Very strong disturbances of the emotional-volitional sphere. Emotionally volitional disorders

Of course, all loving parents care about the health of their children. However, often mothers and fathers pay attention exclusively to the physical development of the child, for some reason without paying due care to the emotional state of the baby. But emotions play a significant role in a person’s life. Emotions appear from the first days of a baby’s life; with their help, the child communicates with his parents, making it clear that he is upset, in pain, or feels good.

As the child develops, his emotions also undergo changes and it is important to prevent emotional disturbances in children during this period. The baby learns not only to speak, walk or run, but also to feel. From the simple emotions that he experiences in infancy, he moves on to a more complex sensory perception, and begins to get acquainted with the entire emotional palette.

As a child gets older, he not only tells his parents that he is feeling uncomfortable because he is hungry or has a stomach ache, but he also begins to show more complex emotions.

Like an adult, a baby learns to be happy, delighted, sad, surprised or angry. True, the main difference between a five-year-old child and a one-year-old baby is not only that he knows how to feel “widely,” but also that he knows how to control his emotions.

IN modern society Experts are increasingly trying to draw attention to such a serious problem as emotional disorders in children.

Causes and consequences of emotional disorders in children

According to medical statistics, in 50% of cases, emotional disturbances in children who have completed primary school are expressed in the development of nervous diseases. This is a very alarming result, especially considering the fact that we are talking about nervous diseases of children who have not yet reached 16 years of age.

Child psychologists believe that the main causes of emotional disorders in children can be:

• illnesses and stress suffered in childhood;
• features of the child’s physical and psycho-emotional development, including delays, impairments or retardation in intellectual development;
• microclimate in the family, as well as the characteristics of upbringing;
• social and living conditions of the child, his close environment.

Emotional disorders in children can be caused by other factors. For example, psychological trauma to a child’s body can be caused by films he watches or computer games which he plays. Emotional disorders in children most often manifest themselves in turning points development.

A striking example of such mentally unstable behavior is the so-called “adolescent age”. Young people always rebel, but this is especially noticeable in adolescence, when the child begins to determine his desires and evaluate his own capabilities.

The most common manifestations of emotional disorders in children are:

• general anxiety of the child, as well as the presence of fears and excessive timidity;
• emotional exhaustion;
• aggression, sometimes without cause;
• problems communicating and interacting with other children or adults;
• depression.

Correction of emotional-volitional disorders in children

Before talking about methods for correcting emotional-volitional disorders in children, it is worth defining this problem. Emotional-volitional sphere or in other words psycho-emotional state of a person represents the dynamics of the development of his feelings, as well as emotions. Therefore, emotional-volitional disorders in children are nothing more than mental state disorders.

When the emotional sphere is disturbed, children develop a feeling of severe anxiety or apathy, the mood becomes gloomy and the child withdraws into himself, begins to show aggression or become depressed. In order to improve the condition of a child suffering from emotional disturbances, you should contact a specialized specialist. He, in turn, will begin individual or group work with the child, and will also tell parents how to behave correctly if the child is mentally unstable.

Psycho-emotional disorders can be successfully treated if detected early and with a competent approach to their correction.

Some tips for parents who are faced with emotional disturbances in children:

• When communicating with an injured child, try to remain absolutely calm and show your friendly attitude;
• communicate with your child more often, question him, empathize, in general, be interested in what he feels;
• play or do physical labor together, draw, pay more attention to the child;
• be sure to monitor your children’s daily routine;
• try not to expose your child to stress and unnecessary worries;
• watch what your child watches; violence on the TV screen or in a computer game will only worsen emotional disturbances;
• support the child, help build self-confidence.

A child psychologist will help eliminate emotional disturbances in children, who, using special educational games, will explain to the child how to properly respond to stressful situations and control their feelings. However, parental involvement in treatment psycho-emotional disorders No one can replace children, since kids trust their parents and, of course, follow their example.

Therefore, if in the future you want to avoid the development of severe mental illness in your child, then immediately begin to take an active part in his treatment.

The decisive factor in the correction of psycho-emotional disorders is attention from adults. Learn to pay more attention to your child, help him understand his feelings and emotions. You should not demand that your child stop worrying, but you should support him in any worries and help him understand difficult emotions. Patience, care and boundless parental love will help maintain the mental health of your children.

– these are symptoms of a violation of the purposefulness of activity, represented by weakening, absence, intensification and distortion of voluntary activity. Hyperbulia is manifested by extraordinary determination and hasty actions. Hypobulia is a pathological decrease in volitional abilities, accompanied by lethargy, passivity, and inability to carry out plans. With abulia, a complete loss of desires and motivations is determined. Variants of parabulia are stupor, stereotypies, negativism, echopraxia, echolalia, catalepsy. Diagnosis is made through conversation and observation. Treatment is medicinal and psychotherapeutic.

ICD-10

F60.7 Dependent personality disorder

General information

Will is a mental function that ensures a person’s ability to consciously control his emotions, thoughts and actions. The basis of purposeful activity is motivation - a set of needs, motivations, desires. An act of will unfolds in stages: a motivation and a goal are formed, ways to achieve a result are realized, a struggle of motives unfolds, a decision is made, an action is carried out. If the volitional component is violated, the stages decrease, intensify or distort. The prevalence of volitional disorders is unknown due to the fact that mild deviations do not come to the attention of doctors, and more pronounced ones are found in a wide range of diseases - neurological, mental, general somatic.

Causes

Mild volitional disorders are considered as features of the emotional-personal sphere, determined by the type of higher nervous activity, conditions of upbringing, and the nature of interpersonal relationships. For example, children who are often ill find themselves in a situation of overprotection from parents, teachers, and peers, and as a result, their strong-willed qualities are weakened. The reasons for pronounced changes in will are:

• Depressive disorders. A decrease in willpower up to the complete absence of impulses is observed with endogenous depression. In neurotic and symptomatic forms, the intention is preserved, but the implementation of the action is inhibited.
• Schizophrenia. Weakening of volitional operations is a characteristic feature of the schizophrenic defect. Patients with schizophrenia are suggestible, fall into a catatonic stupor, and are prone to stereotypies and echolalia.
• Psychopathic disorders. Disorders of will may result improper upbringing, pointed character traits. Dependence on others, uncertainty and subordination are determined in persons with anxious, suspicious, hysterical traits, prone to alcoholism and drug addiction.
• Manic states. An increased desire for activity, a high speed of decision-making and their implementation are diagnosed in people with bipolar affective disorder in the manic phase. Also, pronounced symptoms develop during hysterical attacks.
• Organic pathologies of the brain. Damage to the central nervous system is accompanied by a decrease in all components of volitional activity. Hypobulia and abulia are found in encephalitis, consequences of head injury and intoxication.

Pathogenesis

The neurophysiological basis of volitional disorders is a change in the complex interactions of various brain structures. When the frontal regions are damaged or underdeveloped, there is a violation of focus, a decrease in the ability to plan and control complex actions. An example is teenagers who have many desires, needs, and energy to satisfy them, but do not have sufficient persistence and perseverance. The pathology of the pyramidal tract is manifested by the inability to perform voluntary actions - paralysis, paresis, and tremors occur. This is a physiological (not mental) level of change in voluntariness.

The pathophysiological basis of willpower disorders may be dysfunction or damage to the reticular formation, which provides energy supply to cortical structures. In such cases, the first stage of the volitional act is disrupted - the formation of motives and motivation. Patients with depression and organic lesions of the central nervous system have a reduced energy component, they do not want to act, and do not have goals and needs that motivate them to be active. Manic patients, on the contrary, are overly excited, ideas quickly replace each other, and planning and control of activities are insufficient. In schizophrenia, the hierarchy of motives is distorted; changes in perception and thinking make it difficult to plan, evaluate and control actions. Energy processes are reduced or increased.

Classification

Violations of volitional acts refer to the pathology of the effector link - the system that transmits information from the central nervous system to executive systems. IN clinical practice It is customary to classify these disorders according to the nature of the symptoms: hypobulia (weakening), abulia (absence), hyperbulia (intensification) and parabulia (distortion). According to the stages of a voluntary act, seven groups of volitional pathologies are distinguished:

1. Disorder of voluntary acts. A person cannot perform actions whose results are not obvious or distant in time. In particular, he cannot learn complex skills, save money for large purchases in the future, or perform altruistic acts.
2. Coping disorder. The accomplishment of the plan may be hindered by physical barriers, social conditions, novelty of the situation, or the need for search. Patients cannot make efforts to overcome even minor difficulties and quickly give up on their plans: if they fail in exams, graduates do not try to re-enter universities, depressed patients are left without lunch, since the need to prepare food becomes an obstacle.
3. Conflict coping disorder. It is based on the incompatibility of actions, the need to choose one of the goals. Clinically, the disorder is manifested by the inability to make a choice, avoidance of decision-making, shifting this function to surrounding people or chance (fate). In order to begin to act at least somehow, patients perform “rituals” - tossing a coin, using nursery rhymes, connecting a random event with a certain decision option (if a red car passes, I’ll go to the store).
4. Premeditation disorder. The strength, speed or pace of action changes pathologically, the inhibition of inadequate motor and emotional reactions is impaired, the organization of mental activity and the ability to resist reflex acts are weakened. Examples: autonomous limb syndrome with loss of motor control of the hand, affective explosiveness in psychopathy, preventing the achievement of goals.
5. Disorder with automatisms, obsessions. Automated actions are pathologically easily developed and control over them is lost. Obsessions are perceived as either one's own or someone else's. In practice, this manifests itself as difficulty in changing habits: the same route to work, the same breakfasts. At the same time, adaptive abilities decrease, and in changing conditions people experience severe stress. Obsessive thoughts and actions cannot be changed by willpower. Patients with schizophrenia lose control not only over behavior, but also over their own personality (alienation of the self).
6. Disorder of motives and drives. The feeling of primary attraction, natural urge at the level of instinct and purposeful act is distorted. The idea of ​​the means and consequences of achieving a goal, the awareness of voluntariness as a natural human ability changes. This group includes psychopathological phenomena in eating disorders and sexual disorders.
7. Disorder of prognostic functions. Patients have difficulty anticipating the outcome and secondary effects of their own activities. Symptoms are caused by a decrease in the function of predicting and assessing objective conditions. This variant of the disorder partially explains the hyperactivity and determination of adolescent manic patients.

Symptoms of volitional disorders

The clinical picture is varied, represented by strengthening, distortion, weakening and absence of voluntary functions. Hypobulia – decreased volitional activity. The strength of motives and motivations is weakened, setting a goal and maintaining it is difficult. The disorder is typical for depression and long-term somatic illnesses. Patients are passive, lethargic, not interested in anything, sit or lie for a long time without changing posture, and are unable to begin and continue purposeful action. They need treatment control and constant stimulation to perform simple everyday tasks. Lack of will is called abulia. Urges and desires are completely absent, patients are absolutely indifferent to what is happening, inactive, do not talk to anyone, do not make any effort to eat or go to the toilet. Abulia develops with severe depression, schizophrenia (apatoabulic syndrome), senile psychoses, and damage to the frontal lobes of the brain.

With hyperbulia, patients are overly active, full of ideas, desires, and aspirations. They have a pathologically relieved determination, a readiness to act without thinking through the plan and taking into account the consequences. Patients are easily involved in any ideas, begin to act under the influence of emotions, and do not coordinate their activities with objective conditions, tasks, and the opinions of other people. When mistakes are made, they do not analyze them and do not take them into account in subsequent activities. Hyperbulia is a symptom of manic and delusional syndrome, some somatic diseases, and can be provoked by taking medications.

Perversion of the will is represented by parabulia. They manifest themselves in strange, absurd behaviors: eating sand, paper, chalk, glue (parorexia), sexual perversions, a desire for arson (pyromania), a pathological attraction to theft (kleptomania) or vagrancy (dromomania). A significant portion of parabulia are motor control disorders. They are part of syndromes characterized by disturbances of movement and will. A common variant is catatonia. With catatonic excitement, sudden attacks of rapid, inexplicable fury or unmotivated actions with inappropriate affect develop. The enthusiastic exaltation of patients is quickly replaced by anxiety, confusion, and fragmented thinking and speech. The main symptom of catatonic stupor is absolute immobility. More often, patients freeze while sitting or lying in the fetal position, less often - standing. There are no reactions to surrounding events and people, contact is impossible.

Another form of motor-volitional disorders is catalepsy (waxy flexibility). The arbitrariness of active movements is lost, but pathological subordination to passive ones is observed - any posture given to the patient is maintained for a long time. With mutism, patients are silent and do not establish verbal contact while the physiological component of speech is preserved. Negativism is manifested by meaningless opposition, unmotivated refusal to perform expedient actions. Sometimes it is accompanied by the opposite activity. Characteristic of children during periods age crises. Stereotypes are monotonous monotonous repetitions of movements or rhythmic repetition of words, phrases, syllables. Patients with passive obedience always follow the orders of others, regardless of their content. With echopraxia, there is a complete repetition of all the actions of another person, with echolalia - a complete or partial repetition of phrases.

Complications

With prolonged course and absence of treatment volitional disorders may become dangerous to the health and life of the patient. Hypobulic symptoms interfere with professional activities and become grounds for dismissal. Abulia leads to weight loss, exhaustion of the body, and infectious diseases. Hyperbulia is sometimes the cause of illegal actions, as a result of which patients are brought to administrative and criminal liability. Among parabulia, the most dangerous is the perversion of the instinct of self-preservation. It manifests itself in severe anorexia, the development of suicidal behavior and is accompanied by a risk fatal outcome.

Diagnostics

The main method of examining patients with volitional disorders remains clinical and anamnestic analysis. A psychiatrist needs to find out the presence of neurological diseases (studying outpatient records, neurologist notes), mental disorders and hereditary burden. The collection of information is carried out in the presence of relatives, because the patients themselves are not always able to maintain productive contact. During the diagnosis, the doctor differentiates disorders of volition with the characterological traits of the psychasthenic and excitable/hyperthymic type. In these cases, deviations in emotional-volitional reactions are the result of upbringing and are built into the structure of the personality. Methods for studying the volitional sphere include:

• Clinical conversation. During direct communication with the patient, the psychiatrist determines the preservation of a critical attitude towards the disease, the ability to establish contact, and maintain the topic of conversation. Hypobulia is characterized by poor speech, long pauses; for hyperbulia – asking again, quickly changing the direction of the conversation, an optimistic view of problems. Patients with parabulia provide information distorted, the motive of their communication differs from the motives of the doctor.
• Observation and experiment. To obtain more varied information, the doctor asks the patient to perform simple and complex tasks - take a pencil and a piece of paper, stand up and close the door, fill out a form. Disorders of the will are evidenced by changes in expressiveness, accuracy and speed of movements, the degree of activity and motivation. With hypobulic disorders, task performance is difficult, motor skills are slow; with hyperbulic – the speed is high, but the focus is reduced; with parabulia, the patient’s answers and reactions are unusual and inadequate.
• Specific questionnaires. In medical practice, the use of standardized methods for studying volitional deviations is not widespread. In the context of a forensic psychiatric examination, questionnaires are used that make it possible to objectify the data obtained to a certain extent. An example of such a technique is the Normative Scale for the Diagnostics of Volitional Disorders. Its results indicate the characteristics of volitional and affective deviations and the degree of their severity.

Treatment of volitional disorders

Violations of volitional functions are treated in combination with the underlying disease that caused them. The selection and prescription of therapeutic measures is carried out by a psychiatrist and a neurologist. As a rule, treatment is carried out conservatively with the use of medications, and in some cases, psychotherapy. Rarely, for example, with a brain tumor, the patient needs surgery. The general treatment regimen includes the following procedures:

• Drug treatment. With a decrease in willpower, a positive effect can be achieved by using antidepressants and psychostimulants. Hyperbulia and some types of parabulia are corrected with the help of antipsychotics, tranquilizers, and sedatives. Patients with organic pathology are prescribed vascular drugs and nootropics.
• Psychotherapy. Individual and group sessions are effective for pathologies of the volitional and affective sphere due to psychopathic and neurotic personality disorders. Patients with hypobulia are shown cognitive and cognitive-behavioral directions, psychoanalysis. Hyperbulic manifestations require mastering relaxation, self-regulation (auto-training), improving communication skills, and the ability to cooperate.
• Physiotherapy. Depending on the prevailing symptoms, procedures are used to stimulate or reduce activity nervous system. Low-frequency current therapy and massages are used.

Prognosis and prevention

If you consult a doctor in a timely manner and strictly follow his prescriptions, the prognosis for volitional disorders is favorable - patients return to their usual lifestyle, and the ability to regulate their own actions is partially or completely restored. It is quite difficult to prevent disorders; prevention is based on preventing the causes - mental illness, damage to the central nervous system. Following the following helps to become more stable psycho-emotionally healthy image life, compilation correct mode day. Another way to prevent disorders is regular examinations for the purpose of early detection of the disease, prophylactic appointment medicines.

Increased excitability or, conversely, passivity indicates a violation of the emotional-volitional sphere. Along with this, general hyperesthesia occurs, as well.

It is very difficult for babies to fall asleep during this period. They become restless at night and wake up frequently. A child can react violently to any stimuli, especially if he is in an unfamiliar environment.

Adults also largely depend on their mood, which can change for seemingly unknown reasons. Why does this happen and what is important to know about it?

Definition of the emotional-volitional sphere

For appropriate development in society, as well as normal life activity, the emotional-volitional sphere is important. A lot depends on her. And this applies not only to family relationships, but also to professional activities.

The process itself is very complex. Its origin is influenced by various factors. This can be either a person’s social conditions or his heredity. This area begins to develop at an early age and continues to develop until adolescence.

From birth, a person overcomes the following types of development:

• somato-vegetative;
• psychomotor;
• affective;
• dominance;
• stabilization.

Emotions are different...

As well as their manifestations in life

For what reasons does the failure occur?

There are a number of reasons that can influence the development of this process and cause emotional and volitional disturbances. To the main factors should include:

• lag in terms of intellectual development;
• lack of emotional contact with family;
• problems of a social and everyday nature.

Along with this, you can name any other reasons that can cause internal discomfort and a feeling of inferiority. At the same time, a child will be able to develop harmoniously and correctly only if he has a trusting relationship with his family.

Spectrum of disorders of will and emotions

Emotional volitional disorders include:

• hyperbulia;
• hypobulia;

With a general increase in will, hyperbulia develops, which can affect all major drives. This manifestation is considered characteristic of. So, for example, a person’s appetite will increase; if he is in a department, he will immediately eat the food that is brought to him.

Both will and drive decrease with hypobulia. In this case, the person does not need communication; he is burdened by strangers who are nearby. He feels better alone. Such patients prefer to immerse themselves in their own world of suffering. They do not want to take care of their relatives.

When a decrease in will occurs, this indicates abulia. Such a disorder is considered persistent, and together with apathy it is composed of an apathetic-abulic syndrome, which, as a rule, manifests itself during the final state of schizophrenia.

With obsessive drive, the patient has desires that he is able to control. But when he begins to renounce his desires, this gives rise to serious anxiety in him. He is haunted by thoughts of a need that has not been satisfied. For example, if a person has a fear of pollution, he will try not to wash his hands as often as he would like, but this will make him painfully think about his own need. And when no one is looking at him, he will wash them thoroughly.

Stronger feelings include compulsive attraction. It is so strong that it is compared to instincts. The need becomes pathological. Her position is dominant, so the internal struggle stops very quickly and the person immediately satisfies his desire. This can be a gross antisocial act, which will be followed by punishment.

Volitional disorders

Will is the mental activity of the individual, which is aimed at a specific goal or overcoming obstacles. Without this, a person will not be able to realize his intentions or solve life problems. Volitional disorders include hypobulia and abulia. In the first case, volitional activity will be weakened, and in the second, it will be completely absent.

If a person is faced with hyperbulia, which is combined with distractibility, then this may indicate or.

The desire for food and self-preservation are disrupted in the case of parabulia, that is, when a volitional act is perverted. The patient, refusing normal foods, begins to eat inedible foods. In some cases, pathological gluttony is observed. When the sense of self-preservation is impaired, the patient can cause serious injury to himself. This also includes sexual perversions, in particular masochism and exhibitionism.

Spectrum of volitional qualities

Emotional disorders

Emotions are different. They characterize people’s relationships to the world around them and to themselves. There are many emotional disorders, but some of them are considered an urgent reason to visit a specialist. Among them:

• depressed, melancholy mood, of a recurring, protracted nature;
• constant change of emotions, without serious reasons;
• uncontrollable emotional states;
• chronic;
• stiffness, uncertainty, timidity;
• high emotional sensitivity;
• phobias.

Emotional disorders include the following pathological deviations:

When a child is overly aggressive or withdrawn

Violations of the emotional-volitional sphere, which are most pronounced in children:

1. Aggressiveness. Almost every child can show aggression, but here it is worth paying attention to the degree of the reaction, its duration and the nature of the reasons.
2. Emotional disinhibition. IN in this case there is an overreaction to everything. Such children, if they cry, do so loudly and defiantly.
3. Anxiety. With such a violation, the child will be embarrassed to clearly express his emotions, he does not talk about his problems, and feels discomfort when attention is paid to him.

In addition, the disorder occurs with increased and decreased emotionality. In the first case, this concerns euphoria, depression, anxiety syndrome, dysphoria, fears. When it is low, apathy develops.

Violation of the emotional-volitional sphere and behavioral disorder are observed in a hyperactive child who experiences motor restlessness, suffers from restlessness, and impulsivity. He can't concentrate.

Such failures can be quite dangerous as they can lead to serious nervous disease, which recently often occur in children under 16 years of age. It is important to remember that psycho-emotional disruption can be corrected if it is detected at an early stage.

A modern view of correction

Identified as one of the main methods soft correction. It involves communication with horses. This procedure Suitable not only for children, but also for adults.

It can be used for the whole family, which will help unite it and improve trusting relationships. This treatment will allow you to say goodbye to a depressive mood, negative experiences, and reduce anxiety.

If we are talking about correcting disorders in a child, then a variety of psychological methods. Among them it is worth highlighting:

• play therapy, which involves the use of games (this method is considered especially effective for preschoolers);
• body-oriented therapy, dance;
• fairy tale therapy;
• , which is divided into two types: perception of finished material or independent drawing;
• music therapy, in which music is used in any form.

It is better to try to prevent any disease or deviation. To prevent emotional and volitional disorders, you should listen to these simple tips:

• if an adult or child is emotionally traumatized, then those nearby should be calm and show their goodwill;
• people need to share their experiences and feelings as often as possible;
• need to do physical labor or draw;
• monitor your daily routine;
• try to avoid unnecessary worry.

It is important to understand that a lot depends on those who are nearby. You don’t need to share your experiences with everyone around you, but you need to have someone who will help in a difficult situation, support and listen. In turn, parents must show patience, care and boundless love. This will preserve the baby’s mental health.

Emotions - this is one of the most important mechanisms of mental activity, producing a sensually colored subjective summary assessment of incoming signals, well-being internal state person and the current external situation.

A general favorable assessment of the current situation and existing prospects is expressed in positive emotions - joy, pleasure, tranquility, love, comfort. The general perception of the situation as unfavorable or dangerous is manifested by negative emotions - sadness, melancholy, fear, anxiety, hatred, anger, discomfort.

Thus, the quantitative characteristics of emotions should be carried out not along one, but along two axes: strong - weak, positive - negative. For example, the term “depression” refers to strong negative emotions, while the term “apathy” indicates weakness or complete absence of emotions (indifference). In some cases, a person does not have sufficient information to evaluate a particular stimulus - this can cause vague emotions of surprise and bewilderment. Healthy people rarely experience conflicting feelings: love and hatred at the same time. Emotion (feeling) is an internally subjective experience that is inaccessible to direct observation. The doctor judges the emotional state of a person by (in the broad sense of this term), i.e. by external expression of emotions: facial expressions, gestures, intonation, vegetative reactions. In this sense, the terms “affective” and “emotional” are used interchangeably in psychiatry. Often one has to deal with a discrepancy between the content of the patient’s speech and the facial expression and tone of the statement. Facial expressions and intonation in this case make it possible to assess the true attitude to what was said. Statements by patients about love for relatives, desire to get a job, combined with monotony of speech, lack of proper affect, indicate the unfoundedness of the statements, the predominance of indifference and laziness.

Emotions are characterized by some dynamic features. Prolonged emotional states correspond to the term “ mood

", which in a healthy person is quite flexible and depends on a combination of many circumstances - external (success or failure, the presence of an insurmountable obstacle or expectation of a result) and internal (physical ill health, natural seasonal fluctuations in activity). A change in the situation in a favorable direction should lead to an improvement in mood. At the same time, it is characterized by a certain inertia, so joyful news against the background of sorrowful experiences cannot evoke an immediate response from us. Along with stable emotional states, there are also short-term violent emotional reactions - a state of affect (in the narrow sense of the word). There are several main functions of emotions. The first of them, signal, allows you to quickly assess the situation - before a detailed logical analysis is carried out. Such an assessment, based on a general impression, is not completely perfect, but it allows you to avoid wasting unnecessary time on the logical analysis of unimportant stimuli. Emotions generally signal to us about the presence of some kind of need: we learn about the desire to eat by feeling hungry; about the thirst for entertainment - through a feeling of boredom. The second important function of emotions is communicative. person. It is emotions that make it possible to assess the significance of a particular human need and serve as an impetus for its implementation. Thus, the feeling of hunger prompts us to look for food, suffocation - to open the window, shame - to hide from spectators, fear

Ha- flee. It is important to consider that emotion does not always accurately reflect the true state of internal homeostasis and the characteristics of the external situation. Therefore, a person, experiencing hunger, can eat more than the body needs; experiencing fear, he avoids a situation that is not actually dangerous. On the other hand, a feeling of pleasure and satisfaction (euphoria) artificially induced with the help of drugs deprives a person of the need to act despite a significant violation of his homeostasis. Loss of the ability to experience emotions during mental illness naturally leads to inaction. Such a person does not read books or watch TV because he does not feel bored, and does not take care of his clothes and body cleanliness because he does not feel shame. Based on their influence on behavior, emotions are divided into: sthenic (inducing action, activating, exciting) and asthenic

(depriving activity and strength, paralyzing the will).

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

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

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

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

8.1.

Symptoms of Emotional Disorders

Emotional disorders are an excessive expression of a person’s natural emotions (hyperthymia, hypothymia, dysphoria, etc.) or a violation of their dynamics (lability or rigidity). We should talk about the pathology of the emotional sphere when emotional manifestations deform the patient’s behavior as a whole and cause serious maladjustment. persistent painful depression of mood. The concept of hypothymia corresponds to sadness, melancholy, and depression. Unlike the natural feeling of sadness caused by an unfavorable situation, hypothymia in mental illness is surprisingly persistent. Regardless of the immediate situation, patients are extremely pessimistic about their current condition and existing prospects. It is important to note that this is not only a strong feeling of sadness, but also an inability to experience joy. Therefore, a person in such a state cannot be cheered up by either a witty anecdote or good news. Depending on the severity of the disease, hypothymia can take the form of mild sadness, pessimism to a deep physical (vital) feeling, experienced as “mental pain,” “tightness in the chest,” “stone on the heart.” This feeling is called vital (pre-cardiac) melancholy,

it is accompanied by a feeling of catastrophe, hopelessness, collapse. Hypotymia as a manifestation of strong emotions is classified as a productive psychopathological disorder. This symptom is not specific and can be observed during an exacerbation of any mental illness; it is often found in severe somatic pathology (for example, with malignant tumors ), and is also included in the structure of obsessive-phobic, hypochondriacal and dysmorphomanic syndromes. However, first of all, this symptom is associated with the concept

depressive syndrome for which hypothymia is the main syndrome-forming disorder. Hyperthymia - persistent painful increase in mood. This term is associated with bright positive emotions - joy, fun, delight. Unlike situationally determined joy, hyperthymia is characterized by persistence. Over the course of weeks and months, patients constantly maintain amazing optimism and a feeling of happiness. They are full of energy, show initiative and interest in everything. Neither sad news nor obstacles to the implementation of plans disturb their general joyful mood. Hyperthymia is a characteristic manifestation manic syndrome.

The most acute psychoses are expressed by especially strong exalted feelings, reaching the degree ecstasy. which should be considered not so much as an expression of joy and happiness, but as a complacent and carefree affect. Patients do not show initiative, are inactive, and are prone to empty talk. Euphoria can be a sign of a wide variety of exogenous and somatogenic brain lesions (intoxication, hypoxia, brain tumors and extensive disintegrating extracerebral neoplasms, severe damage to hepatic and renal function, myocardial infarction, etc.) and can be accompanied by delusional ideas of grandeur (with paraphrenic syndrome, in patients with progressive paralysis).

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

Dysphoria are called sudden attacks of anger, malice, irritation, dissatisfaction with others and with oneself. In this state, patients are capable of cruel, aggressive actions, cynical insults, crude sarcasm and bullying. The paroxysmal course of this disorder indicates the epileptiform nature of the symptoms.

In epilepsy, dysphoria is observed either as an independent type of seizures, or is part of the structure of the aura and twilight stupefaction. Dysphoria is one of the manifestations of psychoorganic syndrome (see section 13.3.2). Dysphoric episodes are also often observed in explosive (excitable) psychopathy and in patients with alcoholism and drug addiction during the period of abstinence. Anxiety -

the most important human emotion, closely related to the need for security, expressed by a feeling of an impending uncertain threat, internal excitement. Anxiety is a sthenic emotion: accompanied by tossing, restlessness, restlessness, and muscle tension. As an important signal of trouble, it can arise in the initial period of any mental illness. In obsessive-compulsive neurosis and psychasthenia, anxiety is one of the main manifestations of the disease. In recent years, suddenly occurring (often against the backdrop of a traumatic situation) panic attacks, manifested by acute attacks of anxiety, have been identified as an independent disorder. A powerful, unfounded feeling of anxiety is one of the early symptoms of incipient acute delusional psychosis. In acute delusional psychoses (syndrome of acute sensory delirium), anxiety is extremely expressed and often reaches the degree in which it is combined with uncertainty, misunderstanding of the situation, and impaired perception of the surrounding world (derealization and depersonalization). Patients are looking for support and explanations, their gaze expresses surprise ( affect of bewilderment). Like the state of ecstasy, such a disorder indicates the formation of oneiroid.

Ambivalence - simultaneous coexistence of 2 mutually exclusive emotions (love and hatred, affection and disgust). In mental illness, ambivalence causes significant suffering to patients, disorganizes their behavior, and leads to contradictory, inconsistent actions ( ambition).

Swiss psychiatrist E. Bleuler (1857-1939) considered ambivalence as one of the most typical manifestations of schizophrenia. Currently, most psychiatrists consider this condition to be a nonspecific symptom, observed, in addition to schizophrenia, in schizoid psychopathy and (in a less pronounced form) in healthy people prone to introspection (reflection). Apathy

- absence or sharp decrease in the expression of emotions, indifference, indifference. Patients lose interest in loved ones and friends, are indifferent to events in the world, and are indifferent to their health and appearance. The patients' speech becomes boring and monotonous, they do not show any interest in the conversation, their facial expressions are monotonous. The words of others do not cause them any offense, embarrassment, or surprise. They may claim that they feel love for their parents, but when meeting with loved ones they remain indifferent, do not ask questions and silently eat the food brought to them. The unemotionality of patients is especially pronounced in a situation that requires an emotional choice (“What food do you like best?”, “Who do you love more: dad or mom?”). Lack of feelings prevents them from expressing any preference. Apathy refers to negative (deficit) symptoms. It often serves as a manifestation of final states in schizophrenia. It should be taken into account that apathy in patients with schizophrenia is constantly increasing, going through a number of stages that differ in the degree of severity of the emotional defect: smoothness (leveling) of emotional reactions, emotional coldness,

emotional dullness. Another cause of apathy is damage to the frontal lobes of the brain (trauma, tumors, partial atrophy). (anaesthesiapsychicadolorosa, mournful insensibility).

The main manifestation of this symptom is not considered to be the absence of emotions as such, but a painful feeling of one’s own immersion in selfish experiences, the consciousness of the inability to think about anyone else, often combined with delusions of self-blame.

The phenomenon of hypoesthesia often occurs (see section 4.1). Patients complain that they have become “like a piece of wood”, that they “don’t have a heart, but an empty tin can”; They lament that they do not feel worried about their young children and are not interested in their successes at school. The vivid emotion of suffering indicates the severity of the condition, the reversible productive nature of the disorders. Anaesthesiapsychicadolorosa is a typical manifestation of the depressive syndrome.

Symptoms of disturbances in the dynamics of emotions include emotional lability and emotional rigidity. Emotional lability- this is extreme mobility, instability, ease of emergence and change of emotions. Patients easily move from tears to laughter, from fussiness to carefree relaxation. Emotional lability is one of the important characteristics of patients with hysterical neurosis and hysterical psychopathy. A similar condition can also be observed in syndromes of stupefaction (delirium, oneiroid). One of the options for emotional lability is weakness (emotional weakness). For

A 69-year-old patient with diabetes mellitus and severe memory disorders vividly experiences her helplessness: “Oh, doctor, I was a teacher. The students listened to me with their mouths open. And now kneading kneading.

Whatever my daughter says, I don’t remember anything, I have to write everything down. My legs can’t walk at all, I can barely crawl around the apartment...” The patient says all this while constantly wiping her eyes. When the doctor asks who else lives in the apartment with her, he answers: “Oh, our house is full of people! It's a pity my dead husband didn't live long enough. My son-in-law is hard-working and caring. The granddaughter is smart: she dances, and draws, and speaks English... And her grandson will go to college next year - his school is so special!” The patient pronounces the last phrases with a triumphant face, but the tears continue to flow, and she constantly wipes them with her hand. Emotional rigidity

- stiffness, stuckness of emotions, tendency to experience feelings for a long time (especially emotionally unpleasant ones). Expressions of emotional rigidity are vindictiveness, stubbornness, and perseverance. In speech, emotional rigidity is manifested by thoroughness (viscosity). The patient cannot move on to discussing another topic until he fully speaks out about the issue that interests him. Emotional rigidity is a manifestation of general torpidity

mental processes

observed in epilepsy. There are also psychopathic characters with a tendency to get stuck (paranoid, epileptoid).

8.2. - a general increase in will and drives, affecting all the basic drives of a person. An increase in appetite leads to the fact that patients, while in the department, immediately eat the food brought to them and sometimes cannot resist taking food from someone else’s nightstand. Hyperthymia -

Hypersexuality is manifested by increased attention to the opposite sex, courtship, and immodest compliments. Patients try to attract attention with bright cosmetics, flashy clothes, stand for a long time in front of the Mirror, tidying up their hair, and can engage in numerous casual sexual relationships. There is a pronounced desire to communicate: every conversation of others becomes interesting for patients, they try to join in the conversations of strangers. Such people strive to provide patronage to any person, give away their things and money, make expensive gifts, get involved in a fight, wanting to protect the weak (in their opinion). It is important to take into account that the simultaneous increase in drives and will, as a rule, does not allow patients to commit obviously dangerous and grossly illegal actions, sexual violence. Although such people usually do not pose a danger, they can disturb others with their intrusiveness, fussiness, behave carelessly, and misuse property. - Hyperbulia is a characteristic manifestation Tipobulia general decline Suppression of impulses in depression is a temporary, transient disorder.

Relieving an attack of depression leads to renewed interest in life and activity. At abulia

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

characteristic of final states in schizophrenia.

With progressive diseases, doctors can observe an increase in the phenomena of abulia - from mild laziness, lack of initiative, inability to overcome obstacles to gross passivity. A 31-year-old patient, a turner by profession, after suffering an attack of schizophrenia, left work in the workshop because he considered it too difficult for himself. He asked to be hired as a photographer for the city newspaper, since he had done a lot of photography before. One day, on behalf of the editors, I had to write a report about the work of collective farmers. I arrived in the village in city shoes and, in order not to get my shoes dirty, did not approach the tractors in the field, but only took a few pictures from the car. He was fired from the editorial office for laziness and lack of initiative. I didn’t apply for another job. At home he refused to do any household chores. I stopped caring for the aquarium that I had built with my own hands before I got sick. All day long I lay in bed dressed and dreamed of moving to America, where everything was easy and accessible. He did not object when his relatives turned to psychiatrists with a request to register him as disabled. Manifestations of mental disorders may include perversion of appetite, sexual desire, desire for antisocial behavior (theft, alcoholism, vagrancy), and self-harm. Table 8.1 shows the main terms denoting impulse disorders according to ICD-10.

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

Table 8.1. Clinical variants of impulse disorders

Code according to ICD-10	Name of disorder	Nature of manifestation
	Pathological
	passion for gambling
	games
	Pyromania	The desire to commit arson
	Kleptomania	Pathological theft
	Trichotillomania	The urge to snatch at myself
	Pica (pica)	The desire to eat inedible things
	» in children	(as a variety, coprofa-
		Gia- eating excrement)
	Dipsomania	Craving for alcohol
	Dromomania	The desire to wander
	Homicidomania	A senseless desire to
		commit murder
	Suicidemania	Suicidal impulse
	Oniomania	The urge to shop (often
		unnecessary)
	Anorexia nervosa	The desire to limit oneself
		food, lose weight
	Bulimia	Binges of overeating
	Transsexualism	The desire to change gender
	Transvestism	The desire to wear clothes
		opposite sex
	Paraphilias,	Sexual predilection disorders
	including:	respects
	fetishism	Getting sexual pleasure
		joy from contemplating before
		intimate wardrobe items
	exhibitionism	Passion for nudity
	voyeurism	Passion for peeping
		married
	pedophilia	Attraction to minors
		in adults
	sadomasochism	Achieving sexual pleasure
		creation by causing
		pain or mental distress
	homosexuality	Attraction to one's own person

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

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

Each of the pathological drives can be expressed to varying degrees.

There are 3 clinical variants of pathological drives - obsessive and compulsive drives, as well as impulsive actions. Obsessive (obsessive) attraction

involves the emergence of desires that the patient can control in accordance with the situation. Attractions that clearly diverge from the requirements of ethics, morality and legality are in this case never implemented and are suppressed as unacceptable. However, refusal to satisfy the drive gives rise to strong feelings in the patient; against your will, thoughts about an unfulfilled need are constantly stored in your head. If it is not clearly antisocial in nature, the patient carries it out as soon as possible.

Thus, a person with an obsessive fear of contamination will restrain the urge to wash his hands for a short time, but will definitely wash them thoroughly when no one is looking at him, because all the time he endures, he constantly thinks painfully about his need. are committed by a person immediately, as soon as a painful attraction arises, without a previous struggle of motives and without a decision-making stage. Patients can think about their actions only after they have been committed. At the moment of action, an affectively narrowed consciousness is often observed, which can be judged by subsequent partial amnesia. Among impulsive actions, absurd ones, devoid of any meaning, predominate.

Often patients subsequently cannot explain the purpose of what they did.

Impulsive actions are a frequent manifestation of epileptiform paroxysms.

Patients with catatonic syndrome are also prone to commit impulsive actions.

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

8.3. Syndromes of emotional-volitional disorders The most striking manifestations of affective disorders are depressive and manic syndromes (Table 8.2). 8.3.1.

Depressive syndrome

Clinical picture of a typical depressive syndrome

usually described as a triad of symptoms: decreased mood (hypotymia), slowed thinking (associative inhibition) and motor retardation. It should, however, be taken into account that a decrease in mood is the main syndrome-forming symptom of depression.

Depressive triad: decreased mood, ideational retardation, motor retardation

Low self-esteem

pessimism

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

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

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

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

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

Manic triad: increased mood, accelerated thinking, psychomotor agitation

High self-esteem, optimism

Delusions of grandeur

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

Sleep disorder: reduced sleep duration, not emotive fatigue

Somatic disorders are not typical. Patients have no complaints, look young;

increased blood pressure corresponds to high activity of patients; body weight decreases with pronounced psychomotor agitation

Slowing down of thinking in mild cases is expressed by slow monosyllabic speech, long thinking about the answer. In more severe cases, patients have difficulty comprehending the question asked and are unable to cope with solving the simplest logical tasks. They are silent, there is no spontaneous speech, but complete mutism (silence) usually does not occur. Motor retardation is manifested in stiffness, slowness, clumsiness, and in severe depression it can reach the level of stupor (depressive stupor).

devotes his time to such an insignificant person. Not only their present state, but also their past and future are assessed pessimistically. They declare that they could not do anything in this life, that they brought a lot of trouble to their family, and were not a joy for their parents. They make the saddest forecasts; as a rule, they do not believe in the possibility of recovery.

In severe depression, delusional ideas of self-blame and self-deprecation are not uncommon.

Patients consider themselves deeply sinful before God, guilty of the death of their elderly parents and the cataclysms occurring in the country. They often blame themselves for losing the ability to empathize with others (anaesthesiapsychicadolorosa). The appearance of hypochondriacal delusions is also possible. Patients believe that they are hopelessly ill, perhaps with a shameful disease;

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

Depression, as a rule, is accompanied by a variety of somatovegetative symptoms. As a reflection of the severity of the condition, peripheral sympathicotonia is more often observed. A characteristic triad of symptoms is described: tachycardia, dilated pupils and constipation ( Protopopov's triad). The appearance of the patients is noteworthy. The skin is dry, pale, flaky. A decrease in the secretory function of the glands is expressed in the absence of tears (“I cried all my eyes out”). Hair loss and brittle nails are often noted.

A decrease in skin turgor manifests itself in the fact that wrinkles deepen and patients look older than their age. An atypical eyebrow fracture may be observed. Oscillations are recorded blood pressure

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

Vividness of emotional experiences, presence of delusional ideas, signs of hyperactivity vegetative systems allow us to consider depression as a syndrome of productive disorders (see Table 3.1). This is confirmed by the characteristic dynamics of depressive states. In most cases, depression lasts several months. However, it is always reversible.

Before the introduction of antidepressants and electroconvulsive therapy into medical practice, doctors often observed spontaneous recovery from this state. The most typical symptoms of depression have been described above. In each individual case, their set may vary significantly, but a depressed, melancholy mood always prevails. Full-blown depressive syndrome is considered a disorder psychotic level. The severity of the condition is indicated by the presence of delusional ideas, lack of criticism, active suicidal behavior, pronounced stupor, suppression of all basic drives. The mild, non-psychotic version of depression is referred to as subdepression. When conducting

scientific research To measure the severity of depression, special standardized scales (Hamilton, Tsung, etc.) are used. Depressive syndrome is not specific and can be a manifestation of a wide variety of mental illnesses: manic-depressive psychosis, schizophrenia, organic brain damage and psychogenic disorders. For depression caused by an endogenous disease (MDP and schizophrenia), severe somatovegetative disorders are more typical,

important sign

endogenous depression is a special daily dynamics of the state with increased melancholy in the morning and some weakening of feelings in the evening. It is the morning hours that are considered to be the period associated with the greatest risk of suicide. characterized by the absence of pronounced stiffness and passivity. The sthenic affect of anxiety makes patients fuss, constantly turn to others with a request for help or with a demand to stop their torment, to help them die. The premonition of an imminent catastrophe does not allow patients to sleep; they may attempt to commit suicide in front of others.

At times, the patients' excitement reaches the level of frenzy (melancholic raptus, raptus melancholicus), when they tear their clothes, make terrible screams, and bang their heads against the wall. Anxious depression is more often observed at involutionary age. Depressive-delusional syndrome, in addition to the melancholy mood, it is manifested by such plots of delirium as delusions of persecution, staging, and influence. Patients are confident of severe punishment for their crimes; “notice” constant observation of themselves. They fear that their guilt will lead to oppression, punishment or even the murder of their relatives. Patients are restless, constantly asking about the fate of their relatives, trying to make excuses, swearing that they will never make a mistake in the future. So atypical

delusional symptoms more typical not for MDP, but for an acute attack of schizophrenia (schizoaffective psychosis in terms of ICD-10).

Apathetic depression

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

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

An increase in all basic drives is characteristic. Appetite increases sharply, and sometimes there is a tendency to alcoholism. Patients cannot be alone and are constantly looking for communication. When talking with doctors, they do not always maintain the necessary distance, calling simply “brother!” Patients pay a lot of attention to their appearance, try to decorate themselves with badges and medals, women use excessively bright cosmetics, and try to emphasize their sexuality with clothes. Increased interest in the opposite sex is expressed in compliments, immodest proposals, declarations of love. Patients are ready to help and patronize everyone around them. At the same time, it often turns out that there is simply not enough time for one’s own family. They waste money and make unnecessary purchases. If you are too active, you will not be able to complete any of the tasks because new ideas arise every time. Attempts to prevent the realization of their drives cause a reaction of irritation and indignation ( angry mania).

Manic syndrome is characterized by a sharp decrease in the duration of night sleep. Patients refuse to go to bed on time, continuing to fuss at night. In the morning they wake up very early and immediately get involved in vigorous activity, but they never complain of fatigue and claim that they sleep quite enough. Such patients usually cause a lot of inconvenience to others, harm their financial and social situation, but, as a rule, they do not pose an immediate threat to the life and health of other people. Mild subpsychotic mood elevation ( hypomania)

in contrast to severe mania, it may be accompanied by awareness of the unnaturalness of the state; no delirium is observed. Patients can make a favorable impression with their ingenuity and wit. Physically, those suffering from mania look completely healthy, somewhat rejuvenated. With pronounced

psychomotor agitation

Manic syndrome is most often a manifestation of MDP and schizophrenia. Occasionally, manic states caused by organic brain damage or intoxication (phenamine, cocaine, cimetidine, corticosteroids, cyclosporine, teturam, hallucinogens, etc.) occur. Mania is a sign acute psychosis. The presence of bright productive symptoms allows us to count on a complete reduction of painful disorders. Although individual attacks can be quite long (up to several months), they are still often shorter than attacks of depression.

Along with typical mania, atypical syndromes of complex structure are often encountered. Manic-delusional syndrome, in addition to the affect of happiness, it is accompanied by unsystematized delusional ideas of persecution, staging, and megalomaniacal delusions of grandeur ( acute paraphrenia). Patients declare that they are called upon to “save the whole world,” that they are endowed with incredible abilities, for example, they are “the main weapon against the mafia,” and criminals are trying to destroy them for this.

A similar disorder does not occur in MDP and most often indicates an acute attack of schizophrenia. At the height of a manic-delusional attack, oneiric stupefaction can be observed.

8.3.3.

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

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

8.4.

Physiological and pathological affect The reaction to a traumatic event can proceed very differently depending on the individual significance of the stressful event and the characteristics of the person’s emotional response. In some cases, the form of manifestation of affect can be surprisingly violent and even dangerous for others. There are well-known cases of murder of a spouse due to jealousy, violent fights between football fans, heated disputes between political leaders. Rough antisocial manifestation of affect can be facilitated by a psychopathic personality type ( excitable psychopathy

- see section 22.2.4). Still, we have to admit that in most cases such aggressive actions are committed consciously: participants can talk about their feelings at the moment of committing the act, repent of their incontinence, and try to smooth out a bad impression by appealing to the severity of the insult inflicted on them. is called short-term psychosis, which occurs suddenly after the action of psychological trauma and is accompanied by clouding of consciousness with subsequent amnesia for the entire period of psychosis. The paroxysmal nature of the onset of pathological affect indicates that a psychotraumatic event becomes a trigger for the implementation of existing epileptiform activity. It is not uncommon for patients to have a history of severe head trauma or signs of organic dysfunction from childhood. The confusion of consciousness at the moment of psychosis is manifested by fury, the amazing cruelty of the violence committed (dozens of severe wounds, numerous blows, each of which can be fatal). Those around him are unable to correct the patient’s actions because he does not hear them. Psychosis lasts several minutes and ends with severe exhaustion: patients suddenly collapse without strength, sometimes falling into deep sleep. Upon emerging from psychosis, they cannot remember anything that happened, they are extremely surprised when they hear about what they have done, and cannot believe those around them. It should be recognized that disorders of pathological affect can only conditionally be classified as emotional disorders, since the most important expression of this psychosis is

twilight stupefaction

(see section 10.2.4). Pathological affect serves as the basis for declaring the patient insane and releasing him from responsibility for the crime committed. BIBLIOGRAPHY

Izard K. Human emotions. - M.: Moscow State University Publishing House, 1980.

Numer Yu.L., Mikhalenko I.N. Affective psychoses. - L.: Medicine, 1988. - 264 p.

Psychiatric diagnosis / Zavilyansky I.Ya., Bleikher V.M., Kruk I.V., Zavilyanskaya L.I. - Kyiv: Vyshcha School, 1989.

Psychology emotions. Texts / Ed. V.K.Vilyunas, Yu.B.Gippen-reuter. - M.: MSU, 1984. - 288 p.

Psychosomatic disorders in cyclothymic and cyclothymic-like conditions. - Proceedings of MIP., T.87. - Answer. ed. S.F. Semenov. - M.: 1979. - 148 p.

Reikovsky Ya. Experimental psychology of emotions.

- M.: Progress, 1979. Sinitsky V.N. Depressive states (pathophysiological characteristics, clinical picture, treatment, prevention). - Kyiv: Naukova Dumka, 1986.

Teacher - psychologist State government

educational institution

IN CHILDREN AND ADOLESCENTS,

PSYCHOLOGICAL SUPPORT

Bekhtereva Natalya Vladimirovna

teacher - psychologist

State government educational institution of the Sverdlovsk region “Novouralsk School No. 2, implementing adapted basic general education programs”

Nowadays, it is increasingly possible to meet families in which children not only do not want to study, but generally do not attend school for several months.The urgency of the problem affects not only one family, but also society as a whole.

« Motivation is a psychophysiological process that, under the influence of external or internal factors, stimulates people’s desire to engage in a particular activity.”

Motivation can be internal and external.

We can talk about internal motivation when a person does something simply for pleasure, interest, or achieving a goal.

With external motivation, activity is aimed at achieving certain goals. Moreover, they may not be directly related to the nature of this activity - for example, a child may go to school not because he wants to study, but so as not to be scolded by his parents (coercion and threat of punishment), for rewards, or to communicate with friends. External motivation is the stimuli that come to us from other people or circumstances. As for children, their external motivation is often coercion from an adult. That is, a child starts studying only because he was forced, intimidated, and not at all because he was instilled with an interest in learning new things. The development of the emotional volitional sphere proceeds in parallel with the formation of the child’s motivation and needs, and is one of the most important conditions formation of the child's personality. The development of the emotional sphere is facilitated by family, school, and all the life that surrounds and constantly influences the child. The emotional-volitional sphere is recognized as the primary form of mental life, the “central link” in the mental development of the individual.

In the process of growing up, a child faces problems that he has to solve with varying degrees of independence. Attitude to a problem or situation causes a certain emotional response, and attempts to influence the problem cause additional emotions. For the correct emotional-volitional development of a child, increasing ability to control the expression of emotions is essential.

The main causes of violations are:

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

Violations in the emotional-volitional sphere of a child’s personality have characteristic features of age-related manifestations.

In preschool age, excessive aggressiveness or passivity, tearfulness, “getting stuck” on a certain emotion, inability to follow norms and rules of behavior, and insufficient development of independence are observed.

At school age, these deviations, along with those listed, can be combined with self-doubt, violation social interaction, decreased sense of purpose, inadequate self-esteem.

The main external manifestations are as follows:

• Emotional tension. With increased emotional tension, difficulties in organizing mental activity and a decrease in play activity characteristic of a particular age may be expressed.
• The rapid mental fatigue of a child in comparison with peers or with earlier behavior is expressed in the fact that the child has difficulty concentrating, he may demonstrate a clear negative attitude towards situations where the manifestation of thinking and intellectual qualities is necessary.
• Increased anxiety can be expressed in avoidance of social contacts and decreased desire to communicate.
• Aggressiveness. Manifestations can be in the form of demonstrative disobedience to adults, physical aggression and verbal aggression. Also, his aggression can be directed at himself, he can hurt himself. The child becomes disobedient and with great difficulty succumbs to the educational influences of adults.
• Lack of empathy. In case of disturbances in the emotional-volitional sphere, it is usually accompanied by increased anxiety. Failure to empathize may also be a worrying sign mental disorder or intellectual retardation.
• Unpreparedness and unwillingness to overcome difficulties. The child is lethargic and does not enjoy contact with adults. Extreme manifestations of behavior may look like complete ignorance of parents or other adults - in certain situations, a child may pretend that he does not hear an adult.
• Low motivation to succeed. A characteristic sign of low motivation for success is the desire to avoid hypothetical failures, so the child takes on new tasks with displeasure and tries to avoid situations where there is even the slightest doubt about the result. It is very difficult to persuade him to try to do anything. A common answer in this situation is: “it won’t work,” “I don’t know how.” Parents may mistakenly interpret this as a manifestation of laziness.
• Expressed distrust of others. It can manifest itself as hostility, often accompanied by tearfulness; school-age children can manifest it as excessive criticism of the statements and actions of both peers and surrounding adults.
• Excessive impulsiveness of a child, as a rule, is expressed in poor self-control and insufficient awareness of his actions.
• Avoiding close contacts with other people. A child may repel others with remarks expressing contempt or impatience, or impudence.

Currently, there is an increase in emotional and volitional disorders.

The lack of formation of the emotional-volitional sphere can manifest itself at different levels:

• Behavioral – in the form of infantile personality traits, negative self-presentation, impaired ability to manage one’s emotions and adequately express them;
• Social – in the form of violations of emotional contacts, low level formation of motives for establishing and maintaining positive relationships with adults and peers, maladjustment;
• Communicative – in the form of undeveloped skills to establish and maintain a constructive level of communication, to understand and adequately assess the state and feelings of the interlocutor in accordance with the situation;
• Intellectual - in the form of inability to distinguish and determine emotions and emotional states of people, difficulties in understanding the conventionality (non-obvious meaning) of a situation, difficulties in understanding relationships between people, a reduced level of development of higher emotions and intellectual feelings (feelings of beauty, the joy of knowledge and discovery, a sense of humor ), and in general in a decrease in social intelligence and competence.

There are two types of emotional and volitional disorders:

• Impulsive type. The child begins to commit unexpected and rash actions that cannot be called reasonable only because of the emotions he experiences. Reacts poorly to criticism; they show aggression to any comments. Characteristic of people suffering from psychopathy.

• Borderline type. It often manifests itself in adolescence; this disorder is expressed in the fact that a person overreacts to any life situations, begins to exaggerate his own failures, and has a hard time withstanding stress. Often the result of such instability is the use of drugs and alcohol, suicide and violations of the law.

Causes:

Psychological trauma ( chronic stress, prolonged emotional stress);

- Hyper or hypoprotection from loved ones (especially in adolescence);

— Psychasthenia;

— Hormonal imbalance (hormonal imbalance);

— Acute shortage useful substances(vitamins, minerals).

Emotional unformation (instability) can also accompany some somatic diseases (diabetes mellitus, vascular and organic diseases brain, traumatic brain injury).

The most striking manifestations of emotional disorders are depressive and manic syndromes.

At depressive syndrome Three main signs can be observed in children and adolescents:

• Hypotomia (decreased mood).

The child is constantly yearning, feels depressed and sad,

shows reactions to joyful and other events.

• Associative inhibition (mental inhibition).

In its mild manifestations, it is expressed in the form of slowing down monosyllabic speech and taking a long time to think about the answer. A severe course is characterized by an inability to comprehend questions asked and solving a number of simple logical problems.

• Motor retardation.

Motor retardation manifests itself in the form of stiffness and slowness of movements. In severe depression, there is a risk of depressive stupor (a state of complete depression).

In manic syndrome, three main symptoms can be observed:

• Elevated mood due to hyperthymia (constant optimism, disregard for difficulties);
• Mental excitability in the form of accelerated thought processes and speech (tachypsia);
• Motor excitement.

Violations of the emotional and volitional sphere in children and adolescents must be treated comprehensively, taking into account psychological and physiological symptoms.

A school psychologist conducts a comprehensive psychodiagnostics of a student(methods and tests are used to assess the development and psychological state of a child, taking into account his age-related characteristics: art therapeutic techniques, Luscher color test, Beck Anxiety Scale, Well-Being, Activity, Mood (WAM) questionnaire, Philips School Anxiety Test).

Correction of disharmonies in the development of the child’s personality,teach how to react correctly when stressful situations arise and control your feelings,teach children to cope with life's difficulties, overcome barriers in communication, relieve psychological stress, and create an opportunity for self-expression.

Consultative work with parents or persons replacing them, with the child.

A doctor is a neurologist (he will help treat neurological disorders, diagnose, prescribe drug therapy to form dynamic balance and a certain safety margin of the central nervous system).

Including other specialists of a narrow profile (endocrinologist, psychiatrist).

Comprehensive and timely treatment in children and adolescents helps to completely eliminate the symptoms of the disease. That is why the main role is given to parents.

Analyzing the experience of doctors, psychologists, and teachers, we can give the following recommendations for working with the emotional and volitional sphere in children and adolescents:

1. 1. Create a clear daily routine for your child. This helps stabilize his unbalanced nervous system.
   2. Keep a close eye on the workload in your child's life. At the first signs of neurological distress, a consultation with a neurologist is necessary.
   3. Adequate physical activity is necessary; it reduces mental stress (sports sections, “Sports – Hour”).
   4. At psychological problems in the family - consultation with a school psychologist is necessary.
   5. If possible, ensure that your child attends child psychologist, for correction emotional disturbance Various areas are used (art therapy, play therapy, fairy tale therapy, ethnofunctional psychotherapy, relaxation exercises).

Prevention emotional states for children and adolescents in an educational institution the following:

— Knowledge of the family environment and the child’s predisposition to neurotic reactions.

— A benevolent atmosphere in the lesson, mitigating emotional discomfort (the teacher must constantly reinforce the child’s success, stimulate him to perform the activity with tips, approval, praise, and constant statements of success).

— Increasing activity and independence among students.

Correction of self-esteem, level of consciousness, formation of emotional stability and self-regulation.

— Choosing the right communication style.

Involvement in active creative forms of activity (a meaningful assessment of its results, every possible emphasis on achievements and a number of other means should help improve the academic performance of children with neuroses).

— Increasing teacher self-control.

— Motor relief for children, physical education lessons.

Literature:

1. Alyamovskaya V.G., Petrova S.N. Prevention of psycho-emotional stress in children preschool age. M., Scriptorium, 2002.- 432 p.
2. Benilova S. Yu. Special children - special communication // Journal of Education and training of children with developmental disorders, 2006. – No. 2.
3. Bozhovich L.I. Personality and its formation in childhood. – St. Petersburg: Peter, 2008. – 400 p.
4. Godovnikova L.V. Fundamentals of correctional and developmental work in mass schools: Textbook. allowance / Under scientific. ed. I. F. Isaeva. – Belgorod: BelSU Publishing House, 2005. – 201 p.
5. Rozhenko A. Correction of the emotional-volitional sphere of the child // Social security, 2005 - No. 3 February - pp. 16-17.
6. Semago N.Ya., Semago M.M. Problem children. Fundamentals of diagnostic and correctional work of a psychologist. M.: ARKTI, 2000.

Emotional - volitional disorders in children and adolescents, psychological support