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Non-psychotic affective disorders include a variety of manifestations depressive states, which have a significant negative impact on a person’s quality of life and prevent full social adaptation. Affective disorders are characterized by a persistent deterioration in a person’s mood – hypothymia. The individual loses the ability to fully experience positive emotions: he does not experience joy from the positive moments of life, does not enjoy pleasant activities.

With depression, a person has a pessimistic assessment of his life and current situation in society, and views his own personality from a negative point of view. He is sure that there are no prospects in his future.

In case of affective disorders, a decrease in the patient’s intellectual potential and a significant inhibition of motor activity are determined. A subject suffering from depression lacks motivation to be active and has reduced drive. A person loses all desire to do routine things.

Affective disorders are manifested by various somatic and autonomic disorders. The characterological portrait of the personality undergoes changes: a person appears excessive irritability, hostile and aggressive attitude towards others, intolerance to the weaknesses of others, conflict.

Currently, affective disorders occupy the first position in the number of patients among all psychopathological conditions. Symptoms of depression in varying degrees of severity have been identified in more than 350 million contemporaries. The ratio of male to female patients varies depending on the type of affective disorder. Most often, the first depressive episodes occur between the ages of twenty and forty.

Depression is manifested not only by typical affective syndromes. Atypical affective states are often recorded, which in some patients occur in a hidden and erased form.

Affective disorders: causes

To date, there is no common understanding in the scientific community of the causes and mechanisms of development of affective disorders. The creators and followers of various scientific hypotheses to this day they debate and present their arguments about the causes of depressive conditions. The most proven versions are three groups of theories:

• genetic;
• biological (physiological);
• socio-psychological.

Genetic version

Numerous studies have established that there is a family pattern in the formation of inadequate, psychotic reactions. From ancestors to descendants at the gene level, a predisposition to neurotic and psychotic illnesses. Mood disorders are more likely to occur in people whose parents suffered from some type of depression. However, a hereditary tendency to depressive reactions is not the direct cause of affective syndromes, but only acts as a basis for the formation of a disorder that starts when negative life circumstances arise.

Physiological version

Proponents of biological hypotheses believe that the cause of affective disorders is disturbances in the functioning of organs and systems of the body. Scientists call the leading cause of depressive states a decrease in the production of certain neurotransmitters, an imbalance of these biologically active chemical elements, and disruptions in the metabolism of certain neurotransmitters.

Long-term treatment with certain drugs can provoke the development of affective disorders. pharmacological agents eg: benzodiazepines. Depressive syndromes are often caused by endocrine diseases. Yes, hyperfunction thyroid gland makes itself felt with unpleasant symptoms: melancholy mood, excessive tearfulness, insomnia.

Affective disorders often occur with metabolic disorders and an imbalance in the ratio of certain mineral elements in the blood. Depressive status is often recorded in many infectious diseases, viral and bacterial etiology, especially if the infection has affected the central nervous system. Affective disorders almost always accompany severe chronic diseases, which are characterized by intense pain syndrome.

A common cause of depression is human addiction: chronic alcoholism, drug addiction, uncontrolled use of medications. Particularly severe depressive episodes develop during withdrawal symptoms.

Social-psychological version

Many psychotherapists are confident that affective disorders take root in a person’s childhood. Adverse conditions growing up, injuries received in childhood cause irreparable harm to the fragile psyche of the child. Particularly dangerous circumstances for a young person are the death of parents and subsequent stay in orphanage or boarding school. Asocial morals in the family, especially living with drinking parents, have a negative impact on the baby’s future. The lack of a unified education strategy also negatively affects the formation of a person’s personal portrait. Anxiety, suspiciousness, lack of confidence in one’s abilities, excessive responsibility, and trying to please everyone are the ideal foundation for the formation of neurotic reactions.

Any chronic stress or sudden extreme situation may trigger the development of symptoms of affective disorders. At the same time, it is important how a person is used to reacting to stress factors, how he interprets the changes that occur. It is a negative assessment of an accomplished event, excessive fixation of attention on a newly discovered circumstance that leads a person into a state of depression.

Mood disorders: types and symptoms

Typical and atypical affective disorders are divided into separate types depending on the predominance of positive (productive) or negative (unproductive) symptoms. Let us describe the signs of the most common types of depressive syndromes in more detail.

Vital depression

A frequently recorded type of affective disorder is vital (melancholy depression). The main characteristics of the disease are severe melancholy, an unreasonable negative outlook on life, hopeless sadness, and depression. Among clinical symptoms In this type of affective disorder, the patient’s dominant feeling of melancholy comes first. The person feels hopelessness and despair.

He develops ideas of his own worthlessness, depravity, and sinfulness. The patient describes his past as a series of mistakes and troubles. He denies own merits and really reduces achievements achieved. The subject blames himself for something he did not do. He obsessively engages in introspection, constantly reproducing past mistakes from memory. The patient is sure that a terrible tragedy is coming in the future.

A common symptom of vital depression is suicidal behavior. The patient considers his existence meaningless. He has a conscious desire to die. He stubbornly strives to commit suicide.

It is worth noting that the symptoms of this type of affective disorder follow a circadian rhythm. The maximum deterioration of the condition is observed in the early morning hours. After lunch, the mood background partially stabilizes.

Apathetic depression

A characteristic symptom of this type of affective disorder is a lack of motivation to act. The person indicates a lack of vitality. He complains of a persistent feeling of internal discomfort. The patient looks lethargic and depressed.

He is indifferent to his own situation. The person is not interested in his surroundings. He is indifferent to the results of his own labor.

Outwardly, the impoverishment of gestures and facial expressions becomes noticeable. The patient's speech is monotonous and laconic. Others get the impression that the subject acts automatically.

A decrease in intellectual potential is determined. The patient has difficulty concentrating. Due to problems with concentration, he cannot perform his duties efficiently.

Depersonalization depression

This type of affective disorder is also called anesthetic depression. The main symptom of the disease is depletion of the emotional background. The patient experiences a loss of belonging to his own emotions and feelings. He ceases to experience emotional involvement in environmental phenomena.

Alienation of emotions can take the form of painful insensitivity. The person indicates that he does not experience any worries regarding close relatives. He complains that all his desires have disappeared. Describes that he has no mood or any emotions. Any events in the outside world do not resonate with his condition. The patient perceives the environment as an alien and unnatural world. He loses the ability to experience pleasure and pleasure.

Another symptom of depersonalization depression is loss or weakening of sensitivity to one’s own feelings. The patient may not feel thirsty or hungry.

Neurotic depression

The leading affective signs of this type of disorder are illogical, incomprehensible, uncontrollable mood swings. The predominant symptoms are depression, depressed mood, and a pessimistic outlook.

All negative experiences of the patient manifest themselves at the physiological level. The patient indicates a burning sensation in chest area, debilitating soreness in the larynx, feeling of cold in the pit of the stomach. It is somatic and autonomic defects that are the main complaint of the patient, since negative experiences are never perceived by the patient as a global depressed state.

Masked depression

In some patients, mental discomfort completely fades into the background, giving way to painful physiological sensations. In this case, one can suspect that the patient has another type of affective disorder - masked depression. Very often, patients complain of heart problems: they indicate instability heart rate, pain, feeling of lack of air. Or they indicate anomalies in the functioning of other organs.

Almost always with masked depression, problems with sleep occur. Man sleeps interrupted sleep with nightmares. He wakes up very early, but his rise requires volitional efforts.

A separate type of masked depression is the anorectic form. Its symptoms are nausea that occurs in the morning, loss of appetite, aversion to food, weight loss.

Characterological dysthymia

This type of affective disorder is characterized by the presence of dysphoria in the structure of depression. Along with a gloomy vision of the world around him, the patient is distinguished by an angry, angry attitude towards others. He demonstrates dissatisfaction with other people: the patient is picky, cruel, and grumpy. Such a person is conflictual and gets into arguments with others. He is prone to demonstrative behavior. Likes to manipulate people.

A feature of characterological dysthymia is the absence of ideas of self-blame. The patient shifts all the blame and responsibility for unpleasant situations onto other people.

Asthenic depression

This type of affective syndrome is clinically similar to asthenic disorder. The patient is distinguished by excessive sensitivity to external stimuli. The patient's main complaint is decreased performance, rapid depletion of nervous and mental resources. He complains of physical weakness and the inability to work at his usual rhythm. With asthenic depression, the patient is depressed and irritable, prone to tearfulness. The maximum symptoms occur in the morning.

Other types of affective disorders are depression:

• hysterical, which most often occurs as a pathological reaction of grief;
• alarming characterized by constant thinking about impending misfortune;
• hypochondriacal, which manifests itself as excessive concern about health.

Affective disorders: treatment methods

The method of treating affective disorders is selected for each person individually, depending on the type of depression, the severity of the syndrome, the presence concomitant diseases. In most cases, treatment is carried out in outpatient setting. However, if there is a threat to life and if the patient demonstrates suicidal behavior, treatment should be carried out in a specialized medical institution.

The basis of treatment of pathological conditions is drug therapy with antidepressants. As a rule, the patient is recommended to take antidepressants for a long period - about six months. Treatment with antidepressants allows you to stabilize the patient’s emotional state, restore intellectual potential, and eliminate motor retardation. The use of antidepressants also helps relieve a person from anxiety, worry and restlessness.

In parallel with drug treatment, various physiotherapeutic manipulations are carried out. Electroconvulsive therapy and transcranial magnetic stimulation show good results in the treatment of affective disorders.

As a rule, pharmacological treatment of patients with affective disorders is accompanied by psychotherapeutic assistance. The maximum result can be achieved using methods of cognitive-behavioral and rational therapy. For some patients, hypnosis sessions are also included in the treatment program.

Of particular importance for overcoming affective disorders is the elimination of stress factors, normalization of work and rest, regular physical activity and balanced nutrition.

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Paranoid schizophrenia– a separate type of schizophrenic disorder, in which the dominant symptoms are productive signs: hallucinations (imaginary perceptions in the absence of a real stimulus) and/or delusions (morbid reasoning, beliefs). Delusional disorders may be of the nature of paraphrenic (imaginative fairy-tale dream-like ideas of grandeur), paranoid (persecution and/or physical influence) or paranoid (exaggerated idea of ​​ordinary life situations) delusions. In the paranoid form of schizophrenia […]...

Affective disorders are a group of mental disorders that are manifested by excessive expression of a person’s natural emotions or disruption of their dynamics (instability or stiffness). Affective disorders are spoken of in cases where emotional manifestations generally change the patient’s behavior and lead to his serious maladjustment.

Why Emotional Disorders Develop

Today, there are several theories of the occurrence of affective disorders. Each of them has the right to its existence, but there is no single reliable theory.

Genetic reasons emotional disturbances may be an abnormal gene on chromosome 11. Scientists suggest the presence of recessive, dominant, and polygenic forms of affective disorders.

Neuroendocrine causes include dysfunction of the hypothalamic-pituitary system, limbic system and pineal gland. In this case, disruptions occur in the rhythm of the release of liberins, which stimulate the synthesis and entry into the blood of pituitary hormones, and melatonin, which regulates circadian rhythms. As a result, there is a change in the overall rhythm of the body, including the rhythm of sleep/wakefulness, eating, and sexual activity.

Stress (negative or distress and positive or eustress) can also lead to the development of affective disorders. Stress negatively affects the body, causing it to become overstrained and subsequently exhausted, and also contributes to the occurrence of depression in constitutionally predisposed individuals. The most significant stressors are the death of a child, death of a spouse, arguments, and loss of economic status.

Classification of affective disorders

1) Single depressive episode
2) Single manic episode
3) Bipolar affective disorder
4) Recurrent depressive disorder
5) Chronic disorders mood

Criteria for affective disorder:

• autochthonous appearance of emotions (i.e. not associated with external reasons, somatic, endocrine pathology and other physiological disorders);
• lack of emotional reactions to personally significant situations and objects;
• disproportion between the intensity and duration of emotional reactions and the reasons that cause them;
• discrepancy between the quality of the emotional reaction and the reason that causes it;
• disorders of adaptation and behavior due to emotion;
• the unusual nature of emotional experiences, different from what was previously characteristic of a healthy individual;
• the appearance of emotional reactions in response to virtual, unreal, meaningless stimuli.

These criteria do not have absolute meaning; they are quite relative, so that an individual’s emotional reactions can be assessed ambiguously.

In fact, situations very often arise when it is quite difficult and even impossible to distinguish between normal and pathological emotions without further observation of the individual.

1. Affect disorders

The above criteria of affect are not differentiated in clinically, although various and numerous deviations were pointed out. In forensic psychiatry, pathological and physiological variants of affect are distinguished, as well as physiological affect on a pathological basis.

The preparatory phase is characterized by the interpretation of psychogeny, the emergence and increase emotional stress. Acute psychogenicity can reduce the duration of the phase to several seconds. A long-term psychotraumatic situation extends the preparatory phase for months, years: the patient during this period for some reason delays in adequately responding to the challenge, and his “spinelessness” can significantly aggravate the situation. Permissive reason (“ last straw") may be quite ordinary, banal, but it is in connection with it that dire consequences arise. In the preparatory phase, an individual may simply not know, not see a decent way out of the situation; If a psychologist or an experienced psychotherapist had happened, the tragedy might not have happened. Consciousness in this phase is not clouded, but its narrowing is observed in the form of an increasing concentration of attention on the traumatic situation.

Pathological affect- an acute, short-term painful state of a psychogenic nature that occurs in a practically healthy individual (Shostakovich, 1997). Pathological affect occurs in three phases.

The explosion phase occurs suddenly, completely unexpectedly both for the individual himself and for those around him. The main thing that characterizes it is an affective twilight stupefaction. This is a psychophysiological process, and not just the dynamics of involuntary attention. During this period, there may be various affective disorders (anger, despair, confusion, other manifestations hidden under the main affect), phenomena of sensory hypo- and hyperesthesia, illusions, perception deceptions, unstable delusional ideas, disturbances in the body diagram and other manifestations of self-perception disorders. Typically acute psychomotor agitation, which has no connection with the patient’s conscious self, but seems to flow from the depths of his unconscious.

Agitation can be chaotic, aimless, or appear to be completely orderly with aggression directed towards a specific goal. Actions are performed “with the cruelty of an automaton or machine” (Korsakov, 1901). Sometimes they are carried out according to the type of motor iterations: for example, an already lifeless victim continues to be inflicted with countless wounds, blows or shots. It is aggression that reigns supreme; it does not switch over to oneself; suicidal acts, apparently, do not happen. States of pathological affect with rage and auto-aggression probably do not occur at all, or they cannot be identified. Patients are disoriented in place, time, circumstances; It cannot be ruled out that autopsychic orientation is disrupted. Patients can vocalize loudly, pronounce individual words clearly, repeating them, but usually speech becomes incoherent.

Apparently, they either do not pay attention to the speech of others or do not understand it. Non-verbal speech, on the contrary, is animated, it is like instinctive speech, and it can be quite understandable (a grimace of rage, baring of teeth, narrowing of the eye slits or, on the contrary, their widening, an unwavering gaze at the object of anger, etc.). The intellect suffers deeply - the individual performs certain actions without understanding the real situation, without realizing their consequences. The nature of the actions - their particular cruelty, the totality of the destruction produced - do not correspond or even contradict personal qualities individual. There are, for example, patients who are unconfident, defenseless, and devoid of any aggressive tendencies. Violent and extremely aggressive individuals usually commit offenses outside of a state of pathological affect.

The final phase begins as quickly and lightningly as the second. Severe exhaustion, prostration, sleep or somnolence occur. Psychomotor retardation sometimes reaches a level of stupor. This phase lasts within tens of minutes. Upon restoration of clarity of consciousness and activity, extensive congrade amnesia for impressions, experiences and actions of the second phase of affect is revealed. Amnesia can be delayed, and usually after minutes, tens of minutes everything is completely forgotten. Individual memories of the final and, to a greater extent, preparatory phase may be retained. An individual often treats something done in a state of pathological affect as if it had nothing to do with him; he does not appropriate or personalize other people’s stories about what happened.

Cases of pathological affect that occur in connection with protracted mental trauma differ from those described in several significant features. This is a long latent or preparatory stage, development for an apparently insignificant reason, of which there were plenty before, awareness and personalization of what was done upon exiting the affect, the polarity of experiences and actions in the affect of the individual’s personal qualities, as well as the fact that immediately or somewhat later an acute depressive reaction to what happened with suicidal actions. Such patients do not try to hide anything or lie; they willingly cooperate with investigative authorities and forensic doctors. Previously, E. Kretschmer designated such variants of pathological affect as short-circuit reactions. Persons falling into states of such affect, in modern literature are designated “as overly self-controlled aggressors.” The exclusion of short-circuit reactions as a special variant of pathological affect is associated, we believe, with ignoring important essential distinctive features between them.

Physiological affect on a pathological basis(Serbsky, 1912) - a transitional form between physiological and pathological affects. The pathological basis of such affect most often appears to be psychopathy, alcohol dependence, possibly other forms of chemical and non-chemical dependence, PTSD. V.P. Serbsky believes that the degree of impairment of consciousness is insignificant.

Typically there is a discrepancy between the strength of the affect and the real significance of the cause that caused it. The affect can be intense to such an extent that it becomes, as it were, the main cause of a serious offense. A common example of such affect are frequent cases of alcoholic (other) intoxication, when at some point the patient’s self-control turns off, the affects of anger come to the fore, hostility, jealousy, a feeling of revenge, a tendency to destructive actions, brutal fights, etc. arise. In another observation with O.A., 39 years old (“schizotypal personality disorder”), after a quarrel with her husband, the patient and her daughter locked themselves in the room with the thought of killing her and herself.

When asked to open the door, she responded with a threat to kill her daughter and herself. Then, she said, she “blacked out.” The relatives, having entered the room, hardly tore the diseased knife out of their hands. “They said that at that time I was crying and laughing.” Then she “felt hands, a knife, and began to come to her senses.” She says that she seriously intended to kill herself and her daughter, but “something inside prevented me from doing it.” Due to the high frequency of such things, questions of sanity are raised very rarely. Here, however, very difficult situations can arise, so that the usual forms of their assessment can give rise to reasonable doubts in the forensic psychiatrist. The possibility that a pathological or physiological affect may arise on an alienated part of one’s self is never excluded.

Physiological affect is a state of very pronounced affect without clear signs of a twilight state of consciousness. Usually, different, including significant, degrees of affective narrowing of consciousness regarding external as well as internal impressions are noted. Physiological affect also occurs in three stages, although it is quite difficult to clearly distinguish between them. Clinically obvious signs of narrowing of consciousness are believed to be observed only in the second phase of affect. The painful episode does not end with pronounced prostration, sleep and somnolence; amnesia is partial. In a state of physiological affect, patients may perform illegal actions- affectdelict. Illustration (Shostakovich, 1997):

K., 42 years old, secondary special education(accountant). By nature, vulnerable, touchy, impressionable. At the age of 17 she suffered a spinal fracture. She separated from her first husband because of his drunkenness. The second husband drinks heavily, is jealous, and beats her. Has a 7 year old son from him. During the next conflict, she killed him.

Reports that recent years lived in constant fear, "experienced panic fear and horror." I didn’t want to live, I didn’t see any other way out of the situation than to commit suicide. On the day of the offense, the husband came home drunk and immediately began to scold her, beat her, and hit her in the body. She tried to hide in the bathroom, but he pulled her out and began to choke her in the kitchen. She says that she experienced “terrible fear” and thought that he would kill her. She notes that she saw everything as if in a fog, only she saw his eyes clearly. She remembers how she ran away from the room, hid, and thought that he wouldn’t chase her. She doesn’t remember how she beat him with a knife, where she took it and how such an idea came to her. He doesn’t remember how long it took to kill his husband and how it all happened. When I came to my senses, I felt weak, tired, and my hands were shaking. Entering the kitchen, I saw my dead husband and realized that it was she who killed him.

Called " ambulance"and the police. Psychological research it was established that the subject is impressionable, vulnerable, prone to “accumulation of negatively colored experiences” and avoidance of conflicts; It is difficult to find constructive ways out of conflicts (which ones are not specified), and has a type of intraputative response to difficult situations for oneself (for example, suicidal tendencies). Psychologists do not mention the presence of signs of increased aggressiveness. A comprehensive examination found her to be healthy. The conclusion of the expert commission indicated that the subject was in a state of physiological affect. That's probably what happened. But this case does not contain evidence that there are no transitional states between undisputed cases of pathological affect and much more common conditions actual physiological affect.

This situation, not without serious comparisons, could be regarded as a short circuit reaction. Psychiatry is poorly suited to Euclidean paradigms based on the priority of visual behavioral impressions, which ignore the fact that internal psychological factors can radically change the sensations, perceptions, interpretations, emotional reactions and behavior of a person, including the researcher himself.

There are a number of painful affects that are not classified as pathological solely because they do not entail violence, although sometimes they are capable of this. Let's name some of them.

Confusion(“affect of bewilderment”, according to S.S. Korsakov). It is manifested by an absolute lack of understanding of the current situation, which is explained by the disintegration of the intellect and the inability to synthesize different impressions, as well as to search for similar or similar ones in memory. This bewilderment is usually combined with fear, anxiety, a feeling of complete helplessness and the patient’s unsuccessful attempts to understand what is happening by seeking help from those present.

Disturbances in orientation in place, situation, time, environment, and sometimes in oneself are typical. Contact with the outside world, the consciousness of which is often preserved, is one-sided: patients usually ask peculiar questions, without addressing anyone in particular, but do not react to the answers, do not take them into account, perhaps not always understanding their meaning. Fear and anxiety are typical, and the mood is mostly depressed. There may be motor agitation with fussiness and akinesia. Hypermetamorphosis is observed, and occasional productive disorders occur (perceptual deceptions, delusions, episodes of confused consciousness, symptoms of mental automatism).

Patients ask one question after another like: “What kind of room is this? Where are you taking me? Why on you white robe? Why are you writing? Who are these people? Where did I end up? What does all this mean? Or: “I don’t understand whether I’m alive or dead? Where am I? Is there anyone here? I think the coffin is here. Am I conscious or unconscious? They don’t give me mirrors, I don’t know if I have a face or not? Am I a man or not?.. It seems like I’m a man. Am I in this world or no longer? What's the matter? They cut, burn, electrify. The scenery changes all the time. Are you relatives, a doctor or someone from prison? Have I really done something? Where am I going now? In the first case, confusion concerns more external impressions; attention constantly moves from one object to another. In the second case, the patient is more concerned about what is happening to himself, in his behavior. At the same time, violations of self-perception are revealed, up to the loss of one’s identity and autometamorphosis, the feeling of reincarnation into another being; delusional ideas of influence, staging. The condition of the patients in both cases approaches amentia, and their thinking approaches fragmentation.

Let us recall that with the actual fragmentation of thinking, there is no confusion and elementary orientation is most often not disturbed; patients seem to understand what is happening, sometimes they behave quite orderly and do not react to their lack of understanding of the essence of what is happening, as well as to the lack of coherence of thinking. Confusion is often encountered during the acute onset of schizophrenia (Kerbikov, 1949). Brief episodes of confusion (“stupidity”) are very common when a patient first appears at the doctor’s office. Entering the office, the patient seems lost, looks around, does not understand where to sit, or asks about it, even though the only chair for conversation has been prepared for him. Confusion is an ominous sign, especially often in schizophrenia, when the patient’s role is not accepted immediately or not at all due, probably, to depersonalization.

Panic fear- spontaneously occurring and short-term states of “horror” with confusion, motor agitation with the desire to run somewhere, making frequent calls to the “ambulance”, sharply expressed autonomic disorders(high rises in blood pressure, difficulty breathing, frequent urination, vomiting, profuse sweat, and many others). Fear or a feeling of madness, loss of self-control, phenomena of mental anesthesia, and painful physical sensations, such as senestopathy, often occur. Attacks of fear occur spontaneously and completely suddenly, sometimes patients sense their approach.

They can arise for random provoking reasons, and then patients also “wind up themselves” with ideas about an impending catastrophe, mistaking fantasies for something that has already happened or for something that will certainly happen. At first, the attacks are sporadic and not so often repeated. Then they can become more frequent and occur several times a day, lengthening to several tens of minutes (usually patients begin to immediately take something sedative, especially tranquilizers, alprozalam), call an ambulance (up to 6-10 times a day). Usually saved obsessive fear recurrence of attacks, anxious anticipation of them. Patients try to avoid visiting places with which they associated the occurrence of attacks, they are afraid to be alone with themselves at home or on the street, some cannot stand riding in public transport, do not risk using the elevator, etc. As a rule, they do not part with their medications. Gradually, patients seem to get used to the attacks, realizing that they are not fatal and can be stopped without much difficulty. There are patients who indicate a seasonal pattern of attacks.

Illustrations: “In the evening after work, a thought suddenly came to me: what if one of the customers cast a spell on me. Fear immediately arose, animal fear, to the point of horror. It seemed like I was going crazy and would do something crazy. I rushed around the house, completely confused, didn’t know what to do... I visited my grandmother, she treated me with prayers. Suddenly it seemed to me that she had missed something the right word in prayer. It got worse than ever before. I feel my heart pounding, blood pressure rising, lack of air, dizzy, pain in the pit of my stomach, everything floats around, sways, seems unreal, everything is mixed up in my head like madness. And fear, wild, indescribable fear to the point of horror. I couldn’t sit still, I jumped off and ran to the other grandmother. Suddenly it becomes eerie, everything floats, it’s unreal, it seems that I’m going crazy, I don’t recognize myself, as if it’s not me anymore.”

Some authors try to distinguish panic disorder into attributive, i.e., psychogenically caused attacks, alexithymic - “without the experience of fear”, hypertypic - without the experience of fear before and after the attack, “existential crises” - with fear of a bodily catastrophe, accepting, it seems, taking into account less significant or even dubious signs.

Terms "panic disorder" or " » are not entirely accurate, since in a painful state there is not an objective, conscious fear, but unaccountable anxiety, autopsychic confusion and many other disorders, among which there is an acute violation of self-perception (depersonalization, derealization, a tendency to mistake the imaginary for reality, the phenomena of mental anesthesia). With that said, a more accurate term would be “acute anxiety attack with depersonalization.”

Moreover, a significant, if not the overwhelming majority of patients subsequently develop distinct anxious depression with symptoms of pathology of self-perception. Neurologists previously identified “diencephalic attacks” with very similar symptoms, although with an emphasis on somatovegetative and neuroendocrine disorders. Panic itself is a symptom of an acute reaction to a sudden and severe psychotraumatic situation, often fraught with disaster for many people. Such panic is accompanied by confusion, psychomotor agitation, or stupor. There have been cases of mass panic. There are no cases of widespread "panic disorder", although individual patients can induce each other, usually exacerbating the severity of the disorder.

Ecstasy- a state of extreme, expressed to the point of frenzy of delight, less often - another emotion. Here is a description of a typical ecstatic state at the beginning of an epileptic seizure (sometimes a focal emotional attack): (It is) “an extraordinary inner light ..., delight ..., supreme calm, full of clear, harmonious joy and hope, full of reason and final reason, ( which) turns out to be in highest degree harmony, beauty, gives a hitherto unheard of and unexpected feeling of completeness, proportion, reconciliation, enthusiastic prayerful merging with the very higher synthesis life, self-awareness and... a sense of self that is extremely immediate, (which) in itself was worth the whole life” (F.M. Dostoevsky).

Orgiastic states- ecstasy that occurs during ritual actions, for example, the ritual of shamans, the dancing of dervishes. Other participants in sacred ceremonies usually also fall into ritual ecstasy if they have fully identified themselves with other members of the group. This type Ecstasy is characterized by possession by a spirit, good or evil. In the first case, members of the ritual group experience a feeling of supreme, endless happiness, jubilation, admiration, power that does not occur in ordinary life, with a feeling of loss or dissolution of their Self, as well as a change in identity.

In the second case, violent rage, rage, senseless and chaotic predominates. The consciousness of the Self also disappears, all feelings and actions have their source in some internal demonic principle. Some sacred rites encourage unlimited sexual intercourse, so that the rite ends in a mad orgy. A number of sects have a practice of mass immersion of their adherents into ecstasy, during which awareness of their Self is also lost and self-identification with a charismatic leader occurs. The memory of the experience of ecstasy is preserved, although perhaps not fully. Memory for what is happening around is not retained. In satanic sects, ecstasy is experienced as self-identification with Satan; adherents are possessed by anger, rage, and bloodthirstiness.

Mystical ecstasy achieved through special exercises that make it possible to experience a feeling of merging with God or another higher power. It is in such states that “insights” arise, “revelations”, “signs from above” are perceived, followed by belief in them as some higher, absolute, indisputable truth.

Meditative ecstasy- “waking dreams”, an uncontrollable flow of dreams in which one experiences a feeling of belonging with transcendental entities, with the essence of something else, inaccessible through ordinary knowledge of the world.

Prayer Ecstasy- a state of delight, bliss, a feeling of merging with God or his Divine will, a feeling of unity with him, merging with him. It is observed among deeply religious people, but is more typical, apparently, of fanatical believers who have no doubt that their faith is the only true and unshakable one. All other religious movements of the spirit are “from the evil one.”

Manic ecstasy- a feeling of inexpressible admiration and delight, observed in some manic patients somewhere at the height of the painful state. This is a special type of mania, involving an altered state of consciousness and a persistent focus on ideas of sublime content; in typical cases of mania, hypervariability of attention and personality regression are usually observed.

Hypnotic ecstasy- an ecstatic state, usually instilled in a state of deep hypnotic sleep. Not all patients experience such an extraordinary feeling as ecstasy in hypnosis. There must probably be some kind of internal predisposition to this. Oneiric ecstasy is observed in a state of manic-ecstatic oneiroid, when dreams and other painful phenomena are produced with the content of “heavenly,” extraterrestrial, cosmic, otherworldly existence, generated by higher, previously unknown forces of love and infinite goodness. These are, as it were, the spiritual quests of patients carried out in a painful state.

Ecstatic dreams- a special type of dreams in which unusually bright, colorful, enchanting images are captured with experiences of extraordinary happiness, amazing beauty that swallowed up the ordinary world and presented it as a kind of vague prototype of reality. Patients talk about an inexplicable feeling of delight, admiration for a different, extremely attractive and only acceptable image of the universe that has become open, tangible and real. Mixed with all this is the feeling of reincarnation as “the queen of the world, a deity, an angelic creature, a messenger of Heaven in the sinful material world.”

Explain such metamorphoses without knowing human essence, rushing upward, is difficult. Coming out of psychosis, some patients remain confident that they have seen with their own eyes the real world, and not some surrogate in which people are doomed to exist. Sometimes such dreams retain the force of reality for a long time, and patients stop themselves from trying to discredit this dream - “reality”.

There are very few, if not almost non-existent, reports of ecstatic episodes from religious patients. Nevertheless, G.V. Morozov and N.V. Shumsky (1998) note a “special” frequency of states of ecstasy when pseudohallucinatory memories arise.

In a state of ecstasy, stupor, incomprehensible, as if symbolic psychomotor agitation, disconnection from reality, desomatization phenomena, disturbances in the sense of time are usually observed (the latter “lengthens” or stops altogether; F.M. Dostoevsky reports that once Mohammed “examined” all the details of a vast Muslim paradise The long journey of the prophet did not last long, according to earthly time, one moment, during which not a drop spilled from the overturned cup of wine).

Memory for subjective experiences during a period of ecstasy is often preserved to the smallest detail (apparently, this is imprinted in memory as in selective hypermnesia, as something of exceptionally great personal significance). Memories of what is happening around are incomplete, inaccurate, distorted, and many are not retained in memory. The duration of ecstatic episodes ranges from a few seconds to a number of hours. Patients treat ecstatic experiences as greatest value of your life.

Amazement- an extreme degree of surprise with a stop in the flow of thoughts, freezing in one position, a frozen facial expression on which surprise froze, and at the same time falling silent. It occurs, as mentioned, when something very unusual, incredible, directly contradicts the individual's absolute confidence in what should happen.

Frenzy- an extreme degree of excitement with loss of self-control, most often occurring during frustration and manifesting itself in the form of impotent anger (Ilyin, 2002).