant difficulties in them in appropriate behavior and decision-making.
MEMORY, VIOLATION. With a mild degree of hypomnesia for current events, the patient generally remembers the events of the next 2-3 days, but sometimes makes minor errors or uncertainty when remembering individual facts (for example, he does not remember the events of the first days of his stay in the hospital). With increasing memory impairment, the patient cannot remember which procedures he took 1-2 days ago; only when reminded does he agree that he already talked to the doctor today; does not remember the dishes he received during yesterday's dinner or today's breakfast, and confuses the dates of his next visits with relatives.
With severe hypomnesia, there is a complete or almost complete absence of memory about immediate events.
Hyponesia for past events begins with the patient experiencing minor difficulties when it comes to remembering the dates of his biography, as well as the dates of well-known events. In this case, sometimes there is a confusion of events in time or dates are named approximately; the patient attributes some of them to the corresponding year, but does not remember the month and day. The observed memory disorders practically do not interfere with normal activities. However, as the disease progresses, the patient finds it difficult to remember the dates of most well-known events or only remembers some of them with great difficulty. At the same time, the memory of events in his personal life is grossly impaired; he answers questions approximately or after complex calculations. With severe hypomnesia, there is a complete or almost complete absence of memory of past events; patients answer “I don’t remember” to the relevant questions. In these cases, they are socially helpless and disabled.
PSYCHOORGANIC (organic, encephalopathic) SYNDROME- a state of fairly stable mental weakness, expressed in its mildest form by increased exhaustion, emotional lability, instability of attention and other manifestations of asthenia, and in more severe cases - also psychopathic-like disorders, memory loss, and increasing mental helplessness. The basis pathological process in psychoorganic syndrome, a current brain disease of an organic nature (traumatic disease, tumor, inflammation, intoxication) or its consequences is determined. Nonspecific psychopathological symptoms are often combined with focal brain lesions with corresponding neurological and mental disorders. Variants of the syndrome include asthenic with a predominance of physical and mental exhaustion; explosive, determined by affective lability; euphoric, accompanied high mood, complacency, a decrease in critical attitude towards oneself, as well as affective outbursts and attacks of anger, ending in tearfulness and helplessness; apathetic, characterized by a decrease in interests, indifference to the environment, weakening of memory and attention.
IRRITABILITY INCREASED
dated June 14, 2007Karaganda State Medical University
Department of Psychology, Psychiatry and NarcologyLECTURE
Subject:
Discipline "Neurology, psychiatry, narcology"
Specialty 051301 – General medicine
Time (duration) 1 hour
Karaganda 2011
Approved at a methodological meeting of the department
05/07/2011 Protocol No. 10
Head of the departmentpsychology, psychiatry and narcology
Candidate of Medical Sciences, Associate Professor M.Yu.Lyubchenko
Subject : Main psychopathological syndromes
The goal is to familiarize students with the classification of mental illnesses
Lecture outline
2. Asthenic syndrome
3. Hallucinosis syndrome
4. Paranoid syndrome
5. Paranoid syndrome.
6. Mental automatism syndrome
7. Paraphrenic syndrome
8. Syndromes of impaired consciousness
9. Korsakoff syndrome
10.Psycho-organic syndrome
A syndrome is a stable combination of symptoms that are closely related to each other and united by a single pathogenetic mechanism and characterize the current condition of the patient.
Thus, peripheral sympathicotonia characteristic of depression leads to the appearance of tachycardia, constipation, and pupil dilation. However, the connection between symptoms can be not only biological, but also logical. Thus, the lack of the ability to remember current events with fixation amnesia naturally leads to disorientation in time and confusion in a new, unfamiliar environment.
Syndrome is the most important diagnostic category in psychiatry, while syndromic diagnosis is not considered as one of the stages in establishing a nosological diagnosis. When solving many practical issues in psychiatry, a correctly described syndrome means much more than a correctly made nosological diagnosis. Since the causes of most mental disorders have not been determined, and the main ones used in psychiatry medicines do not have a nosologically specific effect, then the prescription of therapy in most cases is focused on the leading syndrome. Thus, a pronounced depressive syndrome suggests the presence of suicidal thoughts, and therefore indicates to the doctor the need for urgent hospitalization, careful supervision and the use of antidepressants.
Some diseases are characterized by significant polymorphism of symptoms.
Although syndromes do not directly indicate a nosological diagnosis, they are divided into more and less specific. Thus, apathetic-abulic states and the syndrome of mental automatism are quite specific for paranoid schizophrenia. Depressive syndrome is extremely nonspecific and occurs in a wide range of endogenous, psychogenic, somatogenic and exogenous-organic diseases.
There are simple (small) and complex (large) syndromes. An example of the first is asthenic syndrome, manifested by a combination of irritability and fatigue. Typically, simple syndromes do not have nosological specificity and occur when various diseases. Over time, the syndrome may become more complicated, i.e. the addition of more severe symptoms in the form of delusions, hallucinations, pronounced personality changes, i.e. formation of a complex syndrome.
^ ASTHENIC SYNDROME.
This condition is manifested by increased fatigue, weakening or loss of the ability for prolonged physical and mental stress. Patients experience irritable weakness, expressed by increased excitability and quickly followed by exhaustion, affective lability with a predominance of low mood. Asthenic syndrome is characterized by hyperesthesia.
Asthenic states are characterized by the phenomena of asthenic or figurative mentism, manifested by a stream of vivid figurative ideas. There may also be influxes of extraneous thoughts and memories that involuntarily appear in the patient’s mind.
Headaches, sleep disturbances, and vegetative manifestations are often observed.
The patient's condition may change depending on the level of barometric pressure (meteopathic Pirogov syndrome).
Asthenic syndrome is the most nonspecific of all psychopathological syndromes. It can be observed with cyclothymia, symptomatic psychoses, organic brain lesions, neuroses, intoxication psychoses.
The occurrence of asthenic syndrome is associated with depletion of functional capabilities nervous system when it is overstrained, as well as due to autointoxication or exogenous toxicosis, impaired blood supply to the brain and metabolic processes in brain tissue. This allows us to consider the syndrome in some cases as an adaptive reaction, manifested by a decrease in the intensity of activity various systems organism with the subsequent possibility of restoring their function.
^ HALLUCINOSIS SYNDROMES.
Hallucinosis is manifested by numerous hallucinations (usually simple), which constitute the main and practically the only manifestation of psychosis. There are visual, verbal, tactile, olfactory hallucinosis. Hallucinosis can be acute (lasting several weeks) or chronic (lasting years).
The most typical causes of hallucinosis are exogenous hazards (intoxication, infection, trauma) or somatic diseases (cerebral atherosclerosis). Some intoxications are distinguished by special variants of hallucinosis. Thus, alcoholic hallucinosis is more often manifested by verbal hallucinations of a condemning nature. Tetraethyl lead poisoning causes a sensation of hair in the mouth. Cocaine intoxication results in tactile hallucinosis with the sensation of insects crawling under the skin.
In schizophrenia, this syndrome occurs in the form of pseudohallucinosis.
^ PARANOIAL SYNDROME.
Paranoid syndrome manifests itself as a primary, interpretive monothematic, systematized delusion. The predominant content of delusional ideas is reformism, relationships, jealousy, and the special importance of one’s own personality. There are no hallucinatory disorders. Delusional ideas are formed as a result of a paralogical interpretation of the facts of reality. The manifestation of delusions may be preceded by the long existence of overvalued ideas. Paranoid syndrome tends to be chronic and difficult to treat with psychotropic drugs.
The syndrome occurs in schizophrenia, involutional psychoses, and decompensation of paranoid psychopathy.
^ PARANOID SYNDROME
Paranoid syndrome is characterized by systematized ideas of persecution. Delusions are accompanied by hallucinations, most often auditory pseudohallucinations. The occurrence of hallucinations determines the emergence of new plots of delirium - ideas of influence, poisoning. A sign of an allegedly existing influence, from the point of view of patients, is a feeling of mastery (mental automatism). Thus, in its main manifestations, paranoid syndrome coincides with the concept of mental automatism syndrome. The latter does not include only variants of the paranoid syndrome, accompanied by true taste or olfactory hallucinations and delusions of poisoning. With paranoid syndrome, there is a certain tendency towards the collapse of the delusional system, delirium acquires features of pretentiousness and absurdity. These features become especially pronounced during the transition to paraphrenic syndrome.
SYNDROME OF MENTAL AUTOMATISM (Kandinsky-Clerambault syndrome).
This syndrome consists of delusions of persecution and influence, pseudohallucinations and phenomena of mental automatism. The patient can feel the influence carried out in various ways - from witchcraft and hypnosis, to the action of cosmic rays and computers.
There are 3 types of mental automatism: ideational, sensory, motor.
Ideatorial automatisms are the result of an imaginary influence on thinking processes and other forms of mental activity. Manifestations of this type of automatism are mentism, “sounding” of thoughts, “taking away” or “putting in” thoughts, “madeness” of dreams, a symptom of unwinding memories, “madeness” of mood and feelings.
Sensory automatisms usually include extremely unpleasant sensations that occur in patients also as a result of the influence of an external force.
Motor automatisms include disorders in which patients have the belief that the movements they make are carried out against their will under external influence, as well as speech motor automatisms.
An inverted version of the syndrome is possible, the essence of which is that the patient himself allegedly has the ability to influence others, recognize their thoughts, influence their mood, feelings and actions.
^ PARAPHRENIC SYNDROME.
This condition is a combination of fantastic delusions of grandeur, delusions of persecution and influence, phenomena of mental automatism and affective disorders. Patients call themselves rulers of the Earth, the Universe, heads of state, etc. When presenting the content of delirium, they use figurative and grandiose comparisons. As a rule, patients do not seek to prove the correctness of statements, citing the indisputability of their beliefs.
The phenomena of mental automatism also have a fantastic content, which is expressed in mental communication with outstanding representatives of humanity or with creatures inhabiting other planets. Positive or negative twin syndrome is often observed.
Pseudohallucinations and confabulatory disorders can occupy a significant place in the syndrome. In most cases, the mood of patients is elevated.
^ SYNDROMES OF DISTURBED CONSCIOUSNESS.
Criteria for impaired consciousness have been developed (Karl Jaspers):
Detachment from surrounding reality. The outside world is not perceived or is perceived fragmentarily.
Disorientation in surroundings
Thinking disorder
Amnesia of the period of impaired consciousness, complete or partial
switched off syndromes
clouded consciousness syndromes
Syndromes of clouded consciousness: delirium, amentia, oneiroid, twilight disorder consciousness.
Delirium may be alcoholic, intoxication, traumatic, vascular, infectious. This is an acute psychosis with impaired consciousness, which is most often based on signs of cerebral edema. The patient is disoriented in time and place, experiences frightening visual true hallucinations. Often these are zoohallucinations: insects, lizards, snakes, scary monsters. The patient's behavior is largely determined by psychopathological experiences. Delirium is accompanied by multiple somatovegetative disorders (increased blood pressure, tachycardia, hyperhidrosis, tremor of the body and limbs). In the evening and at night, all these manifestations intensify, and in the daytime they usually weaken somewhat.
Upon completion of psychosis, partial amnesia is observed.
The course of psychosis is characterized by a number of features. Symptoms increase in a certain sequence. It takes from several days to 2 days for psychosis to fully develop. Early signs developing psychosis are anxiety, restlessness, hyperesthesia, insomnia, against the background of which hypnogogic hallucinations appear. As psychosis increases, illusory disorders appear, turning into complex hallucinatory disorders. This period is characterized by pronounced fear and psychomotor agitation. Delirium lasts from 3 to 5 days. The cessation of psychosis occurs after prolonged sleep. After recovery from psychosis, residual delusions may persist. Abortive delirium lasts several hours. However, it is not uncommon severe forms delirium leading to a gross organic defect (Korsakov's syndrome, dementia).
Signs of an unfavorable prognosis are occupational and persistent delirium.
Oneiric(dreamlike) darkening of consciousness. Distinguished by the extreme fantastic nature of psychotic experiences.
Oneiroid is a kind of alloy of real, illusory and hallucinatory perception of the world. A person is transported to another time, to other planets, is present at great battles, the end of the world. The patient feels responsible for what is happening, feels like a participant in the events. However, the behavior of patients does not reflect the richness of experiences. The movement of patients is a manifestation of the catatonic syndrome - stereotypical swaying, mutism, negativism, waxy flexibility, impulsiveness. Patients are disoriented in place, time and self. A symptom of double false orientation is possible, when patients consider themselves patients in a psychiatric hospital and at the same time participants in fantastic events. Feelings of rapid movement, movement in time and space are often observed.
Oneiroid is the most common manifestation acute attack schizophrenia. The formation of psychosis occurs relatively quickly, but can last for several weeks. Psychosis begins with sleep disturbances and the appearance of anxiety; concern quickly reaches the level of confusion. Acute sensory delirium and derealization phenomena appear. Then fear gives way to an affect of bewilderment or ecstasy. Later, catatonic stupor or agitation often develops. The duration of psychosis is up to several weeks. The exit from the oneiric state is gradual. First, hallucinations are leveled out, then catatonic phenomena. Ridiculous statements and actions sometimes persist for quite a long time.
Oneiric experiences that develop against the background of exogenous and somatogenic factors are classified as manifestations fantastic delirium. Among exogenous psychoses, the most consistent with the picture of a typical oneiroid are the phenomena observed with the use of hallucinogens (LSD, hashish, ketamine) and hormonal drugs (corticosteroids).
Amentia – severe clouding of consciousness with incoherent thinking, complete inaccessibility to contact, fragmentary deceptions of perception and signs of severe physical exhaustion. A patient in an amental state usually lies down, despite chaotic agitation. His movements sometimes resemble some actions indicating the presence of hallucinations, but are often completely meaningless and stereotypical. Words are not connected into phrases and are fragments of speech (incoherent thinking). The patient reacts to the doctor’s words, but cannot answer questions and does not follow instructions.
Amentia occurs most often as a manifestation of long-term debilitating somatic diseases. If it is possible to save the lives of patients, the outcome is a pronounced organic defect (dementia, Korsakoff syndrome, affected asthenic conditions). Many psychiatrists consider amentia as one of the options for severe delirium.
^ Twilight darkness of consciousness is a typical epileptiform paroxysm. Psychosis is characterized by a sudden onset, a relatively short duration (from tens of minutes to several hours), an abrupt cessation and complete amnesia of the entire period of upset consciousness.
The perception of the environment at the moment of clouding of consciousness is fragmentary; patients snatch random facts from surrounding stimuli and react to them in an unexpected way. Affect is often characterized by malice and aggressiveness. Antisocial behavior is possible. Symptoms lose all connection with the patient’s personality. Possible productive symptoms in the form of delusions and hallucinations. Once psychosis ends, there are no memories of psychotic experiences. Psychosis usually ends deep sleep.
There are variants of twilight stupefaction with vivid productive symptoms (delusions and hallucinations) and with automated actions (outpatient automatisms).
^ Outpatient automatisms manifest themselves in short periods of confusion without sudden excitement with the ability to perform simple automated actions. Patients can take off their clothes, get dressed, go outside, and give brief, not always appropriate answers to the questions of others. Upon recovery from psychosis, complete amnesia is noted. Varieties of ambulatory automatisms include fugues, trances, and somnambulism.
Twilight clouding of consciousness - typical sign epilepsy and other organic diseases (tumors, cerebral atherosclerosis, head injuries).
It should be distinguished from epileptic hysterical twilight states that arise immediately after the action of mental trauma. At the time of psychosis, the behavior of patients may be characterized by foolishness, infantilism, and helplessness. Amnesia can cover large periods preceding psychosis or following its cessation. However, fragmentary memories of what happened may remain. Resolving a traumatic situation usually leads to restoration of health.
^ KORSAKOV SYNDROME
This is a condition in which memory disorders for events of the present (fixation amnesia) predominate, while it is preserved for events of the past. All information coming to the patient instantly disappears from his memory; patients are not able to remember what they just saw or heard. Since the syndrome can occur after an acute cerebral accident, along with anterograde amnesia, retrograde amnesia is also noted.
One of the characteristic symptoms is amnestic disorientation. Memory gaps are filled with paramnesias. Confabulatory confusion may develop.
The occurrence of Korsakoff syndrome as a result of acute brain damage in most cases allows us to hope for some positive dynamics. Although full recovery memory is impossible in most cases; during the first months after treatment, the patient can record individual repeated facts, the names of doctors and patients, and navigate the department.
^ PSYCHOORGANIC SYNDROME
A state of general mental helplessness with decreased memory, intelligence, weakened will and affective stability, decreased ability to work and other adaptation capabilities. In mild cases, psychopathic-like states are detected organic origin, Mildly expressed asthenic disorders, affective lability, weakening of initiative. Psychoorganic syndrome can be a residual condition that occurs during progressive diseases of organic origin. In these cases, psychopathological symptoms are combined with signs of organic brain damage.
There are asthenic, explosive, euphoric and apathetic variants of the syndrome.
At asthenic variant The clinical picture of the syndrome is dominated by persistent asthenic disorders in the form of increased physical and mental exhaustion, symptoms of irritable weakness, hyperesthesia, affective lability, and disorders of intellectual functions are slightly expressed. There is a slight decrease in intellectual productivity and mild dysmnestic disorders.
For explosive version Characterized by a combination of affective excitability, irritability, aggressiveness with mildly expressed dysmnestic disorders and decreased adaptation. Characterized by a tendency towards overvalued paranoid formations and querulant tendencies. Quite frequent alcohol abuse is possible, leading to the formation of alcohol dependence.
As with the asthenic and explosive variants of the syndrome, decompensation of the condition is expressed in connection with intercurrent diseases, intoxications and mental trauma.
Painting euphoric version The syndrome is determined by an increase in mood with a tinge of euphoria, complacency, confusion, a sharp decrease in criticism of one’s condition, dysmnestic disorders, and increased drives. Anger and aggressiveness are possible, followed by helplessness and tearfulness. Signs of a particularly serious condition are the development in patients of symptoms of forced laughter and forced crying, in which the reason that caused the reaction is amnesic, and the grimace of laughter or crying for a long time is preserved in the form of a facial reaction devoid of affect content.
^ Apathetic option The syndrome is characterized by aspontaneity, a sharp narrowing of the range of interests, indifference to the environment, including one’s own fate and the fate of one’s loved ones, and significant dysmnestic disorders. Noteworthy is the similarity of this condition with the apathetic pictures observed in schizophrenia, however, the presence of mnestic disorders, asthenia, spontaneously occurring syndromes of forced laughter or crying helps to distinguish these pictures from similar conditions in other nosological units.
The listed variants of the syndrome are often stages of its development, and each of the variants reflects a different depth and different extent of damage to mental activity.
Illustrative material (slides – 4 pcs.)
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Literature
Mental illnesses with a course in narcology / edited by prof. V.D. Mendelevich. M.: Academy 2004.-240 p.
Medelevich D.M. Verbal hallucinosis. - Kazan, 1980. - 246 p.
Guide to Psychiatry / Ed. A. V. Snezhnevsky. T. 1-2- M.: Medicine, 1983.
Jaspers K. General psychopathology: Trans. with him. - M.: Practice,
1997. - 1056 p.
Zharikov N.M., Tyulpin Yu.G. Psychiatry. M.: Medicine, 2000 – 540 p.
Psychiatry. Study guide for students medical universities, edited by V.P. Samokhvalova – Rostov on Don: Phoenix 2002
Rybalsky M.I. Illusions and hallucinations. - Baku, 1983., 304 p.
Popov Yu. V., Vid V. D. Clinical psychiatry. - St. Petersburg, 1996.
Security questions (feedback)
name the main features of paraphrenic syndrome
What is included in the concept of psychoorganic syndrome
What are the main reasons for the development of Korsakoff's syndrome?
The disease never manifests itself as a separate symptom. When analyzing its clinical picture, symptoms are noticed that are interconnected and form a syndrome. Any disease process has a certain dynamics, and within the syndrome there are always symptoms that have already formed, as well as those that are in their infancy.
A syndrome is a set of interrelated symptoms that have a common pathogenesis.
The syndrome coexists both positive mental disorders (asthenic, affective, neurotic, delusional, hallucinatory, catatonic, convulsive) and negative (destruction, prolapse, defect). Positive symptoms always variable, negative - invariant.
The syndrome is distinguished by symptoms of the first (leading), second (main) and third (minor) ranks. This distribution allows us to consider them in the dynamics of the disease. During the diagnostic process, the doctor discovers in a particular patient symptoms that are specific to a particular disease, for example, not just asthenia, but asthenia reflecting the characteristics of the disease (atherosclerotic, traumatic, paralytic, etc.), not dementia in general, but atherosclerotic, epileptic, paralytic, etc. .
Syndrome is a stage in the course of the disease. The nosological specificity of the syndromes is variable. The same syndrome can develop in different diseases. Yes. Such syndromes as asthenic and catatonic have no specificity at all. comatose. The specificity of dysmnestic syndromes and organic psychosyndrome is quite pronounced. Syndromes for diseases of the same etiology may differ from each other, and conversely, there are many identical syndromes that arise for different reasons.
Below are short description the main syndromes that are most often observed in mental health clinics.
Classification of main psychopathological syndromes
I. neurotic:
Asthenic:
Obsessively:
Senestopathic-hypochondriacal:
Hysterical:
Depersonalization:
Derealization.
II. affective:
Manic:
Depressive;
Dysphoric
III. HALLUCINATORY-delirium:
Hallucinatory;
Paranoid;
Paraphrenic;
Paranoid;
Mental automatism of Kandinsky-Clerambault;
IV. PATHOLOGIES effector-volitional spheres:
Catatonic;
Hebephrenic.
V. PRODUCTIVE disorder of consciousness (stupefaction):
Delirious;
Oneiric;
Amentive;
Delirium acutum (choreatic)
Twilight state of consciousness: ambulatory automatism, trance, somnambulism, fugue.
VI. Non-productive disorders C information (NON-HYSICHOTIC):
Nullification;
Stun;
Somnolence;
VII. ORGANIC BRAIN DAMAGE:
Organic psychosyndrome;
Korsakov (amnestic)
Paralytic (Pseudoparalytic)
VIII. convulsive:
Grand mal seizure;
Adverse convulsive seizure;
Minor seizures:
Absence;
Propulsive attacks;
Salaama (attacks)
Lightning attacks;
Clonic propulsive attacks;
Retropulsive attacks;
Clonic retropulsive attacks;
Vestigial retropulsive attacks;
Pycnolepsy;
impulsive attacks;
Akinetic attack;
Convulsive syndromes
Jackson's attacks (Jacksonian)
Hysterical attack.
The object of psychiatry is a person who has impaired certain aspects of mental activity - sensations, perception, memory, thinking, experiences, etc.
Between mental health and there are many mental illnesses transition states– the person is not yet sick, but he has slight deviations in his state of mind that prevent him from adapting well to life and working successfully. Timely and qualified advice from a psychiatrist on how to more wisely organize one’s life, work and rest, and how to react more correctly to one or another event, can in such cases be of great help and prevent the development of a more severe mental disorder.
From the above it is clear that the subject of psychiatry is not only a mentally ill person, but in some cases also a healthy one. In order to correctly understand mental illness and know how to treat a patient, how to treat him, what to expect from him, you must first of all be able to distinguish the signs of the disease, its manifestations, i.e. symptoms and their natural combinations - syndromes.
In cases of mental illness it is disrupted mental activity a person as a whole, but with different diseases one or another of the basic mental processes primarily suffers: perception, memory, attention, intellect, thinking, emotions, will.
Perceptual deceptions include primarily illusions and hallucinations. Illusions are understood as a false, erroneous perception of an object, when an object or phenomenon that actually exists is perceived by a person in a distorted form. For example, in the twilight a bush may appear to be a hidden person, words may be heard in the sound of carriage wheels, etc. Illusions can occur not only in mentally ill people, but also in healthy people - due to overwork, an anxious mood (for example, at night in the forest, in a cemetery), insufficient lighting, etc.
Hallucinations– this is a false perception without objects that actually exist at the moment. Hallucinations are divided according to the sense organs into auditory, visual, olfactory, gustatory, tactile, and bodily. The most common auditory hallucinations are “voices.” These “voices” (male, female, children) can be heard from the outside (“true hallucinations”), or inside the head (“pseudohallucinations”). Voices can talk to each other, discuss the patient, his life, actions, they can scold him, mock him, praise him, threaten him, they can address the patient with orders (imperative hallucinations), etc. Patients with imperative hallucinations are especially dangerous, since under their influence patients often try to attack someone around them or commit suicide. With visual hallucinations, patients see objects or images that are not in front of them at the time. They can be shapeless (flame, smoke), vague or clearly defined, colorless or colored, stationary or moving. Patients can see a deceased relative, God, devils, various animals, entire scenes. The content of hallucinations can cause fear or pleasure, curiosity, or interest in the patient. Patients with frightening visual hallucinations are dangerous to themselves and to others. With olfactory hallucinations, patients perceive various odors, often unpleasant (putrid, cadaverous, the smell of gas, feces, etc.). Taste hallucinations are usually associated with olfactory hallucinations. Patients, for example, not only smell the poison, but also taste it, food takes on an unusual taste, etc. Patients may feel internal organs foreign objects, the presence of any living beings are bodily, visceral hallucinations. The perceptions of hallucinating patients can be so real that the patients are convinced of their real existence and it is not possible to convince them until recovery.
Various unpleasant sensations (burning, tightening, bursting, transfusion, etc.) in the head or body are called senestopathies. Under body schema disorders understand a distorted idea of the shape or size of their body (for example, it seems that the head suddenly begins to grow, the ear has moved out of place, etc.). Agnosia represent a disorder of object recognition while the sensory organs are intact. With visual agnosia (“mental blindness”), the patient sees an object, but does not recognize it, does not know why it exists. With auditory agnosia (“mental deafness”), the patient does not recognize an object by its characteristic sound.
Among memory disorders A distinction is made between memory disorders and recollection disorders. With the first of these disorders, a person’s ability to remember new events occurring around him or his actions is reduced or lost. With memory disorder, a person cannot reproduce or remember past events. Often, not the entire memory reserve is affected, but one or another period of time is lost. Memory loss is called amnesia. Retrograde amnesia is called memory loss for periods before the onset of the disease (trauma, hanging, etc.). With memory disorders there are so-called false memories(pseudo-reminiscences and confabulations). Thus, a patient who has been in the hospital for several months remembers with complete conviction and says that yesterday she came home, cooked dinner, etc.
Attention disorders can be expressed in the patient’s excessive distractibility, when he, without completing some thought or phrase, gets distracted, starts talking about something else, jumps from one topic to another, and cannot concentrate on anything. It also happens the other way around - nothing and nothing can be done to distract the patient from his thoughts or switch him to something else. Occurs exhaustion of attention, when at the beginning of a conversation the patient is sufficiently concentrated, but then quickly gets tired, his attention is exhausted and he can no longer gather his thoughts to answer the question.
Among intellectual disorders differentiate congenital dementia or mental retardation (oligophrenia) and dementia(dementia) of various degrees and types.
Everything that a person sees, hears, perceives, everything that gives food to his mind, he thinks about, comprehends, tries to somehow understand, come to some conclusions, conclusions. This process is called thinking. In mental illness, thinking is usually impaired to one degree or another. Thought disorders very diverse. Thinking can be accelerated, when one thought quickly replaces another, more and more new thoughts and ideas continuously arise, up to "leaps of ideas". The accelerated pace of thinking leads to increased distractibility, inconsistency, superficial associations, judgments and conclusions. At slow thinking the flow of thoughts becomes slow and difficult. Accordingly, the thinking and speech of patients becomes either excited or slow, quiet, laconic, with frequent pauses and delays. At incoherent thinking there is no logical connection between individual ideas, speech turns into a meaningless and disordered collection of individual words and phrases. For thorough And viscous thinking It is typical to get stuck on certain minor details, unimportant little things in which the main idea is drowned. Reasonable thinking characterized by a tendency to excessive reasoning, to fruitless philosophizing. Paralogical thinking ignores the laws of normal human logic. Therefore, with such thinking, unfounded and false conclusions and conclusions occur. Autistic thinking characterized by withdrawal from the real world, it is based on personal desires and aspirations. Therefore, such thinking sometimes looks not only wrong, but also ridiculous. At broken (atactic) thinking the logical connection between individual sentences and phrases is broken. For example, when asked why the patient didn’t shave, the answer is: “I didn’t shave because it’s hot in Africa.” If not only sentences, but also individual words are incoherent, they speak of “verbal hash.”
The most common manifestation of thought disorder is rave. Delusional are incorrect, false ideas that are caused by mental illness and cannot be convinced, since patients are confident in their correctness, despite the obvious contradiction with reality. The content of delirium is varied. The patient may believe that he is surrounded by enemies, pursuers who are watching him, want to poison him, destroy him ( delusions of persecution), act on him with the help various devices, radio, televisions, rays, hypnosis, telepathy ( delusions of influence), that everyone around him treats him badly, laughs at him when he enters somewhere, everyone looks at each other, coughs meaningfully, hints at something bad ( nonsense relationship). Patients with such delusional ideas are very dangerous, as they can take brutal aggressive actions against “persecutors,” imaginary enemies. Patients with delirium of jealousy. Such a patient, being for delusional reasons convinced of his wife’s infidelity, constantly monitors her, carefully examines her body and underwear in search of additional confirmation of his conviction, demands a confession from his wife, often cruelly torturing her in the process, and sometimes commits murder. At delirium of damage the patient claims that he is being robbed, people are breaking into his room, things are being damaged, etc. Patients with delirium of self-recrimination They consider themselves guilty of some crimes, sometimes remembering their real minor offense, elevate it to the rank of a heavy, irredeemable guilt, demand cruel punishment for themselves, and often strive for suicide. Close to such experiences ideas of self-deprecation(“I’m an insignificant, pathetic person”), sinfulness(“great sinner, terrible villain”). At hypochondriacal delirium patients believe that they have cancer or another incurable disease, present a mass various complaints, they claim that their lungs and intestines are rotting, food is sinking into their stomachs, their brains are dry, etc. Sometimes the patient claims that he has turned into a corpse, he has no insides, everything has died ( nihilistic delirium). At delirium of grandeur patients talk about their exceptional beauty, wealth, talents, power, etc.
Perhaps the most varied content of delirium - nonsense of reformism, when patients are convinced that they have developed the shortest path to building universal happiness (“among people and animals,” as one patient wrote), delirium of inventions, delirium of love(when patients are convinced that various people, most often high-ranking people, are in love with them); litigious or querulant nonsense(patients write numerous complaints to various authorities, demanding restoration of their allegedly violated rights, punishment of the “culprits”), etc.
The same patient can have delusional ideas of different content, for example, ideas of relationship, persecution, influence. The specific content of delirium depends on the patient’s level of intelligence, his education, culture, and also on the surrounding reality. Nowadays, the once common ideas of bewitchment, corruption, and possession by the devil have become rare; they have been replaced by ideas of action by biocurrents, radiation energy, etc.
Another type of thought disorder is obsessions. These ideas, just like delusional ones, take possession of the patient’s consciousness, but unlike what happens with delirium, here the patient himself understands their incorrectness, tries to fight them, but cannot get rid of them. In a mild form, obsessive ideas also occur in healthy people, when some line from a poem, phrase or motive “gets attached” and for a long time it is not possible to “drive them away”. However, if in healthy people this is a rare episode and does not affect behavior, then in a patient the obsessions are persistent, persistent, completely absorb attention, and change all behavior. Obsessions are very diverse. This can be obsessive counting, when the patient constantly counts steps of stairs, house windows, car license plates, obsessive reading of signs from right to left, decomposition of words into individual syllables, etc. Obsessive thoughts may completely contradict the patient’s beliefs; A religious patient may obsessively have blasphemous thoughts, while a loving mother may have the thought of the desirability of the child’s death.
Obsessive doubts are expressed in the fact that the patient is constantly haunted by thoughts about the correctness of his actions. Such a patient checks several times whether he has locked the door, turned off the gas, etc. Sometimes a patient, contrary to his will and reason, develops obsessive urges, the desire to do senseless, often very dangerous actions, for example, gouge out the eyes of yourself or someone else. Such patients are terrified of the possibility of committing such an act and usually seek medical help themselves.
Very painful obsessive fears(phobias), which are extremely numerous and diverse. Fear of open spaces, squares - Agarophobia, fear of closed spaces, enclosed spaces - claustrophobia, fear of getting syphilis - syphilophobia, cancer - cancerophobia, fear of heights - loneliness, crowds, sudden death, sharp objects, fear of blushing, being buried alive, etc.
Meet obsessive actions, for example, the desire to shake a leg, perform rituals - certain movements, touches, actions - “in order to avoid misfortunes.” So, in order to protect loved ones from death, the patient feels obliged to touch the button every time he reads or hears the word “death.”
All human perceptions, thoughts and actions are accompanied by various feelings, emotions. General emotional (sensual) background, more or less stable emotional condition- This mood. It can be cheerful or sad, cheerful or lethargic - depending on a number of reasons: success or failure, physical well-being, etc. A short-term but violent emotional reaction, an “explosion of feelings” is affect. This includes rage, anger, horror, etc. All these affects can be observed in completely healthy people as a reaction to one reason or another. The better a person’s will and self-control are developed, the less often he experiences affect and the weaker it is. Highlight pathological (i.e. painful) affect- such an “explosion of feelings”, which is accompanied by clouding of consciousness and usually manifests itself in severe destructive aggressive actions.
Various emotional disorders are characterized by a discrepancy between the emotional reaction and the external reasons that caused it, unmotivated or insufficiently motivated emotions.
Mood disorders include manic states- an unreasonably joyful mood, a state of bliss and contentment, when a person considers everything around him and himself to be excellent, delightful, beautiful. At depressed in a painfully depressed mood, everything is perceived in a gloomy light; the patient sees himself, his health, his actions, the past, and the future as especially bad. Self-hatred and loathing, feelings of melancholy and hopelessness in such patients can be so strong that patients strive to destroy themselves and commit suicidal acts (i.e., suicide attempts). Dysphoria- this is a sad-angry mood, when a feeling of depression is accompanied by dissatisfaction not only with oneself, but also with everyone around, irritability, gloominess, and often aggressiveness. Apathy– painful indifference, indifference to everything that happens around and to one’s own situation. Sharply expressed and persistent emotional coldness, apathy is designated as emotional dullness. Pronounced instability, lability of mood is called emotional weakness. It is characterized by rapid and sharp changes in emotional reactions, transitions on the most insignificant occasions from complacency to irritability, from laughter to tears, etc. Painful emotional disorders also include feelings of anxiety, fear, etc.
Let's move on to the description disorders of desire and will. In mentally ill patients, the desire for food is especially often disturbed. This manifests itself either in bulimia– strengthening of this desire, when the patient seeks to eat various inedible objects, or in anorexia– weakening of the food instinct, refusal of food. Refusal to eat for a long time poses a serious threat to the patient’s life. Even more dangerous is a violation of the instinct of self-preservation, expressed in the desire for self-harm, self-torture, and suicide.
At sexual instinct disorder its painful weakening, strengthening or perversion is observed. Sexual perversions include sadism, in which sexual satisfaction is achieved by causing the partner physical pain, up to and including brutal torture and murder followed by sexual intercourse; masochism when sexual satisfaction requires the feeling of physical pain caused by a partner; homosexuality (pederasty)– a man’s sexual attraction to an object of the same sex; lesbianism– a woman’s sexual attraction to an object of the same sex; bestiality (bestiality) performing sexual intercourse with animals, etc.
To the painful drives also include dromomania- an acute and unexpected desire to wander and vagrancy that appears at times; pyromania– a painful attraction to arson, committed, so to speak, “disinterestedly”, not out of revenge, without the goal of causing damage; kleptomania– sudden attacks of desire to commit aimless thefts, etc. This kind of frustrated desire is called impulsive, since they arise suddenly, without clear motivation; with them there is practically no thinking or decision-making that precedes the commission of actions in a healthy person. A mentally ill person may also be impulsive aggression- a sudden, causeless attack on someone around. Along with an increase in volitional activity in mental patients, there is also a weakening of volitional activity with a lack of motivation and a weakening of volitional activity - hypobulia or complete lack of will - abulia.
One of the most common disorders in mental patients is motor and speech stimulation. At the same time, some patients strive to do something, fuss, do not complete anything, talk incessantly, gradually becoming distracted, but still their individual actions are meaningful and purposeful, and this state is accompanied by an elevated mood. This kind of excitement is called manic. Other patients rush around senselessly, aimlessly, make chaotic movements with their limbs, spin in one place, crawl on the floor, clap their hands, mutter something, etc. This is the so called catatonic agitation. There are a number of other excitation options, of which mention should be made epileptiform as the most dangerous, since it is accompanied by a desire for destructive and socially dangerous actions.
The opposite state of excitement is lethargy, sometimes reaching complete immobility - stupor. Patients who are in a stupor can lie in one bizarre position for weeks or months, do not react to anything, do not answer questions ( mutism), resist attempts to change the position of their body, do not comply with any requests, sometimes even do the opposite of what was suggested to them ( negativism), and sometimes they automatically obey any, even unpleasant, demands, freeze in any uncomfortable position given to them (waxy flexibility - catalepsy). This kind of stupor is called catatonic. It should be remembered that catatonic stupor can abruptly and unexpectedly give way to excitement and impulsive aggression. At depressive stupor In contrast to the catatonic patient, neither negativism nor waxy flexibility is observed; the expression of melancholy and sorrow freezes on the face of such patients. With depressive stupor there is a risk of suicide.
TO volitional disorders also apply stereotypies. This could be stereotypical actions, some movement constantly repeated by the patient, a grimace, or the patient shouting the same meaningless phrase. Echopraxia– repetition by the patient of a movement made by someone in his presence, echolalia- repetition of a heard word. Among the symptoms of a disorder of volitional functions should also be mentioned pathological suggestibility. The above phenomena of catalepsy, echolalia, echopraxia are explained by increased suggestibility. But suggestibility can also be reduced, even negative, which manifests itself as a symptom of negativism.
