5. Psychogenic disorders in extreme situations

Psychogenic disorders during extreme situations occupy a special place due to the fact that they can simultaneously occur in a large number of people, introducing disorganization into the overall course of rescue and recovery work. This determines the need for prompt assessment of the condition of victims, prognosis of identified disorders, as well as the application of necessary and possible (in specific extreme conditions) therapeutic measures. In these cases, extreme conditions are understood as situations that are dangerous to the life, health and well-being of significant groups of the population, caused by natural disasters, catastrophes, accidents, or use by the enemy in the event of war. various types weapons. Any extreme impact becomes catastrophic when it causes great destruction, death, injury and suffering of a significant number of people. The World Health Organization defines natural disasters as situations characterized by unforeseen, serious and immediate threats public health. As special studies have shown (Aleksandrovsky Yu.A., Lobastov O.S., Spivak L.I., Shchukin B.P., 1991), psychopathological disorders in extreme situations have much in common with clinical disorders that develop in normal conditions. However, there are also significant differences. Firstly, due to the multiplicity of sudden psycho-traumatic factors in extreme situations, mental disorders occur simultaneously in a large number of people. Secondly, the clinical picture in these cases is not strictly individual, as in ordinary psychotraumatic circumstances, in nature and is reduced to a small number of fairly typical manifestations. Another feature is that, despite the development of psychogenic disorders and ongoing life dangerous situation, the affected person is forced to continue to actively fight the consequences of a natural disaster (catastrophe) for the sake of survival and preserving the lives of loved ones and everyone around him. Reactive states that develop during natural disasters and catastrophes belong to a large group of psychogenic disorders, among which are neurotic and pathocharacterological reactions, neuroses and reactive psychoses. The peculiarities of complex interactions between external and internal acting factors and soil explain the diverse manifestations of all reactive states, including those developing in extreme conditions. In this case, “pathogenic circumstances - factors of the situation”, the severity and strength of their impact, and the semantic content - the semantics of psychotrauma - are of particular importance. Acute and severe traumatic effects are usually associated with situations of catastrophes and natural disasters, in which there is fear for one’s life and for the health and lives of loved ones. One of the main qualities of such injuries is that they are “irrelevant for the individual” and are not associated with the characteristics of the premorbid (Ushakov G.K., 1987). The situation of fear affects predominantly the emotional side and does not require intensive personal processing, “the reaction arises as if reflexively, without intrapsychic processing" (Krasnushkin E.K., 1948; Heimann H., 1971; Hartsough D., 1985). Variations in the rate of influence can explain not only the degree of participation of the individual in the formation of the characteristics of the clinical picture, but also the depth, duration and severity psychogenic disorders, the predominance of certain forms and options during various natural disasters. L.Ya. Brusilovsky, N.P. Brukhansky and T.E. Segalov in a joint report at the First All-Union Congress of Neuropathologists and Psychiatrists (1927) shortly after the devastating earthquake in Crimea specifically analyzed the various neuropsychic reactions observed in the victims. At the same time, as the most typical mechanism for the development of these reactions, they identified “inhibition of higher mental activity,” as a result of which an “earthquake shock” develops, freeing the “subconscious sphere of instincts.” This is precisely what, from the point of view from the point of view of the authors of the report, explains various psychogenic disorders; They assign “a predominantly plastic role” to “constitutional moments” in the formation of neurotic and psychotic reactions. Depending on the clinical picture, psychogenic disorders can be divided into two groups - with non-psychotic symptoms ( psychogenic reactions and states) and with psychotic disorders(reactive psychoses). Differentiated consideration clinical forms and variants of psychogenic disorders, their delimitation from a wide range of neurosis-like and psychopath-like conditions requires qualified observation of patients, analysis, assessment of the dynamics of the condition, paraclinical studies, etc. This is only possible in a medical institution with a psychiatrist and, if necessary, other specialists. It is absolutely clear that in a situation caused by extreme influences, when there may be a large number of people with psychogenic disorders and when there may be no psychiatrist among medical workers, a rationally simplified assessment taxonomy of emerging mental disorders is necessary. It should be based on express diagnostics necessary to resolve a number of questions about the possibility of leaving the victim in a psychogenic-traumatic extreme situation or the order of his evacuation, on the prognosis developing condition, necessary medical appointments. The closer a victim with psychogenic disorders is to a specialized medical institution, the more opportunities there will be for clarifying the initial diagnosis and introducing additional clinical justifications into it. Experience shows that in the vast majority of cases, a specialist doctor, already at the initial stage of medical triage of people with psychogenic disorders, quite quickly and correctly resolves fundamental issues about evacuation, prognosis and the necessary relief therapy. In this case, it is most appropriate to distinguish both non-pathological (physiological) neurotic phenomena (reactions to stress, adaptation reactions) and neurotic reactions, conditions and reactive psychoses. In each of these diagnostic groups there are features that predetermine the medical-organizational and therapeutic tactics.

Table no. Psychogenic disorders observed in life-threatening situations during and after natural disasters and disasters

Reactions and psychogenic disorders		Clinical features
Non-pathological (physiological) reactions		The predominance of emotional tension, psychomotor, psychovegetative, hypothymic manifestations, maintaining a critical assessment of what is happening and the ability to perform purposeful activities
Psychogenic pathological reactions		Neurotic level of disorders - acute, asthenic, depressive, hysterical and other syndromes, decreased critical assessment of what is happening and the possibility of purposeful activity
Psychogenic neurotic conditions		Stabilized and increasingly complicated neurotic disorders - neurasthenia (exhaustion neurosis, asthenic neurosis), hysterical neurosis, neurosis obsessive states, depressive neurosis, in some cases loss of critical understanding of what is happening and the possibilities of purposeful activity
Reactive psychoses	Acute	Acute affective-shock reactions, twilight states of consciousness with motor agitation or motor retardation
	Lingering	Depressive, paranoid, pseudodementia syndromes, hysterical and other psychoses

Reactive psychoses (affective-shock reactions), developing in extreme situations, in contrast to non-pathological neurotic disorders, are characterized by severe disturbances in mental activity, which deprive a person (or a group of people) of the opportunity to correctly (undistorted) reflect what is happening and for a long time cause disruption of work and performance. At the same time, as already noted, autonomic and somatic disorders are clearly manifested - from the cardiovascular, endocrine and respiratory systems, gastrointestinal tract, etc. In some cases, somatic disorders become so pronounced that they lead to painful manifestations. Reactive psychoses usually develop acutely; their occurrence usually requires a combination of extreme unfavorable factors. It is generally accepted that the development of reactive psychoses, as well as neurotic reactions, is facilitated by predisposing factors, for example, overwork, general asthenia, disturbances in sleep, nutrition, etc., preliminary physical and mental trauma (for example, minor injuries to the body and head, worry about the fate of relatives and loved ones, etc.). Fugiform reactions are short-lived - up to several hours, stuporous reactions are longer - up to 15-20 days. Full recovery is observed in almost all cases; the average length of hospitalization for acute affective-shock reactions during the war was up to 30 days. These reactions, typical for combat conditions, according to the mechanisms of their occurrence, are interpreted as “primitive reactions to a threat to life” (Ivanov F.I., 1970). Psychogenic twilight states of consciousness are characterized by a narrowing of the volume of consciousness, predominantly automatic forms of behavior, motor restlessness (less often retardation), sometimes fragmentary hallucinatory and delusional experiences; they are usually short-lived (in 40% of all patients they end within one day). As a rule, all persons who have suffered psychogenic twilight disorders, noted full recovery health and adapted activities. Protracted reactive psychoses develop more slowly than acute ones, usually within several days; the depressive form of protracted psychosis is most often observed. In terms of symptoms, these are typical depressive states with a well-known triad of clinical manifestations (decreased mood, motor retardation, slow thinking). At the same time, patients are “absorbed” by the situation and all their experiences are determined by it. Usually there is a deterioration in appetite, weight loss, bad dream, constipation, tachycardia, dry mucous membranes, in women - cessation of menstruation. Severe manifestations of depression without active treatment often drag on for 2-3 months. The final prognosis is relatively favorable in most cases. Psychogenic paranoid usually develops slowly, over several days, and is usually protracted. Among the clinical manifestations, the first place is taken by affective disorders: anxiety, fear, depression. Against the background of these disorders, persistent delusions of relation and persecution usually develop. There is a close connection between affective disorders and the severity (saturation) of delusional experiences. The pseudodementia form, like other protracted psychoses, develops within a few days, although cases are often noted acute development pseudodementia. The duration of the period of psychotic phenomena reaches a month or more. The condition of the patients is characterized by deliberately crude demonstrations of intellectual impairment (the inability to name age, date, list facts from the anamnesis, names of relatives, perform basic calculations, etc.). The behavior in this case is of the nature of foolishness: inadequate facial expressions, stretching of the lips with a “proboscis”, lisping speech, etc. Pseudodementia manifests itself especially clearly when asked to perform simple arithmetic operations (addition, subtraction, multiplication). The errors are so monstrous that one gets the impression that the patient is deliberately giving incorrect answers. It should be noted that in the literature, special attention is paid to the possibility of the development of psychogenic disorders simultaneously with other lesions - injuries, wounds, burns. In such cases, a more severe course of the underlying lesion is possible. We can probably agree with N.N. Timofeev (1967), who noted that “every closed brain injury is fraught with lung capabilities development of psychogenic, neurotic reactions and fixation painful symptoms"Therefore, the uncomplicated course of a closed brain injury depends on the tactics of a medical specialist who ensures “mental asepsis” to the same extent that proper treatment of the wound ensures its uncomplicated healing. A study of mental disorders observed in extreme situations, as well as an analysis of the entire complex of life-saving measures , social and medical measures makes it possible to schematically identify three periods of development of the situation in which various psychogenic disorders are observed

EMERGENCIES AND PSYCHOGENIC DISORDERS

Behind Lately emergency situations, paradoxical as it may sound, are increasingly becoming a fact of our everyday life. During natural disasters, catastrophes and other extreme impacts, mass psychogenic disorders often develop, causing disorganization in the overall course of rescue and restoration work.
Psychopathological disorders in extreme situations have much in common with those developing under normal conditions. However, there are also significant differences. Firstly, due to a variety of traumatic factors, disorders occur simultaneously in a large number of people. Secondly, their clinical picture is not strictly individual, as usual, but comes down to fairly typical manifestations. A special feature is that the victim is forced to continue to actively fight the consequences of a natural disaster (catastrophe) in order to survive himself and protect loved ones.

“New” diagnostic (terminological) assessments of mental disorders associated with emergency situations, which came into practice in the second half of the twentieth century.
Post-traumatic stress disorders(PTSD):
"Vietnamese" "Afghan" "Chechen" and others	SYNDROMES
Radiation phobia (RF) Battle fatigue (BC) Social stress disorders (SSD)

Differentiated consideration of clinical forms and variants of disorders, their delimitation from a wide range of neurosis-like and psychopath-like conditions require qualified observation, analysis, assessment of the dynamics of the patient’s condition, paraclinical studies, etc. This is only possible in a medical institution with a psychiatrist and, if necessary, other specialists. It is clear that in an emergency, a psychiatrist may not be on site.
Express diagnostics are needed to resolve urgent issues (leave the victim in place or evacuate, what to do medical purposes) and evaluate the forecast. The closer the victim is to a specialized medical institution, the greater the opportunity to clarify the initial diagnosis and add additional clinical justification to it. Experience shows that in the overwhelming majority of cases, the doctor, already at the initial stage of medical triage of persons with psychogenic disorders, quite quickly and correctly resolves the fundamental issues of evacuation, prognosis and the need for relief therapy, highlighting as non-pathological (physiological) neurotic phenomena(reactions to stress, adaptive reactions), as well as neurotic reactions, conditions and reactive psychoses(see table).
Most often, psychogenic disorders arise in life-threatening situations characterized by catastrophic suddenness. Human behavior in this case is largely determined by fear, which to certain limits can be considered physiologically normal and adaptively useful. Essentially, tension and fear arise with every human-recognized catastrophe. "Fearless" mentally normal people in the generally accepted understanding, these words do not exist. It's all about the time needed to overcome confusion, make a rational decision and take action. For a person prepared for an extreme situation, this time period is much shorter; in a completely unprepared person, persistent confusion determines prolonged inactivity, fussiness and is the most important indicator of the risk of developing a psychogenic disorder.

Table. Mental disorders observed in life-threatening situations during and after natural disasters and disasters
Reactions and psychogenic disorders	Clinical features
Reactive psychoses: spicy	Acute affective-shock reactions, twilight states of consciousness with motor agitation or motor retardation
protracted	Depressive, paranoid, pseudodementia syndromes, hysterical and other psychoses
Non-pathological (physiological) reactions	Relatively short-term and directly related to the psychogenic situation, the predominance of emotional tension, psychomotor, psychovegetative, hypothymic manifestations, preservation of a critical assessment of what is happening and the ability to perform purposeful activities
Psychogenic pathological reactions	Neurotic level of disorders - acute asthenic, depressive, hysterical and other syndromes, decreased critical assessment of what is happening and the possibility of purposeful activity
Psychogenic disorders (conditions) of a neurotic level	Stabilized and increasingly complex neurotic disorders - neurasthenia (exhaustion neurosis, asthenic neurosis), hysterical neurosis, obsessive-compulsive neurosis, depressive neurosis, in some cases, loss of critical understanding of what is happening and the possibilities of purposeful activity

This is how a nuclear specialist describes his condition in the extreme conditions associated with an accident at a power unit: “At the moment the AZ-5 (emergency protection) button was pressed, the bright illumination of the indicators flashed in a frightening manner. Even the most experienced and cold-blooded operators’ hearts clench in such seconds. .. I know the feeling experienced by operators at the first moment of an accident. I have been in their shoes many times when I worked in the operation of nuclear power plants. In the first moment - numbness in the chest, everything collapses like an avalanche, a cold wave of involuntary fear, primarily because of being taken by surprise and at first you don’t know what to do, while the arrows of the recorders and instruments scatter in different directions, and your eyes follow them, when the reason and pattern of the emergency mode are still unclear, when at the same time (again involuntarily) you think somewhere in the depths, a third plan, about the responsibility and consequences of what happened. But in the next moment, extraordinary clarity of head and composure sets in..."
In unprepared people who unexpectedly find themselves in a life-threatening situation, fear is sometimes accompanied by an altered state of consciousness. Most often, stupefaction develops, expressed in incomplete understanding of what is happening, difficulty in perceiving it, vagueness (at severe levels - inadequacy) of life-saving actions.
Special studies conducted from the 2nd day of the Spitak earthquake in Armenia in December 1988 revealed in more than 90% of those examined psychogenic disorders of varying severity and duration - from lasting several minutes to long-term and persistent.
Immediately after acute exposure, when signs of danger appear, confusion and lack of understanding of what is happening occur. During this short period with a simple fear reaction activity increases moderately, movements become clear and economical, muscle strength increases, which helps many people move to a safe place. Speech disturbances are limited to acceleration of its tempo, stuttering, the voice becomes loud, ringing, will, attention, and ideational processes are mobilized. Mnestic disturbances are represented by a decrease in fixation of the environment, unclear memories of what is happening around. However, one’s own actions and experiences are remembered in full. A change in the concept of time is characteristic: its flow slows down, the duration of the acute period seems to increase several times.
For complex fear reactions First of all, more pronounced movement disorders. Along with mental disorders, nausea, dizziness, frequent urination, chill-like tremors, fainting, and miscarriages in pregnant women are common. The perception of space changes: the distance between objects, their sizes and shapes are distorted. In a number of observations, the environment seems “unreal”, and this state lasts for several hours after exposure. Kinesthetic illusions (feelings of earth vibrations, flying, swimming, etc.) can also persist for a long time.
Typically, such experiences develop during earthquakes and hurricanes. For example, after a tornado, many victims note the action of an incomprehensible force that “seems to be pulling them into a hole,” they “resist it,” grab various objects with their hands, trying to stay in place. One victim said that he felt as if he was floating through the air, while making the same movements with his arms as when swimming.
With simple and complex reactions of fear, consciousness is narrowed, although in most cases accessibility to external influences, selectivity of behavior, and the ability to independently get out of a difficult situation are preserved. A special place is occupied by states of panic. Individual panic reactions are reduced to affective-shock reactions. When they develop simultaneously in several people, an effect of mutual influence is possible, leading to massive induced emotional disorders, which are accompanied by “animal” fear. Panic inducers are panickers, people with expressive movements, the hypnotizing power of screams, and false confidence in their actions. By becoming crowd leaders in emergency situations, they can create general disorder that quickly paralyzes the entire team.
Prevent panic, preliminary training in actions in critical situations, truthful and complete information during and at all stages of the development of emergency events, special training active leaders who are capable of leading the confused at a critical moment, directing their actions towards self-rescue and the rescue of other victims.
In the development of an extreme situation, 3 periods are defined, each of which is characterized by certain psychogenic disorders (see diagram).
First - acute - period lasts from the beginning of the impact to the organization of rescue operations (minutes, hours). At this time, predominantly psychogenic reactions of a psychotic and non-psychotic level are observed, among which a special place is occupied by mental disorders in those injured and wounded. The doctor has to conduct a qualified differential diagnostic analysis in order to identify the cause-and-effect relationship of mental disorders both directly with psychogenic disorders and with the resulting injuries (traumatic brain injury, intoxication due to a burn, etc.).
Special attention should be paid to the peculiarities of the beginning of the development of a life-threatening situation when the first period is extended in time. The danger at this time may not have signs that allow it to be perceived as threatening (as, for example, in an accident at Chernobyl nuclear power plant). Awareness of a threat to life and health arises only as a result of official and unofficial (rumors) information from various sources. Therefore, psychogenic reactions develop gradually, involving more and more new groups of the population. Non-pathological neurotic manifestations predominate, as well as reactions of a neurotic level, determined by anxiety that appears following the awareness of danger; specific gravity psychotic forms are usually insignificant. Only in isolated cases are reactive psychoses with anxiety-depressive and depressive-paranoid disorders identified and existing mental illnesses are exacerbated.
After the end of the acute period, some victims experience short-term relief, an uplift in mood, actively participate in rescue work, and sometimes talk verbosely, repeating themselves many times, about their experiences. This euphoria phase lasts from a few minutes to several hours.. As a rule, it is replaced by lethargy, indifference, ideational inhibition, difficulties in comprehending the questions asked, and performing even simple tasks. Against this background, episodes of psycho-emotional stress with a predominance of anxiety are observed. In some cases, the victims give the impression of being detached, self-absorbed, sigh frequently and deeply, and bradyphasia is noted. Retrospective analysis shows that the internal experiences of these people are often associated with mystical and religious ideas. Another option for the development of an anxiety state during this period may be "anxiety with activity", manifested by motor restlessness, fussiness, impatience, verbosity, and the desire for an abundance of contacts with others. Expressive movements are somewhat demonstrative and exaggerated. Episodes of psycho-emotional stress are quickly replaced by lethargy and apathy; there is a mental “processing” of what happened, awareness of losses, attempts are made to adapt to new living conditions.
On the background autonomic dysfunctions psychosomatic diseases that were relatively compensated before the extreme event often worsen, and persistent psychosomatic disorders appear. This most often occurs in older people, as well as in the presence of residual phenomena organic disease CNS of inflammatory, traumatic, vascular origin.
In the second period (deployment of rescue operations)“normal” life begins in extreme conditions. At this time, for the formation of states of maladaptation and mental disorders, the personality characteristics of the victims become much more important, as well as their awareness of not only the persistence in some cases of a life-threatening situation, but also new stress influences(loss of relatives, separation of families, loss of home, property). An important element of prolonged stress is the expectation of repeated impacts, discrepancies with the results of rescue operations, the need to identify dead relatives, etc. Psycho-emotional stress, characteristic of the beginning of the second period, is replaced by its end, as a rule, by increased fatigue and “demobilization” with asthenodepressive manifestations .
In the third period, which begins for victims after their evacuation to safe areas, many experience complex emotional and cognitive processing of the situation, a kind of “calculation” of losses. Psychogenic-traumatic factors associated with changes in life stereotypes, which contribute to the formation of relatively persistent psychogenic disorders, are also becoming relevant. Along with persistent nonspecific neurotic reactions and conditions, protracted and developing pathocharacterological changes, post-traumatic and social stress disorders begin to predominate. Somatogenic mental disorders at the same time, they can have a varied “subacute” character; both “somatization” of many neurotic disorders and, to a certain extent, the opposite of this process, “neurotization” and “psychopathy,” are observed. The latter are associated with awareness of traumatic injuries and somatic illnesses, as well as with the real difficulties of life.
Each of the mentioned conditions has its own characteristics that predetermine the methodological, organizational and treatment tactics. Special attention Reactive psychoses that arise in the first period of a life-threatening situation deserve. They are characterized by pronounced disturbances in mental activity, depriving a person (or a group of people) of the opportunity to adequately perceive what is happening, disrupting work and performance for a long time. Autonomic and somatic disorders also develop - from the cardiovascular, endocrine and respiratory systems, gastrointestinal tract, etc., in some cases expressed so sharply that they become leading in painful manifestations. Reactive psychoses, as a rule, develop acutely, under the influence of a combination of extreme unfavorable factors. It is generally accepted that they are facilitated by overwork, general asthenia, disturbances in sleep patterns, nutrition, preliminary physical and mental trauma (for example, minor injuries to the body and head, concern for the fate of relatives and friends, etc.). Fugoform reactions are short-lived - up to several hours, stuporous reactions are longer - up to 15 - 20 days. Complete recovery is observed in almost all cases. These conditions, typical of life-threatening situations, are interpreted based on the mechanisms of their occurrence as primitive reactions to a threat to life.
Psychogenic twilight disorders Consciousness is characterized by a narrowing of the volume of consciousness, predominantly automatic forms of behavior, motor restlessness (less often, retardation), and sometimes fragmentary hallucinatory and delusional experiences. They are usually short-lived (in 40% of all patients they are completed within 24 hours). As a rule, all survivors of psychogenic twilight disorders experience complete restoration of health and adapted activities.
Protracted reactive psychoses form more slowly than acute ones, usually within several days. Their depressive form is more common. In terms of symptoms, these are fairly typical depressive states with a well-known triad of clinical manifestations (decreased mood, motor retardation, slowed thinking). Patients are absorbed in the situation, all their experiences are determined by it. Usually there is a deterioration in appetite, weight loss, poor sleep, constipation, tachycardia, dry mucous membranes, and in women - cessation of menstruation. Severe manifestations of depression without active treatment often drag on for 2 to 3 months. The final prognosis is relatively favorable in most cases.
Psychogenic paranoid usually develops slowly, over several days, and is usually protracted. Among the clinical manifestations, affective disorders take the first place: anxiety, fear, depression. Against their background, persistent delusional ideas of relationship and persecution are usually formed. There is a close connection between affective disorders and the severity of delusional experiences.
Pseudodement form, like other protracted psychoses, develops over several days, although cases of acute development are often observed. Psychotic phenomena persist for a month or more, the condition of the patients is characterized by deliberately crude demonstrations of intellectual impairment (the inability to name age, date, list facts from the anamnesis, names of relatives, perform basic calculations, etc.). The behavior is of the nature of foolishness: inadequate facial expressions, stretching of the lips with a “proboscis”, lisping speech, etc. Pseudodementia manifests itself especially clearly when asked to perform simple arithmetic operations (addition, subtraction, multiplication). The errors are so monstrous that one gets the impression that the patient is deliberately giving incorrect answers.
Of particular importance is the possibility of psychogenic development simultaneously with other lesions - injuries, wounds, burns, which in such cases can be more severe. Every brain injury is fraught with the possibility of easy development of psychogenic, neurotic reactions and fixation of painful symptoms. The uncomplicated course of injuries depends on the tactics of a medical specialist who provides “mental asepsis.”
The greatest difficulties arise when organizing first medical and pre-medical aid for victims. First priority- identify people with acute psychomotor agitation, ensure the safety of them and those around them, eliminate the situation of confusion, and eliminate the possibility of mass panic reactions. Calm, confident actions of those providing assistance have a particularly great “calming” value for people with subshock (subaffective) psychogenic reactions.
Victims with psychogenic reactions react negatively to restraint measures, which should be resorted to only in cases of extreme necessity (aggressive behavior, severe agitation, tendency to self-harm). Restraint measures can be limited by intramuscular injection one of medications, relieving agitation: aminazine, haloperidol, tizercin, phenazepam, diazepam. Excitement is eliminated by a medicinal mixture of aminazine, diphenhydramine and magnesium sulfate in various combinations and dosages (combined use can reduce some side effects of the drugs and enhance the relief effect). It should be borne in mind that chlorpromazine has pronounced general sedative properties, but it reduces blood pressure and predisposes to orthostatic reactions. Diphenhydramine potentiates the neuroplegic effect of aminazine and reduces its hypotensive properties. Magnesium sulfate, along with sedatives, has dehydration properties, which is especially important when closed injury brain. In case of a stuporous state, a 10% solution of calcium chloride (10 - 30 ml) is administered intravenously, neuroleptic drugs or tranquilizers are administered intramuscularly, and in some cases, roush anesthesia is used. For anxiety and depressive disorders, amitriptyline or similar effects are prescribed sedatives, for inhibited depression - melipramine or other activating antidepressants.

After cupping acute condition in the second and third periods of development of the situation Upon completion of the emergency, it is necessary to use a complex of various psychotherapeutic methods, medications and social rehabilitation programs. They are not only necessary therapeutic measures for specific mental disorders, but also serve as a preventive basis for post-traumatic stress disorders.

Severe natural disasters and catastrophes, not to mention the possible massive sanitary losses during war, are a difficult experience for many people. A mental reaction to extreme conditions, especially in cases of significant material losses and loss of life, can permanently deprive a person of the ability to act rationally and effectively, despite the “psychological protection” that helps prevent disorganization of mental activity and behavior. Many researchers have concluded that preventive health care will be the most effective means of preventing the impact of trauma on mental health person. A group of American researchers (Fullerton S., Ursano R. et al., 1997), based on a generalization of their own data, came to the conclusion that preventive medical care in anticipating mental trauma, during an emergency event and during overcoming its consequences can be considered in the following three directions.

I. Primary prevention

Informing you of what to expect.

Training in control and mastery skills.

Limit exposure.

Sleep hygiene.

Filling the psychological need for support and rest.

Informing and training loved ones to enhance “natural support.”

II. Secondary prevention

Restore security and public services.

Primary care training.

Sorting the sick and wounded.

Early diagnosis of the wounded.

Diagnosis of somatization as a possible mental distress.

Training teachers for early decontamination of distress.

Collection of information.

III. Tertiary prevention

Treatment of comorbid disorders.

Increased attention to family distress, loss and demoralization, violence against loved ones or children in the family.

Compensation.

Deactivation of the processes of “withdrawal” and social avoidance.

Psychotherapy and necessary drug treatment.

Practical measures aimed at preventing psychiatric and medical-psychological consequences of emergency situations can be divided into those carried out in the period before the occurrence, during the action of psychotraumatic extreme factors and after the cessation of their influence.

Preparation is essential before an emergency occurs medical service Civil defense (CD) and rescuers to work in extreme conditions. It is worth noting that it should include:

Training of personnel of sanitary posts and teams to provide medical care victims with psychogenic disorders;

Formation and development of high psychological qualities, the ability to behave correctly in extreme situations, the ability to overcome fear, determine priorities and act purposefully; development of organizational skills for psychoprophylactic work with the population;

Informing medical workers and the population about the possibilities of using psychotherapeutic and medications for psychoprophylaxis.

The list of the indicated ways to prevent states of mental disadaptation in extreme conditions, directly addressed primarily to various units of the civil defense medical service, should be supplemented by a wide range of educational and organizational activities aimed at overcoming carelessness and neglect of certain life-threatening effects on a person, both in those cases when “harmfulness” is clearly tangible, so also when it is, until a certain time, hidden from the sight and understanding of ignorant people. It's important to know that great importance has mental hardening, i.e. development by a person of courage, will, composure, endurance and the ability to overcome feelings of fear.

This kind of need preventive work follows from the analysis of many emergency situations, incl. and the Chernobyl disaster.

“...From Minsk in this car, I (an engineer, a nuclear power plant worker) was driving towards the city of Pripyat... I was approaching the city somewhere around two hours and thirty minutes at night... I saw a fire above the fourth power unit. A flame-lit ventilation pipe with transverse red stripes was clearly visible. I remember well that the flame was higher than the chimney. That is, it reached a height of about one hundred and seventy meters above the ground. I did not turn home, but decided to drive closer to the fourth power unit in order to get a better look... I stopped about a hundred meters from the end of the emergency unit (in this place, as it will be calculated later, at that time the background radiation reached 800-1500 roentgens per an hour mainly from the graphite, fuel and flying radioactive cloud scattered by the explosion) I saw in the near light of the fire that the building was dilapidated, there was no central hall, no separator rooms, the separator drums, displaced from their places, gleamed reddishly. Such a picture really hurt my heart... I stood there for a minute, there was an oppressive feeling of incomprehensible anxiety, numbness, my eyes absorbed everything and remembered it forever. But anxiety kept creeping into my soul, and involuntary fear appeared. Feeling of an invisible threat nearby. It smelled like after a strong lightning strike, still astringent smoke, it began to burn my eyes and dry my throat. I was coughing. And to get a better look, I lowered the glass. It was such a spring night. I turned the car around and drove to my home. When I entered the house, mine were asleep. It was about three o'clock in the morning. It is worth noting that they woke up and said that they heard explosions, but did not know what they were. Soon an excited neighbor came running, whose husband was already on the block. It is worth noting that she informed us about the accident and suggested drinking a bottle of vodka to decontaminate the body...”

“At the time of the explosion, two hundred and forty meters from the fourth block, just opposite the turbine room, two fishermen were sitting on the bank of the supply canal and catching fry. It is worth noting that they heard explosions, saw a blinding burst of flame and pieces of hot fuel, graphite, reinforced concrete and steel beams flying like fireworks. Both fishermen continued their fishing, unaware of what had happened. They thought that a barrel of gasoline had probably exploded. Literally before their eyes, fire crews deployed, they felt the heat of the flames, but blithely continued fishing. The fishermen received 400 roentgens each. Closer to the morning, they developed uncontrollable vomiting; according to them, it was as if the chest was burning with heat, like fire, the eyelids were cutting, the head was bad, as if after a wild hangover. Realizing that something was wrong, they barely made it to the medical unit...”

“Resident of Pripyat X., senior engineer of the production and administrative department of the Chernobyl NPP construction department, testifies: “On Saturday, April 26, 1986, everyone was already preparing for the May 1st holiday. Note that it is a warm, fine day. Spring. The gardens are blooming... Among the majority of builders and installers, no one knew anything yet. Then something leaked about an accident and fire at the fourth power unit. But no one really knew what exactly happened. The children went to school, the kids played outside in sandboxes and rode bicycles. By the evening of April 26, all of them already had high activity in their hair and clothes, but we didn’t know that then. Not far from us on the street they were selling delicious donuts. An ordinary day off... A group of neighboring kids rode bicycles to the overpass (bridge), from there the emergency block from the Yanov station was clearly visible. This, as we later learned, was the most radioactive place in the city, because a cloud of nuclear release passed there. But it became clear later, and then, on the morning of April 26, the guys were simply interested in watching the reactor burn. These children later developed severe radiation sickness."

Both in the above and in many similar examples, belief in a miracle, in “maybe”, in the fact that everything can be easily fixed, paralyzes, makes a person’s thinking inflexible, deprives him of the opportunity to objectively and competently analyze what is happening, even in the case when there is the necessary theoretical knowledge and some practical experience. Amazing carelessness! In the case of the Chernobyl accident, it turned out to be criminal.

During the period of exposure to psychotraumatic extreme factors, the most important psychoprophylactic measures will be:

Organization of clear work to provide medical care to victims with psychogenic disorders;

Objective information from the population about the medical aspects of a natural disaster (catastrophe);

Assistance to civil society leaders in suppressing panic, statements and actions;

Involving lightly injured people in rescue and emergency recovery operations.

After the end of a life-threatening catastrophic situation [It should be emphasized that psychotraumatic factors quite often continue to operate after the culmination of a natural disaster or catastrophe, although less intensely. This includes the anxious anticipation of aftershocks during an earthquake, and the ever-increasing fear of a “dose set” when being in an area with an increased level of radiation, etc.] psychoprophylaxis should include the following measures:

Complete information to the population about the consequences of a natural disaster (catastrophe) and other impacts and their impact on human health;

Maximum use of all opportunities to involve large groups of victims in order to make generalized collective decisions on the organization of rescue operations and medical care;

Prevention of relapses or repeated mental disorders (so-called secondary prevention), as well as the development of psychogenically caused somatic disorders;

Drug prevention of delayed psychogenic reactions;

Involving the easily injured in participation in rescue and emergency recovery operations and in providing medical care to victims.

Experience shows that the main causes of “man-made” tragedies are quite similar in different countries in case of all kinds of disasters: technical imperfection of machines and mechanisms, violation technical requirements on their operation. At the same time, behind this there are human flaws - incompetence, superficial knowledge, irresponsibility, cowardice, which prevents the timely detection of detected errors, inability to take into account the capabilities of the body, calculate forces, etc. Such phenomena should be condemned not only by various control bodies, but first of all by the conscience of every person brought up in the spirit of high morality.

One of the most important socio-psychological preventive tasks is information to the population about the situation, carried out permanently. Information must be complete, objective, truthful, but also, within reasonable limits, reassuring. The clarity and brevity of the information makes it especially effective and understandable. The absence or delay of information necessary for making rational decisions during or after a natural disaster or catastrophe gives rise to unpredictable consequences. For example, untimely and half-true information from the population about the radiation situation in the Chernobyl accident zone led to many tragic results both directly for public health and for the adoption of organizational decisions to eliminate the accident and its consequences.

This contributed to the development of neuroticism in wide circles of the population and the formation of psychogenic mental disorders at the remote stages of the Chernobyl tragedy. For this reason, in the territories where the population lives, to one degree or another affected by the accident (contamination zones, places of residence of displaced persons), Psychological Rehabilitation Centers were created, combining socio-psychological and informational assistance and focused on the prevention of preclinical forms of mental maladaptation .

Do not forget that an important place in the implementation primary prevention psychogenic disorders is focused on understanding that modern man must be able to behave correctly in any, even the most difficult, situations.

Along with developing the ability not to get lost in difficult life situations that develop in extreme conditions, competence, professional knowledge and skills, moral qualities of people managing complex mechanisms and technological processes, the ability to give clear and constructive instructions.

Particularly terrible consequences are caused by incompetent decisions and the choice of the wrong course of action during the initial stages of an extreme pre-catastrophic situation or during an already developed disaster. Consequently, during the professional selection and training of managers and performers of the most critical areas of work in many areas of economic activity, it is extremely important to take into account the psychological characteristics and professional competence of a particular candidate. Anticipation of his behavior in extreme conditions should occupy an important place in the system of general prevention of the development of life-threatening situations and the psychogenic disorders caused by them.

It is not without reason that they believe that uncontrollable fear indicates a lack of self-confidence, knowledge, and skills. It is worth noting that it can also lead to panic reactions, to prevent which it is necessary to stop the spread of false rumors, be firm with the “leaders” of alarmists, direct people’s energy to rescue work, etc. It is known that the spread of panic is facilitated by many factors caused by a person’s psychological passivity in extreme situations and lack of readiness to fight the elements.

Special mention should be made of the possibilities of primary drug prevention of psychogenic disorders. In recent decades, significant attention has been paid to such prevention. It is extremely important to keep in mind that the use of psychopharmacological drugs for prevention is limited. Such remedies can be recommended exclusively for small groups of people. In case of this, one should take into account the possibility of developing muscle weakness, drowsiness, decreased attention (tranquilizers, antipsychotics), hyperstimulation (psychoactivators), etc. A preliminary consideration of the doses of the recommended drug, as well as the nature of the intended activity, is required. The material was published on http://site
It can be used much more widely to prevent mental disorders in people surviving after a natural disaster or catastrophe.

Extreme situations Malkina-Pykh Irina Germanovna

1.2.2 Psychogenies in extreme situations

In conditions of disasters and natural disasters neuropsychiatric disorders manifest themselves in a wide range: from a state of maladjustment and neurotic, neurosis-like reactions to reactive psychoses. Their severity depends on many factors: age, gender, level of initial social adaptation; individual characterological characteristics; additional aggravating factors at the time of the disaster (loneliness, caring for children, the presence of sick relatives, one’s own helplessness: pregnancy, illness, etc.).

The psychogenic impact of extreme conditions consists not only of a direct, immediate threat to human life, but also an indirect one associated with its anticipation. Mental reactions during a flood, hurricane and other extreme situations do not have any specific character, inherent only in a specific extreme situation. These are rather universal reactions to danger, and their frequency and depth are determined by the suddenness and intensity of the extreme situation (Aleksandrovsky, 1989; Aleksandrovsky et al., 1991).

The traumatic impact of various unfavorable factors arising in life-threatening conditions on mental activity a person is divided into non-pathological psycho-emotional (to a certain extent physiological) reactions and pathological conditions- psychogenia (reactive states). The former are characterized by psychological clarity of the reaction, its direct dependence on the situation and, as a rule, a short duration. With non-pathological reactions, working capacity is usually preserved (although it is reduced), the ability to communicate with others and critical analysis your behavior. Typical for a person who finds himself in a catastrophic situation are feelings of anxiety, fear, depression, concern for the fate of family and friends, and the desire to find out the true extent of the catastrophe (natural disaster). Such reactions are also referred to as a state of stress, mental tension, affective reactions, etc.

Unlike non-pathological reactions, pathological psychogenic disorders are painful conditions that incapacitate a person, depriving him of the opportunity for productive communication with other people and the ability to take purposeful actions. In some cases, disorders of consciousness occur and psychopathological manifestations arise, accompanied by a wide range of psychotic disorders.

Psychopathological disorders in extreme situations have much in common with the clinical picture of disorders that develop under normal conditions. However, there are also significant differences. Firstly, due to the multiplicity of sudden psycho-traumatic factors in extreme situations, mental disorders occur simultaneously in a large number of people. Secondly, the clinical picture in these cases is not as individual as in “usual” traumatic circumstances, and is reduced to a small number of fairly typical manifestations. Thirdly, despite the development of psychogenic disorders and the ongoing dangerous situation, the victim is forced to continue to actively fight the consequences of a natural disaster (catastrophe) for the sake of survival and preserving the lives of loved ones and everyone around him.

The most frequently observed psychogenic disorders during and after extreme situations are divided into 4 groups: non-pathological (physiological) reactions, pathological reactions, neurotic states and reactive psychoses (see Table 1.1).

Table 1.1.

Psychogenic disorders observed during and after extreme situations (Alexandrovsky, 2001)

A person’s behavior in a suddenly developed extreme situation is largely determined by the emotion of fear, which to a certain extent can be considered physiologically normal, since it contributes to the emergency mobilization of the physical and mental state necessary for self-preservation. With the loss of a critical attitude towards one’s own fear, the appearance of difficulties in purposeful activities, the decrease and disappearance of the ability to control actions and make logically based decisions, various psychotic disorders (reactive psychoses, affective-shock reactions), as well as states of panic, are formed.

Among reactive psychoses in situations of mass disasters, affective shock reactions and hysterical psychoses are most often observed. Affective-shock reactions occur with a sudden shock that threatens life; they are always short-lived, lasting from 15–20 minutes to several hours or days and are presented in two forms shock states- hyper- and hypokinetic. The hypokinetic variant is characterized by phenomena of emotional and motor inhibition, general “numbness,” sometimes even to the point of complete immobility and mutism (affectogenic stupor). People freeze in one position, their facial expressions express either indifference or fear. Vasomotor-vegetative disturbances and deep confusion of consciousness are noted. The hyperkinetic variant is characterized by acute psychomotor agitation (motor storm, fugiform reaction). People are running somewhere, their movements and statements are chaotic and fragmentary; facial expressions reflect frightening experiences. Sometimes acute speech confusion predominates in the form of an incoherent speech stream. People are disoriented, their consciousness is deeply darkened.

With hysterical disorders, vivid figurative ideas begin to predominate in a person’s experiences, people become extremely suggestible and self-hypnosis. Against this background, disturbances of consciousness often develop. For the hysterical twilight darkness Consciousness is characterized not by its complete shutdown, but by a narrowing with disorientation and deceptions of perception. A specific psychotraumatic situation is always reflected in people’s behavior. IN clinical picture demonstrative behavior with crying, absurd laughter, and hysteroform seizures is noticeable. Hysterical psychoses also include hysterical hallucinosis, pseudodementia, and poirilism.

The most typical manifestations of non-psychotic (neurotic) disorders at various stages of the development of the situation are acute reactions to stress, adaptive (adaptive) neurotic reactions, neuroses (anxiety, hysterical, phobic, depressive, hypochondriacal, neurasthenia).

Acute reactions to stress are characterized by quickly passing non-psychotic disorders of any nature that arise as a reaction to extreme physical activity or psychogenic situation during a natural disaster and usually disappear after a few hours or days. These reactions occur with a predominance of emotional disorders (states of panic, fear, anxiety and depression) or psychomotor disorders (states of motor agitation, retardation).

Adaptive reactions are expressed in mild or transient non-psychotic disorders that last longer than acute reactions to stress. They are observed in people of any age without any obvious preexisting mental disorder. Such disorders are often limited to some extent in clinical manifestations(partial) or identified in specific situations; they are usually reversible. Usually they are closely related in time and content to traumatic situations caused by bereavement.

The most frequently observed adaptive reactions under extreme conditions include:

Short-term depressive reaction (loss reaction);

Prolonged depressive reaction;

A reaction with a predominant disorder of other emotions (reaction of worry, fear, anxiety, etc.).

The main observed forms of neuroses include:

Anxiety (fear) neurosis, which is characterized by a combination of mental and somatic manifestations of anxiety that do not correspond to real danger and manifest themselves either in the form of attacks or in the form of a stable state. Anxiety is usually diffuse and can increase to a state of panic. Other neurotic manifestations, such as obsessive or hysterical symptoms, may be present, but they do not dominate the clinical picture;

Hysterical neurosis characterized by neurotic disorders, in which disturbances of vegetative, sensory and motor functions predominate (“conversion form”), selective amnesia that occurs according to the type of “conditioned pleasantness and desirability”, suggestion and self-hypnosis against the background of an affectively narrowed consciousness. Pronounced changes in behavior may occur, sometimes taking the form of a hysterical fugue. This behavior may mimic psychosis or, rather, correspond to the patient's idea of ​​psychosis;

Neurotic phobias, for which it is typical neurotic state with a pathologically expressed fear of certain objects or specific situations;

Depressive neurosis is defined by neurotic disorders characterized by depression of inadequate strength and clinical content, which is a consequence of traumatic circumstances. It does not include vital components, daily and seasonal fluctuations among its manifestations and is determined by the patient’s concentration on the traumatic situation that preceded the illness. Usually in the experiences of patients there is no projection of longing for the future. Often there is anxiety, as well as a mixed state of anxiety and depression;

Neurasthenia, expressed by autonomic, sensorimotor and affective dysfunctions and occurring as irritable weakness with insomnia, increased fatigue, distractibility, low mood, constant dissatisfaction with oneself and others. Neurasthenia may be a consequence of prolonged emotional stress, overwork, occur against the background of traumatic injuries and somatic diseases;

Hypochondriacal neurosis - manifests itself mainly by excessive preoccupation with one’s own health, the functioning of an organ, or, less commonly, the state of one’s mental abilities. Usually painful experiences are combined with anxiety and depression.

The study of mental disorders observed in extreme situations, as well as the analysis of a complex of rescue, social and medical measures, makes it possible to schematically identify three periods of development of the situation in which various psychogenic disorders are observed.

First (acute) period characterized by a sudden threat to one’s own life and the death of loved ones. It lasts from the beginning of exposure to an extreme factor until the organization of rescue operations (minutes, hours). Powerful extreme exposure during this period mainly affects vital instincts (for example, self-preservation) and leads to the development of nonspecific, extrapersonal psychogenic reactions, the basis of which is fear of varying intensity. At this time, psychogenic reactions of psychotic and non-psychotic levels are predominantly observed. In some cases, panic may develop.

Immediately after acute exposure, when signs of danger appear, people become confused and do not understand what is happening. After this short period, with a simple fear reaction, a moderate increase in activity is observed: movements become clear, economical, muscle strength increases, which facilitates movement to a safe place. Speech disturbances are limited to acceleration of its tempo, hesitations, the voice becomes loud, ringing. Mobilization of will and animation of ideational processes are noted. Mnestic disturbances during this period are represented by a decrease in fixation of the environment, unclear memories of what is happening around, but one’s own actions and experiences are fully remembered. Characteristic is a change in the sense of time, the flow of which slows down, so that the duration of the acute period in perception is increased several times. With complex fear reactions, first of all, more pronounced movement disorders are observed in the hyperdynamic or hypodynamic variants described above. Speech production is fragmentary, limited to exclamations, and in some cases there is aphonia. Memories of the event and their behavior among victims during this period are undifferentiated and summary.

Along with mental disorders, nausea, dizziness, frequent urination, chill-like tremors, fainting, and in pregnant women - miscarriages are often observed. The perception of space changes, the distance between objects, their size and shape are distorted. Sometimes the environment seems “unreal”, and this feeling persists for several hours after exposure. Kinesthetic illusions (the feeling of the earth swaying, flying, swimming, etc.) can also be long-lasting.

With simple and complex reactions of fear, consciousness is narrowed, although in most cases accessibility to external influences, selectivity of behavior, and the ability to independently find a way out of a difficult situation are preserved.

In second period, taking place during the deployment of rescue operations, begins, in a figurative expression, “normal life in extreme conditions.” At this time, in the formation of states of maladaptation and mental disorders, a much greater role is played by the personality characteristics of the victims, as well as their awareness of not only the ongoing situation in some cases, but also new stressful influences, such as the loss of relatives, separation of families, loss of home and property. Important elements Prolonged stress during this period is the expectation of repeated impacts, the discrepancy between expectations and the results of rescue operations, and the need to identify dead relatives. The psycho-emotional stress characteristic of the beginning of the second period is replaced by its end, as a rule, by increased fatigue and “demobilization” with astheno-depressive or apatho-depressive manifestations.

After the end of the acute period, some victims experience short-term relief, an uplift in mood, a desire to actively participate in rescue operations, verbosity, endless repetition of the story about their experiences, their attitude towards what happened, bravado, and discrediting the danger. This phase of euphoria lasts from a few minutes to several hours. As a rule, it is replaced by lethargy, indifference, ideational inhibition, difficulty in understanding the questions asked, and difficulties in completing even simple tasks. Against this background, episodes of psycho-emotional stress with a predominance of anxiety are observed. In a number of cases, peculiar states develop; the victims give the impression of being detached and self-absorbed. They sigh frequently and deeply, bradyphasia is noted, retrospective analysis shows that in these cases internal experiences are often associated with mystical and religious ideas. Another variant of the development of an anxious state during this period may be characterized by the predominance of “anxiety with activity.” Characteristic are motor restlessness, fussiness, impatience, verbosity, desire for an abundance of contacts with others. Expressive movements can be somewhat demonstrative and exaggerated. Episodes of psycho-emotional stress are quickly replaced by lethargy and apathy.

IN third period, which begins for victims after their evacuation to safe areas, many experience complex emotional and cognitive processing of the situation, reassessment of their own experiences and sensations, and awareness of losses. At the same time, psychogenically traumatic factors associated with a change in life pattern, living in a destroyed area or in a place of evacuation also become relevant. Becoming chronic, these factors contribute to the formation of relatively persistent psychogenic disorders. Along with persistent nonspecific neurotic reactions and conditions, protracted and developing pathocharacterological disorders begin to predominate during this period. Somatogenic mental disorders can be subacute in nature. In these cases, both the “somatization” of many neurotic disorders and, to a certain extent, the opposite of this process, “neurotization” and “psychopathy,” are observed.

In the dynamics of asthenic disorders that developed after an extreme, sudden situation, autochthonous episodes of psycho-emotional stress with a predominance of anxiety and increased vegetosomatic disorders are often observed. Essentially, asthenic disorders are the basis on which various borderline neuropsychiatric disorders are formed. In some cases they become protracted and chronic.

With the development of pronounced and relatively stable affective reactions against the background of asthenia, asthenic disorders themselves seem to be relegated to the background. The victims experience vague anxiety, anxious tension, bad premonitions, and the expectation of some kind of misfortune. “Listening to danger signals” appears, which may be ground shaking from moving mechanisms, unexpected noise, or, conversely, silence. All this causes anxiety, accompanied by muscle tension, trembling in the arms and legs. This contributes to the formation of persistent and long-term phobic disorders. Along with phobias, as a rule, there is uncertainty, difficulty in accepting even simple solutions, doubts about the fidelity and correctness of one’s own actions. Often there is a constant discussion of the experienced situation, close to obsession, memories of past life with its idealization.

Another type of manifestation of emotional stress is psychogenic depressive disorders. A peculiar awareness of “one’s guilt” before the dead appears, an aversion to life arises, and regret that he survived and did not die along with his relatives. The phenomenology of depressive states is supplemented by asthenic manifestations, and in a number of observations, apathy, indifference, and the appearance of a melancholy affect. The inability to cope with problems leads to passivity, disappointment, decreased self-esteem, and a feeling of inadequacy. Often depressive symptoms are less pronounced, and somatic discomfort comes to the fore (somatic “masks” of depression): diffuse headache, worsening in the evening, cardialgia, disorders heart rate, anorexia.

In general, depressive disorders do not reach a psychotic level, victims do not experience ideational inhibition, and they, although with difficulty, cope with everyday worries.

Along with these neurotic disorders, people who have experienced an extreme situation quite often experience decompensation of character accentuations and psychopathic personality traits. In this case, both the individually significant psychotraumatic situation and the previous life experience and personal attitudes of each person are of great importance. Personality characteristics leave an imprint on neurotic reactions, playing an important pathoplastic role.

The main group of states of personal decompensation is usually represented by reactions with a predominance of the radical excitability and sensitivity. Such persons, for an insignificant reason, give violent emotional outbursts that are objectively inappropriate to the occasion. At the same time, aggressive actions are not uncommon. Such episodes are most often short-lived, occur with some demonstrativeness, theatricality, and are quickly replaced by an asthenic-depressive state, lethargy and indifference to the environment.

A number of observations indicate dysphoric mood coloring. People in this state are gloomy, gloomy, and constantly dissatisfied. They challenge orders and advice, refuse to complete tasks, quarrel with others, and abandon work they have begun. There are also frequent cases of increased paranoid accentuations - those who have survived an acute extreme situation become envious, spy on each other, write complaints to various authorities, believe that they have been deprived, that they have been treated unfairly. In these situations, rental attitudes most often develop.

Along with the noted neurotic and psychopathic reactions at all three stages of the development of the situation, the victims experience autonomic dysfunction and sleep disorders. The latter not only reflect the entire complex of neurotic disorders, but also significantly contribute to their stabilization and further aggravation. Most often, it is difficult to fall asleep; it is hampered by a feeling of emotional tension, anxiety, and hyperesthesia. Night sleep is superficial, accompanied by nightmares, and usually short-lived. The most intense changes in the functional activity of the autonomic nervous system appear in the form of vibrations blood pressure, pulse lability, hyperhidrosis, chills, headaches, vestibular disorders, gastrointestinal disorders. In some cases, these conditions acquire a paroxysmal character, becoming most pronounced during an attack. Against the background of autonomic dysfunctions, exacerbation is often observed psychosomatic diseases, relatively compensated before the extreme event, and the emergence of persistent psychosomatic disorders.

During all of these periods, the development and compensation of psychogenic disorders in emergency situations depend on three groups of factors: the peculiarity of the situation, individual response to what is happening, social and organizational events. However, the importance of these factors in different periods of development of the situation is not the same. Over time, the nature of the emergency situation and the individual characteristics of the victims lose their immediate significance, and on the contrary, not only medical, but also socio-psychological assistance and organizational factors increase and become fundamental.

The main factors influencing the development and compensation of mental disorders in emergency situations can be classified as follows.

Directly during an event (catastrophe, natural disaster, etc.):

1) Features of the situation:

Emergency intensity;

Duration of emergency;

The suddenness of the emergency.

2) Individual reactions:

Somatic condition;

Age;

Emergency preparedness;

Personal characteristics.

Awareness;

- “collective behavior”.

When carrying out rescue operations after the completion of a dangerous event:

1) Features of the situation:

- “secondary psychogenies”.

2) Individual reactions:

Personal characteristics;

Individual assessment and perception of the situation;

Age;

somatic condition.

3) Social and organizational factors:

Awareness;

Organization of rescue operations;

- “collective behavior”.

During the later stages of an emergency:

1) Social-psychological and medical assistance:

Rehabilitation;

Somatic condition.

2) Social and organizational factors:

Social structure;

Compensation.

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