Main signs of psychopathological syndromes. Main psychopathological symptoms
APATHY (indifference). At the initial stages of the development of apathy, there is a slight weakening of hobbies; the patient reads or watches TV mechanically. In case of psycho-affective indifference, during questioning he expresses relevant complaints. With a shallow emotional decline, for example in schizophrenia, the patient calmly reacts to events of an exciting, unpleasant nature, although in general the patient is not indifferent to external events.
In a number of cases, the patient’s facial expressions are impoverished, he is not interested in events that do not concern him personally, and almost does not participate in entertainment. Some patients are little affected even by their own situation and family affairs. Sometimes there are complaints about “stupidity”, “indifference”. The extreme degree of apathy is characterized by complete indifference. The patient's facial expression is indifferent, there is indifference to everything, including his appearance and cleanliness of his body, to his stay in the hospital, to the appearance of relatives.
ASTHENIA (increased fatigue). With minor symptoms, fatigue occurs more often with increased load, usually in the afternoon. In more pronounced cases, even with relatively simple types of activity, a feeling of fatigue, weakness, and an objective deterioration in the quality and pace of work quickly appear; rest doesn't help much. Asthenia is noticeable at the end of a conversation with a doctor (for example, the patient talks sluggishly, tries to quickly lie down or lean on something). Among vegetative disorders, excessive sweating and pallor of the face predominate. Extreme degrees of asthenia are characterized by severe weakness up to prostration. Any activity, movement, short-term conversation is tiring. Rest doesn't help.
AFFECTIVE DISORDERS characterized by instability (lability) of mood, a change in affect towards depression (depression) or elevation (manic state). At the same time, the level of intellectual and motor activity changes, and various somatic equivalents of the condition are observed.
Affective lability (increased emotional reactivity). With unexpressed disorders, the range of situations and reasons in connection with which affect arises or mood changes are somewhat expanded compared to the individual norm, but these are still quite intense emotiogenic factors (for example, actual failures). Usually, affect (anger, despair, resentment) occurs rarely and its intensity largely corresponds to the situation that caused it. With more severe affective disorders, mood often changes for minor and varied reasons. The intensity of the disorders does not correspond to the real significance of psychogenicity. In this case, affects can become significant, arise for completely insignificant reasons or without a perceptible external reason, change several times within a short time, which makes goal-directed activity extremely difficult.
Depression. With minor depressive disorders, the patient sometimes develops a noticeably sad expression on his face and sad intonations in conversation, but at the same time his facial expressions are quite varied and his speech is modulated. The patient manages to be distracted and cheered up. There are complaints of “feeling sad” or “lack of cheerfulness” and “boredom.” Most often, the patient is aware of the connection between his condition and traumatic influences. Pessimistic experiences are usually limited to a conflict situation. There is some overestimation of real difficulties, but the patient hopes for a favorable resolution of the situation. A critical attitude towards the disease has been maintained. With a decrease in psycho-traumatic influences, the mood normalizes.
As depressive symptoms worsen, facial expressions become more monotonous: not only the face, but also the posture expresses despondency (shoulders are often slumped, the gaze is directed into space or down). There may be sad sighs, tearfulness, a pitiful, guilty smile. The patient complains of a depressed, “decadent” mood, lethargy, and unpleasant sensations in the body. He considers his situation gloomy and does not notice anything positive in it. It is almost impossible to distract and cheer up the patient.
With severe depression, a “mask of grief” is observed on the patient’s face; the face is elongated, grayish-cyanotic in color, the lips and tongue are dry, the gaze is suffering, expressive, there are usually no tears, blinking is rare, sometimes the eyes are half-closed, the corners of the mouth are downturned, the lips are often compressed. Speech is not modulated, up to an unintelligible whisper or silent lip movements. The pose is hunched over, with head down, knees together. Raptoid states are also possible: the patient groans, sobs, rushes about, tends to self-harm, and breaks his arms. Complaints of “unbearable melancholy” or “despair” predominate. He considers his situation hopeless, hopeless, hopeless, his existence unbearable.
A special type of depression is the so-called hidden (masked, larved) or somatized depression. With its development in patients observed primarily in general somatic institutions, against the background of a slight change in affect, various somatovegetative (viscerovegetative) disorders develop, simulating various diseases of organs and systems. At the same time, depressive disorders themselves fade into the background, and the patients themselves, in most cases, object to the assessment of their condition as " depression". A somatic examination in these cases does not reveal significant disorders that could explain the patient’s persistent and massive complaints. By excluding one or another prolonged somatic suffering, taking into account the phasic course of somatovegetative disorders (including diurnal fluctuations with a significant deterioration in the condition in the morning ), by identifying hidden, atypical anxiety and depression using clinical and psychodiagnostic studies, and most importantly, by observing the effect when prescribing an antidepressant, one can make a final conclusion about the presence of hidden depression.
Manic state. With the development of a manic state, a barely noticeable elation of mood appears at first, in particular the revival of facial expressions. The patient notes vigor, tirelessness, good health, “is in excellent shape,” and somewhat underestimates the real difficulties. Subsequently, there is a clear revival of facial expressions, the patient smiles, his eyes sparkle, he is often prone to humor and witticisms, in some cases he states that he feels a “special surge of strength”, “rejuvenated”, is unreasonably optimistic, considers events with an unfavorable meaning to be trivial, all difficulties - easily overcome. The pose is relaxed, the gestures are excessively sweeping, and sometimes a raised tone slips into the conversation.
In a pronounced manic state, generalized, non-targeted motor and ideational excitation occurs, with extreme expression of affect - to the point of frenzy. The face often turns red and the voice becomes hoarse, but the patient notes “unusually good health.”
DELUSIONAL SYNDROMES. Rave- a false, but not amenable to logical correction, belief or judgment that does not correspond to reality, as well as to the social and cultural attitudes of the patient. Delusions must be differentiated from delusional ideas that characterize erroneous judgments expressed with excessive persistence. Delusional disorders are characteristic of many mental illnesses; as a rule, they are combined with other mental disorders, forming complex psychopathological syndromes. Depending on the plot, delusions of relation and persecution are distinguished (the patient’s pathological conviction that he is a victim of persecution), grandeur (the belief in a high, divine purpose and special personal importance), changes in one’s own body (the belief in physical, often bizarre changes in body parts ), the appearance of a serious illness (hypochondriacal delusion, in which, on the basis of real somatic sensations or without them, concern develops, and then a belief in the development of a particular disease in the absence of its obvious signs), jealousy (usually a painful conviction of a spouse’s infidelity is formed on the basis complex emotional state). There is also a distinction between primary delusion, the content of which and the patient’s actions resulting from it cannot be associated with the history of his life and personality characteristics, and secondary delusion, conditionally “arising” from other mental disorders (for example, from hallucinations, affective disorders, etc.). From the point of view of dynamics, relative specificity of signs of mental illness and prognosis, three main types of delusions are distinguished - paranoid, paranoid and paraphrenic.
With paranoid delusions, the content of pathological experiences arises from ordinary life situations; it is, as a rule, logically constructed, reasoned and not of an absurd or fantastic nature. Delusions of reformation and invention, jealousy, etc. are typical. In some cases, there is a tendency to constantly expand delusional constructions, when new real life circumstances seem to be “strung” onto the pathological “core” of a painful idea. This helps to systematize delirium.
Paranoid rave less logical. More often, ideas of persecution and influence are characteristic, often combined with pseudohallucinations and phenomena of mental automatism.
Paraphrenic delusions are usually fantastic and completely absurd. More often it is delusions of grandeur. Patients consider themselves the rulers of enormous wealth, the creators of civilization. They are usually in high spirits and often have false memories (confabulation).
ATTRACTION, DISORDERS. The pathology of desire reflects a weakening as a result of various reasons (hypothalamic disorders, organic disorders of the central nervous system, states of intoxication, etc.) of volitional, motivated mental activity. The consequence of this is a “deep sensory need” for the realization of impulses and the strengthening of various drives. Clinical manifestations of desire disorders include bulimia (a sharp increase in the food instinct), dromomania (an attraction to vagrancy), pyromania (an attraction to arson), kleptomania (an attraction to theft), dipsomania (alcoholic binges), hypersexuality, various types of perversion of sexual desire and etc. Pathological attraction can have the nature of obsessive thoughts and actions, be determined by mental and physical discomfort (dependence), and also arise acutely as impulsive reactions. Unlike other options, in the latter case there is often a complete absence of a critical assessment of the situation in which the patient is trying to implement an action determined by pathological attraction.
Violation of desire can be observed in various mental disorders; their differential diagnostic assessment is based, as in other cases, taking into account the entire complex of painful manifestations and the personal-typological characteristics of the patient.
HALLUCINATIVE SYNDROMES. Hallucinations are a truly felt sensory perception that occurs in the absence of an external object or stimulus, displaces actual stimuli and occurs without phenomena of impaired consciousness. There are auditory, visual, olfactory, tactile (the sensation of insects crawling under the skin) and others. hallucinations. A special place belongs to verbal hallucinations, which can be commentary or imperative, manifesting themselves in the form of a monologue or dialogue. Hallucinations can appear in healthy people while half asleep (hypnagogic hallucinations). Hallucinations are not specific psychopathological manifestations of endogenous or other mental illnesses. They are observed in schizophrenia, epilepsy, intoxication, organic and other psychoses, and can be both acute and chronic. As a rule, hallucinations are combined with other mental disorders; most often various variants of hallucinatory-paranoid syndrome are formed.
DELIRIUM- a nonspecific syndrome characterized by a combined disorder of consciousness, perception, thinking, memory, sleep-wakefulness rhythm, and motor agitation. The delirious state is transient and fluctuating in intensity. It is observed against the background of various intoxicating effects caused by alcohol, psychoactive substances, as well as liver diseases, infectious diseases, bacterial endocarditis and other somatic disorders.
DEMENTIA- a condition caused by a disease, usually of a chronic or progressive nature, in which there are disturbances in higher cortical functions, including memory, thinking, orientation, understanding of what is happening around, and the ability to learn. At the same time, consciousness is not changed, disturbances in behavior, motivation, and emotional response are observed. Characteristic of Alzheimer's disease, cerebrovascular and other diseases that primarily or secondary affect the brain.
HYPOCHONDRIC SYNDROME characterized by unjustifiably increased attention to one’s health, extreme preoccupation with even minor ailments, and the belief in the presence of a serious illness in the absence of its objective signs. Hypochondria is usually a component of more complex senestopathic-hypochondriacal, anxiety-hypochondriacal and other syndromes, and is also combined with obsessions, depression, and paranoid delusions. THINKING, VIOLATION. Characteristic symptoms are thorough thinking, mentalism, reasoning, obsessions, and increased distractibility. At first, these symptoms are almost invisible and have little effect on the productivity of communication and social contacts. However, as the disease progresses, they become more pronounced and permanent, which makes it difficult to communicate with the patient. When they are most severe, productive contact with patients is practically impossible due to the development of significant difficulties in them in appropriate behavior and decision-making.
MEMORY, VIOLATION. With a mild degree of hypomnesia for current events, the patient generally remembers the events of the next 2-3 days, but sometimes makes minor errors or uncertainty when remembering individual facts (for example, he does not remember the events of the first days of his stay in the hospital). With increasing memory impairment, the patient cannot remember which procedures he took 1-2 days ago; only when reminded does he agree that he already talked to the doctor today; does not remember the dishes he received during yesterday's dinner or today's breakfast, and confuses the dates of his next visits with relatives.
With severe hypomnesia, there is a complete or almost complete absence of memory about immediate events.
Hyponesia for past events begins with the patient experiencing minor difficulties when it comes to remembering the dates of his biography, as well as the dates of well-known events. In this case, sometimes there is a confusion of events in time or dates are named approximately; the patient attributes some of them to the corresponding year, but does not remember the month and day. The observed memory disorders practically do not interfere with normal activities. However, as the disease progresses, the patient finds it difficult to remember the dates of most well-known events or only remembers some of them with great difficulty. At the same time, the memory of events in his personal life is grossly impaired; he answers questions approximately or after complex calculations. With severe hypomnesia, there is a complete or almost complete absence of memory of past events; patients answer “I don’t remember” to the relevant questions. In these cases, they are socially helpless and disabled.
PSYCHOORGANIC (organic, encephalopathic) SYNDROME- a state of fairly stable mental weakness, expressed in the mildest form by increased exhaustion, emotional lability, instability of attention and other manifestations of asthenia, and in more severe cases - also by psychopathic-like disorders, memory loss, and increasing mental helplessness. The basis of the pathological process in psychoorganic syndrome is determined by the current disease of the brain of an organic nature (traumatic disease, tumor, inflammation, intoxication) or its consequences. Nonspecific psychopathological symptoms are often combined with focal brain lesions with corresponding neurological and mental disorders. Variants of the syndrome include asthenic with a predominance of physical and mental exhaustion; explosive, determined by affective lability; euphoric, accompanied by increased mood, complacency, decreased critical attitude towards oneself, as well as affective outbursts and bouts of anger, ending in tearfulness and helplessness; apathetic, characterized by a decrease in interests, indifference to the environment, weakening of memory and attention.
IRRITABILITY INCREASED
Main psychopathological syndromes
A syndrome is a complex of symptoms. Psychopathological syndrome is a complex, more or less typical set of internally (pathogenetically) interconnected psychopathological symptoms, in the particular clinical manifestations of which the volume and depth of damage to mental functions, the severity and massiveness of the effect of pathogenic harmfulness on the brain are expressed.
Psychopathological syndromes are the clinical expression of various types of mental pathology, which include mental illnesses of the psychotic (psychosis) and non-psychotic (neuroses, borderline) types, short-term reactions and persistent psychopathological conditions.
6.1. Positive psychopathological syndromes
There is currently practically no single view on the concept of positive, and therefore negative, syndromes. Syndromes that are qualitatively new, absent normally, are considered positive syndromes (they are also called pathological positive, “plus” disorders, phenomena of “irritation”), indicating the progression of a mental illness, qualitatively changing the mental activity and behavior of the patient.
6.1.1. Asthenic syndromes. Asthenic syndrome - a state of neuropsychic weakness - is the most common in psychiatry, neurology and general medicine and at the same time a simple syndrome of predominantly quantitative mental disorders. The leading manifestation is mental asthenia itself. There are two main variants of asthenic syndrome - emotional-hyperesthetic weakness (hypersthenic and hyposthenic).
With emotional-hyperesthetic weakness, short-term emotional reactions of dissatisfaction, irritability, anger on minor occasions (the “match” symptom), emotional lability, weakness arise easily and quickly; patients are capricious, gloomy, dissatisfied. Drives are also labile: appetite, thirst, food cravings, decreased libido and potency. Characterized by hyperesthesia to loud sounds, bright light, touch, smells, etc., intolerance and poor tolerance of anticipation. Replaced by exhaustion of voluntary attention and its concentration, distractibility and absent-mindedness increase, concentration becomes difficult, a decrease in the volume of memorization and active recollection appears, which is combined with difficulties in thinking, speed and originality in solving logical and professional problems. All this complicates neuropsychic performance, fatigue, lethargy, passivity, and a desire for rest appear.
Typically there is an abundance of somato-vegetative disorders: headaches, hyperhidrosis, acrocyanosis, lability of the cardiovascular system, sleep disturbances, predominantly shallow sleep with an abundance of everyday dreams, frequent awakenings up to persistent insomnia. There is often a dependence of somato-vegetative manifestations on meteorological factors and fatigue.
In the hyposthenic variant, physical asthenia, lethargy, fatigue, weakness, fatigue, pessimistic mood with decreased performance, increased drowsiness with lack of satisfaction from sleep and a feeling of weakness and heaviness in the head in the morning come to the fore.
Asthenic syndrome occurs in somatic (infectious and non-infectious) diseases, intoxications, organic and endogenous mental illnesses, and neuroses. It constitutes the essence of neurasthenia (asthenic neurosis), going through three stages: hypersthenic, irritable weakness, hyposthenic.
6.1.2. Affective syndromes. The syndromes of affective disorders are very diverse. The modern classification of affective syndromes is based on three parameters: the affective pole itself (depressive, manic, mixed), the structure of the syndrome (harmonious - disharmonious; typical - atypical) and the degree of severity of the syndrome (non-psychotic, psychotic).
Typical (harmonious) syndromes include a uniformly depressive or manic triad of obligatory symptoms: pathology of emotions (depression, mania), changes in the course of the associative process (slowdown, acceleration) and motor-volitional disorders / inhibition (substupor) - disinhibition (excitement), hypobulia-hyperbulia /. The main (core) among them are emotional. Additional symptoms include: low or high self-esteem, disturbances in self-awareness, obsessive, overvalued or delusional ideas, suppression or increased desires, suicidal thoughts and actions during depression. In the most classic form, endogenous affective psychoses occur and, as a sign of endogeneity, include the somato-vegetative symptom complex of V.P. Protopopov (arterial hypertension, tachycardia, constipation, miosis, hyperglycemia, menstrual irregularities, changes in body weight), daily fluctuations in affect (improved well-being during afternoon), seasonality, periodicity and autochthony.
Atypical affective syndromes are characterized by a predominance of optional symptoms (anxiety, fear, senestopathies, phobias, obsessions, derealization, depersonalization, non-holothymic delusions, hallucinations, catatonic symptoms) over the main affective syndromes. Mixed affective syndromes include those disorders that seem to be introduced from the opposite triad (for example, motor agitation during the affect of melancholy - depressive agitation).
There are also subaffective disorders (subdepression, hypomania; they are also non-psychotic), classical affective and complex affective disorders (affective-delusional: depressive-paranoid, depressive-hallucinatory-paranoid, depressive-paraphrenic or manic-paranoid. manic-hallucinatory-paranoid , matsnakal-paraphrenic).
6.1.2.1. Depressive syndromes. The classic depressive syndrome includes the depressive triad: severe melancholy, depressed gloomy mood with a touch of vitality; intellectual or motor retardation. Hopeless melancholy is often experienced as mental pain, accompanied by painful feelings of emptiness, heaviness in the heart, mediastinum or epigastric region. Additional symptoms are a pessimistic assessment of the present, past and future, reaching the level of holothym overvalued or delusional ideas of guilt, self-humiliation, self-blame, sinfulness, low self-esteem, disturbances in self-awareness of activity, vitality, simplicity, identity, suicidal thoughts and actions, sleep disorders in the form of insomnia, sleep agnosia, shallow sleep with frequent awakenings.
Subdepressive (non-psychotic) syndrome is represented by not clearly expressed melancholy with a tinge of sadness, boredom, depression, pessimism. Other main components include hypobulia in the form of lethargy, fatigue, tiredness and decreased productivity and slowing of the associative process in the form of difficulty finding words, decreased mental activity, and memory impairment. Additional symptoms include obsessive doubts, low self-esteem, and disturbances in self-awareness and activity.
Classic depressive syndrome is characteristic of endogenous depressions (manic-depressive psychosis, schizophrenia); subdepression in reactive psychoses, neuroses.
Atypical depressive syndromes include subdepressive ones. relatively simple and complex depression.
The most common subdepressive syndromes are:
Astheno-subdepressive syndrome - low mood, spleen, sadness, boredom, combined with a feeling of loss of vitality and activity. Symptoms of physical and mental fatigue, exhaustion, weakness combined with emotional lability, and mental hyperesthesia predominate.
Adynamic subdepression includes low mood with a hint of indifference, physical inactivity, lethargy, lack of desire, and a feeling of physical impotence.
Anesthetic subdepression is a low mood with a change in affective resonance, the disappearance of feelings of closeness, sympathy, antipathy, empathy, etc. with a decrease in motivation for activity and a pessimistic assessment of the present and future.
Masked (manifested, hidden, somatized) depression (MD) is a group of atypical subdepressive syndromes in which facultative symptoms (senestopathies, algia, paresthesia, intrusiveness, vegetative-visneral, drug addiction, sexual disorders) come to the fore, and the actual affective (subdepressive manifestations) erased, inexpressive, appear in the background.The structure and severity of optional symptoms determine various variants of MD (Desyatnikov V.F., Nosachev G.N., Kukoleva I.I., Pavlova I.I., 1976).
The following variants of MD have been identified: 1) algic-senestopathic (cardialgic, cephalgic, abdominal, arthralgic, panalgic); agrypnic, vegetative-visceral, obsessive-phobic, psychopathic, drug addict, variants of MD with sexual disorders.
Algic-senestopathic variants of MD. Optional symptoms are represented by a variety of senestopathies, paresthesias, algias in the heart area (cardialgic), in the head area (cephalgic), in the epigastric area (abdominal), in the joint area (arthralgic), and various “walking” symptoms (panalgic). They constituted the main content of the patients’ complaints and experiences, and subdepressive manifestations were assessed as secondary, insignificant.
The agripnic variant of MD is represented by pronounced sleep disturbances: difficulty falling asleep, shallow sleep, early awakening, lack of a feeling of rest from sleep, etc., while experiencing weakness, decreased mood, and lethargy.
The vegetative-visceral variant of MD includes painful, diverse manifestations of vegetative-visceral disorders: pulse lability, increased blood pressure, dipnea, tachypnea, hyperhidrosis, feeling of chills or heat, low-grade fever, dysuric disorders, false urge to defecate, flatulence, etc. By structure and in character they resemble diencephalic or hypothalamic paroxysms, episodes of bronchial asthma or vasomotor allergic disorders.
The psychopathic-like variant is represented by behavioral disorders, most often in adolescence and adolescence: periods of laziness, spleen, leaving home, periods of disobedience, etc.
The drug-addicted variant of MD is manifested by episodes of alcohol or drug intoxication with subdepression without a clear connection with external causes and reasons and without signs of alcoholism or drug addiction.
A variant of MD with disorders in the sexual sphere (periodic and seasonal impotence or frigidity) against the background of subdepression.
Diagnosis of MD presents significant difficulties, since complaints are represented only by optional symptoms, and only a special questioning allows one to identify the leading and obligatory symptoms, but they are often assessed as secondary personal reactions to the disease. But all variants of MD are characterized by the obligatory presence in the clinical picture, in addition to somato-vegetative manifestations, senestopathies, paresthesias, and algia, of affective disorders in the form of subdepression; signs of endogeneity (daily hypothmic disorders of both leading and obligatory symptoms and (optional; periodicity, seasonality, autochthony of occurrence, recurrence of MD, distinct somato-vegetative components of depression), lack of effect from somatic therapy and the success of treatment with antidepressants.
Subdepressive disorders occur in neuroses, cyclothymia, cyclophrenia, schizophrenia, involutional and reactive depression, and organic diseases of the brain.
Simple depressions include:
Adynamic depression is a combination of melancholy with weakness, lethargy, powerlessness, lack of motivation and desires.
Anesthetic depression is the predominance of mental anesthesia, painful insensibility with painful experience.
Tearful depression is a depressed mood with tearfulness, weakness and asthenia.
Anxious depression, in which, against a background of melancholy, anxiety with obsessive doubts, fears, and ideas about relationships predominate.
Complex depression is a combination of depression with symptoms of other psychopathological syndromes.
Depression with delusions of enormity (Cotard's syndrome) is a combination of melancholy depression with nihilistic delirium of megalomaniac fantastic content and delirium of self-blame, guilt in serious crimes, expectation of terrible punishment and cruel executions.
Depression with delusions of persecution and poisoning (depressive-paranoid syndrome) is characterized by a picture of sad or anxious depression combined with delusions of persecution and poisoning.
Depressive-paranoid mentaldromas, in addition to those described above, include depressive-hallucinatory-paranoid, depressive-paraphrenic. In the first case, in combination with melancholy, less often anxious depression, there are verbal true or pseudo-hallucinations of accusing, condemning and slanderous content. phenomena of mental automatism, delusions of persecution and influence. Depressive-paraphrenic, in addition to the listed symptoms, includes megalomanic delusional ideas of nihilistic, cosmic and apoplectic content, up to depressive oneiroid.
Characteristic of affective psychoses, schizophrenia, psychogenic disorders, organic and infectious mental diseases.
6.1.2.2. Manic syndromes. Classic manic syndrome includes severe mania with a feeling of immense happiness, joy, delight, ecstasy (obligatory symptoms are manic hyperbulia with many plans, their extreme instability, significant distractibility, which is caused by impaired productivity of thinking, acceleration of its pace, “jumping” ideas, inconsistency logical operations, and increased motor activity, they take on a lot of things without bringing any of them to the end, they are verbose, they talk incessantly. Additional symptoms are an overestimation of the qualities of their personality, reaching unstable holotymic ideas of greatness, disinhibition and increased drives.
Hypomanic (non-psychotic) syndrome includes a confidently expressed increase in mood with a predominant feeling of the joy of being, fun, and cheerfulness; with a subjective feeling of creative enthusiasm and increased productivity, some acceleration of the pace of thinking, with fairly productive activity, although with elements of distraction, behavior is not seriously affected,
Atypical manic syndromes. Unproductive mania involves elevated mood, but is not accompanied by a desire for activity, although it may be accompanied by a slight acceleration of the associative process.
Angry mania is characterized by increased mood with incontinence, irritability, pickiness with the transition to anger; inconsistency of thinking and activity.
Complex mania is a combination of mania with other non-affective syndromes, mainly delusional ones. The structure of the manic syndrome is joined by delusions of persecution, relationships, poisoning (manic-paranoid), verbal true and pseudohallucinations, phenomena of mental automatism with delusions of influence (manic-hallucinatory-paranoid), fantastic delusions and delusions of grandeur (manic-paraphrenic) up to oneiroid.
Manic syndromes are observed in cyclophrenia, schizophrenia, epilepsy, symptomatic, intoxication and organic psychoses.
6.1.2.3. Mixed affective syndromes. Agitated depression is characterized by an anxious affect combined with fussy anxiety and delusional ideas of condemnation and self-blame. Fussy anxiety can be replaced by motor agitation up to depressive raptus with increased suicidal danger.
Dysphoric depression, when a feeling of melancholy and displeasure is replaced by irritability, grumbling, spreading to everything around and to one’s well-being, outbursts of rage, aggression against others and self-aggression.
Manic stupor occurs at the height of manic excitement or a change from a depressive phase to a manic phase, when increasing mania is accompanied (or replaced) by persistent motor and intellectual retardation.
Occurs in endogenous psychoses, infectious, somatogenic, intoxicating and organic mental diseases.
6.1.3. Neurotic syndromes. It is necessary to distinguish between neurotic syndromes themselves and the neurotic level of disorders. The neurotic level of the disorder (borderline neuropsychiatric disorders), according to most domestic psychiatrists, also includes asthenic syndromes and non-psychotic affective disorders (subdepression, hypomania).
The actual neurotic syndromes include obsessive (obsessive-phobic, obsessive-compulsive syndrome), senestopathic and hypochondriacal, hysterical syndromes, as well as depersonalization-derealization syndromes, syndromes of overvalued ideas.
6.1.3.1. Obsessive-compulsive syndromes. The most common types are obsessive and phobic syndromes.
6.1.3.1.1. Obsessive syndrome includes as the main symptoms obsessive doubts, memories, ideas, an obsessive feeling of antipathy (blasphemous and blasphemous thoughts), “mental chewing gum,” obsessive desires and associated motor rituals. Additional symptoms include emotional stress, a state of mental discomfort, powerlessness and helplessness in the fight against obsessions. In their “pure” form, affectively neutral obsessions are rare and are represented by obsessive philosophizing, counting, obsessive remembering of forgotten terms, formulas, phone numbers, etc.
Obsessive syndrome (without phobias) occurs in psychopathy, low-grade schizophrenia, and organic diseases of the brain.
6.1.3.1.2. Phobic syndrome represented predominantly by a variety of obsessive fears. The most unusual and senseless fears may arise, but most often at the beginning of the disease there is a distinct monophobia, which gradually grows “like a snowball” with more and more new phobias. For example, cardiophobia is joined by agorophobia, claustophobia, thanatophobia, phobophobia, etc. Social phobias can be isolated for quite a long time.
The most common and diverse nosophobias are: cardiophobia, cancerophobia, AIDS phobia, alienophobia, etc. Phobias are accompanied by numerous somato-vegetative disorders: tachycardia, increased blood pressure, hyperhidrosis, persistent red dermographism, peristalsis and antiperistalsis, diarrhea, vomiting, etc. They join very quickly motor rituals, in some cases turning into additional obsessive actions performed against the desire and will of the patient, and abstract obsessions become rituals.
Phobic syndrome occurs in all forms of neuroses, schizophrenia, and organic diseases of the brain.
6.1.3.2. Senestopathic-hypochondriacal syndromes. They include a number of options: from “pure” senestopathic and hypochondriacal syndromes to senestopathosis. For the neurotic level of the syndrome, the hypochondriacal component can only be represented by overvalued ideas or obsessions.
At the initial stage of development of the syndrome, numerous senestopathies occur in various parts of the body, accompanied by dull depressiveness, anxiety, and mild restlessness. Gradually, a monothematic overvalued idea of hypochondriacal content emerges and is formed on the basis of senestolations. Based on unpleasant, painful, extremely painful sensations and existing experience of communication, diagnosis and treatment, health workers develop judgment: using senestopathies and real circumstances to explain and form a pathological “concept of illness”, which occupies a significant place in the patient’s experiences and behavior and disorganizes mental activity .
The place of overvalued ideas can be taken by obsessive doubts, fears regarding senesthopathy, with the rapid addition of obsessive fears and rituals.
They are found in various forms of neuroses, sluggish schizophrenia, and organic diseases of the brain. With hypochondriacal personality development, sluggish schizophrenia, senestopathic disorders with hypochondriacal overvalued ideas are gradually transformed into paranoid (delusional) syndrome.
Senestopathosis is the simplest syndrome, represented by monotonous senestopathies, accompanied by autonomic disorders and hypochondriacal fixation of attention on senestopathies. Occurs with organic lesions of the thalamo-hypothalamic region of the brain.
6.1.3.3. Depersonalization-derealization syndromes. The most poorly defined in general psychopathology. Symptoms and partly syndromes of impaired self-awareness are described in Chapter 4.7.2. Usually the following variants of depersonalization are distinguished: allopsychic, autopsychic, somatopsychic, bodily, anesthetic, delusional. The last two cannot be attributed to the neurotic level of disorders.
6.1.3.3.1. Depersonalization syndrome at the neurotic level includes violations of self-awareness of activity, unity and constancy of the “I”, slight blurring of the boundaries of existence (allopsychic depersonalization). In the future, the blurring of the boundaries of self-awareness, the impenetrability of the “I” (autopsychic depersonalization) and vitality (somatopsychic depersonalization) becomes more complicated. But there are never any gross changes in the boundaries of self-awareness, alienation of the “I” and stability of the “I” in time and space. It is found in the structure of neuroses, personality disorders, neurosopod schizophrenia, cyclothymia, and residual organic diseases of the brain.
6.1.3.3.2. Derealization syndrome includes as a leading symptom a distorted perception of the surrounding world, the surrounding environment is perceived by patients as “ghostly,” unclear, indistinct, “like in a fog,” colorless, frozen, lifeless, decorative, unreal. Individual metamorphopsia may also be observed (impaired perception of individual parameters of objects - shape, size, color, quantity, relative position, etc.).
Usually accompanied by various symptoms of impaired self-awareness, subdepression, confusion, and fear. Most often occurs in organic diseases of the brain, as part of epileptic paroxysms, and intoxication.
Derealization also includes: “already experienced,” “already seen,” “never seen,” “never heard.” They are found mainly in epilepsy, residual organic diseases of the brain, and some intoxications.
6.1.3.4. Hysterical syndromes. A group of functional polymorphic and extremely variable symptoms and syndromes of mental, motor, sensitivity, speech and somatovegetative disorders. Hysterical disorders also include a psychotic level of disorders: affective (hysterical) twilight states of consciousness, ambulatory automatisms (trances, Ganser syndrome, pseudodementia, puerilism (see section 5.1.6.3.1.1.).
Common to hysterical symptoms are egocentrism, a clear connection with the traumatic situation and the degree of its personal significance, demonstrativeness, external deliberateness, great suggestibility and self-hypnosis of patients (“a great simulator” of other diseases and syndromes), the ability to derive external or “internal” benefit from their painful states that are poorly understood or completely unconscious by the patient (“flight into illness”, “desirability or conditional pleasantness” of manifestations of the disease).
Mental disorders: severe asthenia with physical and mental fatigue, phobias, subdepression, amnesia, hypochondriacal experiences, pathological deceit and fantasies, emotional lability, weakness, sensitivity, impressionability, demonstrativeness, suicidal statements and demonstrative preparations for suicide.
Motor disorders: classic grand mal hysterical attack (“motor storm”, “hysterical arc”, clowning, etc.), hysterical paresis and paralysis, both spastic and flaccid; paralysis of the vocal cords (aphonia), stupor, contractures (trismus, torticollis-torticollis, strabismus, joint contractures, flexion of the body at an angle - captocormia); hyperkinesis, professional dyskinesia, astasia-abasia, hysterical lump in the throat, swallowing disorders, etc.
Sensory disorders: various paresthesias, decreased sensitivity and anesthesia of the “gloves”, “stockings”, “panties”, “jackets” type, etc.; painful sensations (pains), loss of function of the sensory organs - amaurosis (blindness), hemianopsia, scotomas, deafness, loss of smell and taste.
Speech disorders: stuttering, dysarthria, aphonia, mutism (sometimes surdomutism), aphasia.
Somato-vegetative disorders occupy the largest place in hysterical disorders and are the most diverse. Among them are spasms of smooth muscles in the form of lack of air, which sometimes simulates asthma, dysphagia (disturbances in the passage of the esophagus), paresis of the gastrointestinal tract, simulating intestinal obstruction, constipation, and urinary retention. Vomiting, hiccups, regurgitation, nausea, anorexia, and flatulence occur. Disorders of the cardiovascular system are common: pulse lability, blood pressure fluctuations, hyperemia or pallor of the skin, acrocyanosis, dizziness, fainting, pain in the heart area simulating heart disease.
Occasionally, vicarious bleeding (from intact areas of the skin, uterine and throat bleeding), sexual dysfunction, and false pregnancy occur. As a rule, hysterical disorders are caused by psychogenic diseases, but they also occur in schizophrenia and organic diseases of the brain.
6.1.3.5. Anorectic syndrome (anorexia nervosa syndrome) It is characterized by progressive self-limitation in food, selective consumption of food by the patient in combination with incomprehensible arguments about the need to “lose weight”, “get rid of fat”, “correct the figure”. Less common is the bulimic variant of the syndrome, when patients consume a lot of food and then induce vomiting. Often combined with body dysmorphomania syndrome. Occurs in neurotic conditions, schizophrenia, endocrine diseases.
Close to this group of syndromes are psychopathic syndromes, which can include both positive and negative symptoms (see section 5.2.4.).
6.1.3.6. Heboid syndrome. The core disorders in this syndrome are considered to be disturbances of drives in the form of painful intensification and especially their perversion. There is an exaggeration and distortion of affective and personal characteristics characteristic of adolescence, exaggerated oppositional tendencies, negativism, aggressive manifestations appear, there is a loss, or weakening, or slowdown in the development of higher moral principles (the concepts of good and evil, permitted and unlawful, etc.), sexual perversions, tendencies towards vagrancy, and the use of alcohol and drugs are observed. Occurs in psychopathy and schizophrenia.
dated June 14, 2007Karaganda State Medical University
Department of Psychology, Psychiatry and NarcologyLECTURE
Subject:
Discipline "Neurology, psychiatry, narcology"
Specialty 051301 – General medicine
Time (duration) 1 hour
Karaganda 2011
Approved at a methodological meeting of the department
05/07/2011 Protocol No. 10
Head of the departmentpsychology, psychiatry and narcology
Candidate of Medical Sciences, Associate Professor M.Yu.Lyubchenko
Subject : Main psychopathological syndromes
The goal is to familiarize students with the classification of mental illnesses
Lecture outline
2. Asthenic syndrome
3. Hallucinosis syndrome
4. Paranoid syndrome
5. Paranoid syndrome.
6. Mental automatism syndrome
7. Paraphrenic syndrome
8. Syndromes of impaired consciousness
9. Korsakoff syndrome
10.Psycho-organic syndrome
A syndrome is a stable combination of symptoms that are closely related to each other and united by a single pathogenetic mechanism and characterize the current condition of the patient.
Thus, peripheral sympathicotonia characteristic of depression leads to the appearance of tachycardia, constipation, and pupil dilation. However, the connection between symptoms can be not only biological, but also logical. Thus, the lack of the ability to remember current events with fixation amnesia naturally leads to disorientation in time and confusion in a new, unfamiliar environment.
Syndrome is the most important diagnostic category in psychiatry, while syndromic diagnosis is not considered as one of the stages in establishing a nosological diagnosis. When solving many practical issues in psychiatry, a correctly described syndrome means much more than a correctly stated nosological diagnosis. Since the causes of most mental disorders have not been determined, and the main drugs used in psychiatry do not have a nosologically specific effect, the prescription of therapy in most cases is focused on the leading syndrome. Thus, a pronounced depressive syndrome suggests the presence of suicidal thoughts, and therefore indicates to the doctor the need for urgent hospitalization, careful supervision and the use of antidepressants.
Some diseases are characterized by significant polymorphism of symptoms.
Although syndromes do not directly indicate a nosological diagnosis, they are divided into more and less specific. Thus, apathetic-abulic states and the syndrome of mental automatism are quite specific for paranoid schizophrenia. Depressive syndrome is extremely nonspecific and occurs in a wide range of endogenous, psychogenic, somatogenic and exogenous-organic diseases.
There are simple (small) and complex (large) syndromes. An example of the first is asthenic syndrome, manifested by a combination of irritability and fatigue. Typically, simple syndromes do not have nosological specificity and occur in various diseases. Over time, the syndrome may become more complicated, i.e. the addition of more severe symptoms in the form of delusions, hallucinations, pronounced personality changes, i.e. formation of a complex syndrome.
^ ASTHENIC SYNDROME.
This condition is manifested by increased fatigue, weakening or loss of the ability for prolonged physical and mental stress. Patients experience irritable weakness, expressed by increased excitability and quickly followed by exhaustion, affective lability with a predominance of low mood. Asthenic syndrome is characterized by hyperesthesia.
Asthenic states are characterized by the phenomena of asthenic or figurative mentism, manifested by a stream of vivid figurative ideas. There may also be influxes of extraneous thoughts and memories that involuntarily appear in the patient’s mind.
Headaches, sleep disturbances, and vegetative manifestations are often observed.
The patient's condition may change depending on the level of barometric pressure (meteopathic Pirogov syndrome).
Asthenic syndrome is the most nonspecific of all psychopathological syndromes. It can be observed with cyclothymia, symptomatic psychoses, organic brain lesions, neuroses, and intoxication psychoses.
The occurrence of asthenic syndrome is associated with depletion of the functional capabilities of the nervous system when it is overstrained, as well as due to autointoxication or exogenous toxicosis, impaired blood supply to the brain and metabolic processes in brain tissue. This allows us to consider the syndrome in some cases as an adaptive reaction, manifested by a decrease in the intensity of activity of various body systems with the subsequent possibility of restoring their function.
^ HALLUCINOSIS SYNDROMES.
Hallucinosis is manifested by numerous hallucinations (usually simple), which constitute the main and practically the only manifestation of psychosis. There are visual, verbal, tactile, olfactory hallucinosis. Hallucinosis can be acute (lasting several weeks) or chronic (lasting years).
The most typical causes of hallucinosis are exogenous hazards (intoxication, infection, trauma) or somatic diseases (cerebral atherosclerosis). Some intoxications are distinguished by special variants of hallucinosis. Thus, alcoholic hallucinosis is more often manifested by verbal hallucinations of a condemning nature. Tetraethyl lead poisoning causes a sensation of hair in the mouth. Cocaine intoxication results in tactile hallucinosis with the sensation of insects crawling under the skin.
In schizophrenia, this syndrome occurs in the form of pseudohallucinosis.
^ PARANOIAL SYNDROME.
Paranoid syndrome manifests itself as a primary, interpretative, monothematic, systematized delusion. The predominant content of delusional ideas is reformism, relationships, jealousy, and the special importance of one’s own personality. There are no hallucinatory disorders. Delusional ideas are formed as a result of a paralogical interpretation of the facts of reality. The manifestation of delusion may be preceded by the long existence of overvalued ideas. Paranoid syndrome tends to be chronic and difficult to treat with psychotropic drugs.
The syndrome occurs in schizophrenia, involutional psychoses, and decompensation of paranoid psychopathy.
^ PARANOID SYNDROME
Paranoid syndrome is characterized by systematized ideas of persecution. Delusions are accompanied by hallucinations, most often auditory pseudohallucinations. The occurrence of hallucinations determines the emergence of new plots of delirium - ideas of influence, poisoning. A sign of an allegedly existing influence, from the point of view of patients, is a feeling of mastery (mental automatism). Thus, in its main manifestations, paranoid syndrome coincides with the concept of mental automatism syndrome. The latter does not include only variants of the paranoid syndrome, accompanied by true taste or olfactory hallucinations and delusions of poisoning. With paranoid syndrome, there is a certain tendency towards the collapse of the delusional system, delirium acquires features of pretentiousness and absurdity. These features become especially pronounced during the transition to paraphrenic syndrome.
SYNDROME OF MENTAL AUTOMATISM (Kandinsky-Clerambault syndrome).
This syndrome consists of delusions of persecution and influence, pseudohallucinations and phenomena of mental automatism. The patient can feel the influence carried out in various ways - from witchcraft and hypnosis, to the action of cosmic rays and computers.
There are 3 types of mental automatism: ideational, sensory, motor.
Ideatorial automatisms are the result of an imaginary influence on thinking processes and other forms of mental activity. Manifestations of this type of automatism are mentism, “sounding” of thoughts, “taking away” or “putting in” thoughts, “madeness” of dreams, a symptom of unwinding memories, “madeness” of mood and feelings.
Sensory automatisms usually include extremely unpleasant sensations that occur in patients also as a result of the influence of an external force.
Motor automatisms include disorders in which patients have the belief that the movements they make are carried out against their will under external influence, as well as speech motor automatisms.
An inverted version of the syndrome is possible, the essence of which is that the patient himself allegedly has the ability to influence others, recognize their thoughts, influence their mood, feelings and actions.
^ PARAPHRENIC SYNDROME.
This condition is a combination of fantastic delusions of grandeur, delusions of persecution and influence, phenomena of mental automatism and affective disorders. Patients call themselves rulers of the Earth, the Universe, heads of state, etc. When presenting the content of delirium, they use figurative and grandiose comparisons. As a rule, patients do not seek to prove the correctness of statements, citing the indisputability of their beliefs.
The phenomena of mental automatism also have a fantastic content, which is expressed in mental communication with outstanding representatives of humanity or with creatures inhabiting other planets. Positive or negative twin syndrome is often observed.
Pseudohallucinations and confabulatory disorders can occupy a significant place in the syndrome. In most cases, the mood of patients is elevated.
^ SYNDROMES OF DISTURBED CONSCIOUSNESS.
Criteria for impaired consciousness have been developed (Karl Jaspers):
Detachment from surrounding reality. The outside world is not perceived or is perceived in fragments.
Disorientation in surroundings
Thinking disorder
Amnesia of the period of impaired consciousness, complete or partial
switched off syndromes
clouded consciousness syndromes
Syndromes of clouded consciousness: delirium, amentia, oneiroid, twilight disorder of consciousness.
Delirium may be alcoholic, intoxication, traumatic, vascular, infectious. This is an acute psychosis with impaired consciousness, which is most often based on signs of cerebral edema. The patient is disoriented in time and place, experiencing frightening visual hallucinations. Often these are zoohallucinations: insects, lizards, snakes, scary monsters. The patient's behavior is largely determined by psychopathological experiences. Delirium is accompanied by multiple somatovegetative disorders (increased blood pressure, tachycardia, hyperhidrosis, tremor of the body and limbs). In the evening and at night, all these manifestations intensify, and in the daytime they usually weaken somewhat.
Upon completion of psychosis, partial amnesia is observed.
The course of psychosis is characterized by a number of features. Symptoms increase in a certain sequence. It takes from several days to 2 days for psychosis to fully develop. Early signs of developing psychosis are anxiety, restlessness, hyperesthesia, insomnia, against the background of which hypnogogic hallucinations appear. As psychosis increases, illusory disorders appear, turning into complex hallucinatory disorders. This period is characterized by pronounced fear and psychomotor agitation. Delirium lasts from 3 to 5 days. The cessation of psychosis occurs after prolonged sleep. After recovery from psychosis, residual delusions may persist. Abortive delirium lasts several hours. However, severe forms of delirium are not uncommon, leading to a gross organic defect (Korsakoff syndrome, dementia).
Signs of an unfavorable prognosis are occupational and persistent delirium.
Oneiric(dreamlike) darkening of consciousness. Distinguished by the extreme fantastic nature of psychotic experiences.
Oneiroid is a kind of alloy of real, illusory and hallucinatory perception of the world. A person is transported to another time, to other planets, is present at great battles, the end of the world. The patient feels responsible for what is happening, feels like a participant in the events. However, the behavior of patients does not reflect the richness of experiences. The movement of patients is a manifestation of the catatonic syndrome - stereotypical swaying, mutism, negativism, waxy flexibility, impulsiveness. Patients are disoriented in place, time and self. A symptom of double false orientation is possible, when patients consider themselves patients in a psychiatric hospital and at the same time participants in fantastic events. Sensations of rapid movement, movement in time and space are often observed.
Oneiroid is most often a manifestation of an acute attack of schizophrenia. The formation of psychosis occurs relatively quickly, but can last for several weeks. Psychosis begins with sleep disturbances and the appearance of anxiety; concern quickly reaches the level of confusion. Acute sensory delirium and derealization phenomena appear. Then fear gives way to an affect of bewilderment or ecstasy. Later, catatonic stupor or agitation often develops. The duration of psychosis is up to several weeks. The exit from the oneiric state is gradual. First, hallucinations are leveled out, then catatonic phenomena. Ridiculous statements and actions sometimes persist for quite a long time.
Oneiric experiences that develop against the background of exogenous and somatogenic factors are classified as manifestations fantastic delirium. Among exogenous psychoses, the most consistent with the picture of a typical oneiroid are the phenomena observed with the use of hallucinogens (LSD, hashish, ketamine) and hormonal drugs (corticosteroids).
Amentia – severe clouding of consciousness with incoherent thinking, complete inaccessibility to contact, fragmentary deceptions of perception and signs of severe physical exhaustion. A patient in an amental state usually lies down, despite chaotic agitation. His movements sometimes resemble some actions indicating the presence of hallucinations, but are often completely meaningless and stereotypical. Words are not connected into phrases and are fragments of speech (incoherent thinking). The patient reacts to the doctor’s words, but cannot answer questions and does not follow instructions.
Amentia occurs most often as a manifestation of long-term debilitating somatic diseases. If it is possible to save the lives of patients, the outcome is a pronounced organic defect (dementia, Korsakoff syndrome, affected asthenic conditions). Many psychiatrists consider amentia as one of the variants of severe delirium.
^ Twilight darkness of consciousness is a typical epileptiform paroxysm. Psychosis is characterized by a sudden onset, a relatively short duration (from tens of minutes to several hours), an abrupt cessation and complete amnesia of the entire period of upset consciousness.
The perception of the environment at the moment of clouding of consciousness is fragmentary; patients snatch random facts from surrounding stimuli and react to them in an unexpected way. Affect is often characterized by malice and aggressiveness. Antisocial behavior is possible. Symptoms lose all connection with the patient’s personality. Possible productive symptoms in the form of delusions and hallucinations. Once psychosis ends, there are no memories of psychotic experiences. Psychosis usually ends in deep sleep.
There are variants of twilight stupefaction with vivid productive symptoms (delusions and hallucinations) and with automated actions (outpatient automatisms).
^ Outpatient automatisms manifest themselves in short periods of confusion without sudden excitement with the ability to perform simple automated actions. Patients can take off their clothes, get dressed, go outside, and give brief, not always appropriate answers to the questions of others. Upon recovery from psychosis, complete amnesia is noted. Varieties of ambulatory automatisms include fugues, trances, and somnambulism.
Twilight stupefactions are a typical symptom of epilepsy and other organic diseases (tumors, cerebral atherosclerosis, head injuries).
It should be distinguished from epileptic hysterical twilight states that arise immediately after the action of mental trauma. At the time of psychosis, the behavior of patients may be characterized by foolishness, infantilism, and helplessness. Amnesia can cover large periods preceding psychosis or following its cessation. However, fragmentary memories of what happened may remain. Resolving a traumatic situation usually leads to restoration of health.
^ KORSAKOV SYNDROME
This is a condition in which memory disorders for events of the present (fixation amnesia) predominate, while it is preserved for events of the past. All information coming to the patient instantly disappears from his memory; patients are not able to remember what they just saw or heard. Since the syndrome can occur after an acute cerebral accident, along with anterograde amnesia, retrograde amnesia is also noted.
One of the characteristic symptoms is amnestic disorientation. Memory gaps are filled with paramnesias. Confabulatory confusion may develop.
The occurrence of Korsakoff syndrome as a result of acute brain damage in most cases allows us to hope for some positive dynamics. Although complete memory restoration is impossible in most cases, during the first months after treatment the patient can record individual repeated facts, the names of doctors and patients, and navigate the department.
^ PSYCHOORGANIC SYNDROME
A state of general mental helplessness with decreased memory, intelligence, weakened will and affective stability, decreased ability to work and other adaptation capabilities. In mild cases, psychopathic states of organic origin, mild asthenic disorders, affective lability, and weakening of initiative are revealed. Psychoorganic syndrome can be a residual condition that occurs during progressive diseases of organic origin. In these cases, psychopathological symptoms are combined with signs of organic brain damage.
There are asthenic, explosive, euphoric and apathetic variants of the syndrome.
At asthenic variant The clinical picture of the syndrome is dominated by persistent asthenic disorders in the form of increased physical and mental exhaustion, symptoms of irritable weakness, hyperesthesia, affective lability, and disorders of intellectual functions are slightly expressed. There is a slight decrease in intellectual productivity and mild dysmnestic disorders.
For explosive version Characterized by a combination of affective excitability, irritability, aggressiveness with mildly expressed dysmnestic disorders and decreased adaptation. Characterized by a tendency towards overvalued paranoid formations and querulant tendencies. Quite frequent alcohol abuse is possible, leading to the formation of alcohol dependence.
As with the asthenic and explosive variants of the syndrome, decompensation of the condition is expressed in connection with intercurrent diseases, intoxications and mental trauma.
Painting euphoric version The syndrome is determined by an increase in mood with a tinge of euphoria, complacency, confusion, a sharp decrease in criticism of one’s condition, dysmnestic disorders, and increased drives. Anger and aggressiveness are possible, followed by helplessness and tearfulness. Signs of a particularly serious condition are the development in patients of symptoms of forced laughter and forced crying, in which the reason that caused the reaction is amnesic, and the grimace of laughter or crying persists for a long time in the form of a facial reaction devoid of affect content.
^ Apathetic option The syndrome is characterized by aspontaneity, a sharp narrowing of the range of interests, indifference to the environment, including one’s own fate and the fate of one’s loved ones, and significant dysmnestic disorders. Noteworthy is the similarity of this condition with the apathetic pictures observed in schizophrenia, however, the presence of mnestic disorders, asthenia, spontaneously occurring syndromes of forced laughter or crying helps to distinguish these pictures from similar conditions in other nosological units.
The listed variants of the syndrome are often stages of its development, and each of the variants reflects a different depth and different extent of damage to mental activity.
Illustrative material (slides – 4 pcs.)
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Literature
Mental illnesses with a course in narcology / edited by prof. V.D. Mendelevich. M.: Academy 2004.-240 p.
Medelevich D.M. Verbal hallucinosis. - Kazan, 1980. - 246 p.
Guide to Psychiatry / Ed. A. V. Snezhnevsky. T. 1-2- M.: Medicine, 1983.
Jaspers K. General psychopathology: Trans. with him. - M.: Practice,
1997. - 1056 p.
Zharikov N.M., Tyulpin Yu.G. Psychiatry. M.: Medicine, 2000 – 540 p.
Psychiatry. A textbook for students of medical universities, edited by V.P. Samokhvalova – Rostov on Don: Phoenix 2002
Rybalsky M.I. Illusions and hallucinations. - Baku, 1983., 304 p.
Popov Yu. V., Vid V. D. Clinical psychiatry. - St. Petersburg, 1996.
Security questions (feedback)
name the main features of paraphrenic syndrome
What is included in the concept of psychoorganic syndrome
What are the main reasons for the development of Korsakoff's syndrome?
I. HALLUCINATORY AND DELUSIONAL SYNDROMES Hallucinosis is a condition characterized by an abundance of hallucinations within one analyzer and not accompanied by clouding of consciousness. The patient is anxious, restless, or, conversely, inhibited. The severity of the condition is reflected in the patient's behavior and attitude towards hallucinations.
Verbal auditory hallucinosis: voices are heard talking to each other, arguing, condemning the patient, agreeing to destroy him. Auditory hallucinosis defines the clinical picture of alcoholic psychosis of the same name; the syndrome can be isolated in other intoxication psychoses, in neurosyphilis, in patients with vascular lesions of the brain.
It is observed in psychoses of late age, with organic damage to the central nervous system. Patients with tactile hallucinosis feel insects, worms, microbes crawling on and under the skin, touching the genitals; criticism of the experience is usually absent.
Visual hallucinosis is a common form of hallucinosis in the elderly and people who have suddenly lost their vision; it also occurs with somatogenic, vascular, intoxication and infectious psychoses. With hallucinations of Charles Bonnet BLIND (blind during life or from birth), patients suddenly begin to see on the wall, in the room, bright landscapes, sunlit lawns, flower beds, playing children, or simply abstract, bright “images”.
Usually, with hallucinosis, the patient’s orientation in place, time and self is not disturbed, there is no amnesia of painful experiences, i.e., there are no signs of clouding of consciousness. However, with acute hallucinosis with life-threatening content, the level of anxiety sharply increases, and in these cases consciousness can be affectively narrowed.
Paranoid syndrome is a syndrome of delusion, characterized by delirious interpretation of the facts of the surrounding reality, the presence of a system of evidence used to “justify” errors of judgment. The formation of delusions is facilitated by personality traits, manifested by significant strength and rigidity of affective reactions, and in thinking and actions - thoroughness and a tendency to detail. In terms of content, this is litigious delirium, invention, jealousy, persecution.
Paranoid syndrome may be the initial stage in the development of schizophrenic delusions. At this stage there are still no hallucinations and pseudo-hallucinations, no phenomena of mental automatism. Paranoid syndrome exhausts the psychopathological symptoms of paranoid psychopathy, alcoholic paranoid
Hallucinatory-paranoid syndromes, in which hallucinatory and delusional disorders, organically related, are presented in different proportions. When there is a significant predominance of hallucinations, the syndrome is called hallucinatory; when delusional ideas predominate, it is called paranoid.
Paranoid syndrome also refers to the paranoid stage of delusion development. At this stage, the previous system of erroneous conclusions corresponding to paranoid delusions may persist, but signs of its disintegration are revealed: absurdities in behavior and statements, the dependence of delusions on the leading affect and on the content of hallucinations (pseudo-hallucinations), which also appear at the paranoid stage.
Kandinsky-Clerambault mental automatism syndrome is a special case of hallucinatory-paranoid syndrome and includes pseudohallucinations, phenomena of alienation of mental acts - automatisms and delusions of influence. Being in the grip of perceptual disturbances, the patient is confident in their violent origin, in their creation - this is the essence of automatism.
Automaticity can be ideational, sensory or motor. The patient believes that they are controlling his thoughts, “making” them parallel, forcing him to mentally utter curses, putting other people’s thoughts into his head, taking them away, reading them. In this case we are talking about ideptor automatism. This type of automatism includes pseudohallucinations.
Sensory automatism concerns more violations of sensory cognition and corresponds to the statements of patients about “doneness”: Feelings - “cause” indifference, lethargy, a feeling of anger, anxiety Sensations - “cause” pain in different parts of the body, a sensation of electric current passing, burning, itching. With the development of motor automatism, the patient becomes convinced that he is losing the ability to control his movements and actions: at the will of someone else, a smile appears on his face, his limbs move, and complex actions are performed, such as suicidal acts.
There are chronic and acute hallucinatory-paranoid syndromes. Chronic hallucinatory-paranoid syndrome gradually becomes more complex, the initial symptoms acquire new ones, and a full-blown syndrome of mental automatism is formed.
Acute hallucinatory-paranoid syndromes can be reduced under the influence of treatment and can quickly transform into other psychopathological syndromes. The structure of acute hallucinatory-paranoid syndrome contains acute sensory delirium, delusional perception of the environment, confusion or significant intensity of affect;
Acute hallucinatory-paranoid syndrome is often a stage in the development of acute paraphrenia and oneiric state. Hallucinatory-paranoid syndromes can be diagnosed in all known psychoses, except manic-depressive.
II. SYNDROMES OF INTELLECTUAL DISORDERS Intelligence is not a separate, independent mental sphere. It is considered as the ability for mental, cognitive and creative activity, for acquiring knowledge, experience and applying them in practice. With intellectual disabilities, the ability to analyze material, combine, guess, carry out mental processes of synthesis, abstraction, create concepts and inferences, and draw conclusions is insufficient. education of skills, acquisition of knowledge, improvement of previous experience and the possibility of its application in activities.
Dementia (dementia) is a persistent, difficult-to-recover loss of intellectual abilities caused by a pathological process, in which there are always signs of a general impoverishment of mental activity. There is a decrease in intelligence from the level acquired by a person during life, its reverse development, impoverishment, accompanied by a weakening of cognitive abilities, impoverishment of feelings and changes in behavior.
With acquired dementia, sometimes memory and attention are primarily impaired, and the ability to judge is often reduced; the core of personality, criticism and behavior remain intact for a long time. This type of dementia is called partial or lacunar (partial, focal dysmnestic). In other cases, dementia is immediately manifested by a decrease in the level of judgment, violations of criticism, behavior, and leveling of the patient’s characterological characteristics. This type of dementia is called complete or total dementia (diffuse, global).
Organic dementia can be lacunar and total. Lacunar dementia is observed in patients with cerebral atherosclerosis, cerebral syphilis (vascular form), Total dementia - in progressive paralysis, senile psychoses, in Pick and Alzheimer's diseases.
Epileptic (concentric) dementia is characterized by extreme sharpening of characterological features, rigidity, stiffness of all mental processes, slowness of thinking, its thoroughness, difficulty switching attention, impoverished vocabulary, and a tendency to use the same cliched expressions. In character this is manifested by rancor, vindictiveness, petty punctuality, pedantry and, along with this, hypocrisy and explosiveness.
With the steady progression of the pathological process, the increase in rigidity and thoroughness, a person turns out to be less and less capable of diverse social functioning, gets bogged down in trifles, and the range of his interests and activities becomes increasingly narrowed (hence the name of dementia - “concentric”).
Schizophrenic dementia is characterized by a decrease in energy potential, emotional impoverishment, reaching the level of emotional dullness. An uneven disturbance of intellectual processes is revealed: in the absence of noticeable memory disorders and a sufficient level of formal knowledge, the patient turns out to be completely socially maladapted and helpless in practical matters. There is autism, a violation of the unity of the mental process (signs of mental splitting) in combination with inactivity and unproductivity.
III. AFFECTIVE SYNDROMES Manic syndrome in its classic version includes a triad of psychopathological symptoms: 1) increased mood; 2) acceleration of the flow of ideas; 3) speech motor excitation. These are obligate (basic and constantly present) signs of the syndrome. Increased affect affects all aspects of mental activity, which is manifested by secondary, unstable (optional) signs of manic syndrome.
There is an unusual brightness of perception of the environment, in the memory processes there are phenomena of hypermnesia In thinking - a tendency to overestimate one’s capabilities and one’s own personality, short-term delusional ideas of greatness In emotional reactions - anger In the volitional sphere - increased desires, drives, rapid switching of attention Mimicry, pantomime and all the patient's appearance expresses joy.
Depressive syndrome is manifested by a triad of obligate symptoms: Decreased mood, Slowing down of ideas, Speech retardation. Optional signs of depressive syndrome: In perception - hypoesthesia, illusory, derealization and depersonalization phenomena In the mnestic process - a violation of the sense of familiarity In thinking - overvalued and delusional ideas of hypochondriacal content, self-accusation, self-abasement, self-incrimination In the emotional sphere - reactions of anxiety and fear; motor-volitional disorders include suppression of desires and drives, suicidal tendencies. Sorrowful facial expression and posture, quiet voice.
Anxiety-depressive syndrome (agitated depression syndrome), manic stupor and unproductive mania in their origin are so-called mixed conditions, transitional from depression to mania and vice versa.
The psychopathological triad traditional for classical depression and mania is violated here, the effective syndrome loses some of its properties and acquires signs of a polar opposite affective state. Thus, in the syndrome of agitated depression, instead of motor retardation, there is excitement, which is characteristic of a manic state.
Manic stupor syndrome is characterized by motor retardation with elevated mood; Patients with nonproductive mania experience increased mood, motor disinhibition, combined with a slower pace of thinking.
Depressive-paranoid syndrome is classified as atypical for the affective level. A special feature is the intrusion into the affective syndrome corresponding to manic-depressive psychosis, symptoms from other nosological forms of schizophrenia, exogenous and exogenous-organic psychoses.
Paraphrenic delirium of enormity, described by Cotard, can also be classified as atypical affective states: hypochondriacal experiences, which are based in depression on a feeling of one’s own change, take on a grotesque character with the patient’s confidence in the absence of internal organs, with denial of the outside world, life, death, with ideas of doom to eternal torment. Depression with hallucinations, delusions, and confusion is described as fantastic melancholia. Blackout of consciousness at the height of a manic state gives grounds to speak of confused mania.
Asthenodepressive syndrome. Some authors consider this concept of syndrome to be theoretically untenable, believing that we are talking about a combination of two simultaneously existing syndromes - asthenic and depressive. At the same time, attention is drawn to the clinical fact that asthenia and depression are mutually exclusive conditions: the higher the proportion of asthenic disorders, the less the severity of depression; with increasing asthenia, the suicidal risk decreases, motor and ideational retardation disappears.
In the practice of a doctor, asthenodepressive syndrome is diagnosed as one of the most common within the framework of borderline mental pathology. Manic and depressive syndromes can be a stage in the formation of psychopathological symptoms of any mental illness, but in their most typical manifestations they are presented only in manic-depressive psychosis.
IV. SYNDROMES OF MOTOR AND VOLITIONAL DISORDERS Catatonic syndrome is manifested by catatonic stupor or catatonic agitation. These outwardly different states are actually united in their origin and turn out to be only different phases of one and the same phenomenon.
In accordance with the research of I.P. Pavlov, the symptoms of catatonia are the result of a painful weakness of nerve cells, for which ordinary stimuli turn out to be super strong. The inhibition that develops in the cerebral cortex is protective and transcendental. If inhibition covers not only the entire cortex, but also the subcortical region, symptoms of catatonic stupor appear. The patient is inhibited, does not care for himself, does not respond to speech addressed to him, does not follow instructions, and mutism is noted.
Some patients lie motionless, turned to the wall, in a uterine position with the chin brought to the chest, with arms bent at the elbows, knees bent and legs pressed to the stomach for days, weeks, months or years.
The uterine position indicates the release of more ancient reactions characteristic of the early age period of development, which in an adult are inhibited by later, higher-order functional formations. Another very characteristic position is also lying on your back with your head raised above the pillow - a symptom of an air cushion.
Disinhibition of the sucking reflex leads to the appearance of the proboscis symptom; when you touch the lips, they fold into a tube and protrude; In some patients, this position of the lips occurs constantly. The grasping reflex (normally characteristic only of newborns) is also disinhibited: the patient grasps and tenaciously holds everything that accidentally touches his palm.
With incomplete stupor, echosymptoms are sometimes observed: echolalia - repetition of the words of someone around, echopraxia - copying the movements of other people. The basis of echosymptoms is the disinhibition of the imitative reflex, which is characteristic of children and contributes to their mental development. The release of stem postural reflexes is expressed by catalepsy (waxy flexibility): the patient maintains the position given to his body and limbs for a long time.
Phenomena of negativism are observed: the patient either does not fulfill what is required at all (passive negativism), or actively resists, acts opposite to what is required of him (active negativism). In response to a request to show his tongue, the patient compresses his lips tightly, turns away from the hand extended to him for a handshake and removes his hand behind his back; turns away from the plate of food placed in front of him, resists trying to feed him, but grabs the plate and pounces on the food when trying to remove it from the table. I. P. Pavlov considered this an expression of phase states in the central nervous system and associated negativism with the ultraparadoxical phase
In the paradoxical phase, weaker stimuli can produce a stronger response. Thus, patients do not respond to questions asked in a normal, loud voice, but answer questions asked in a whisper. At night, when the flow of impulses into the central nervous system from the outside sharply decreases, some stuporous patients disinhibit, begin to move quietly, answer questions, eat, and wash; with the onset of morning and an increase in the intensity of irritation, the numbness returns. Patients with stupor may not have other symptoms, but more often there are hallucinations and delusional interpretation of the environment. This becomes clear when the patient disinhibits.
Depending on the nature of the leading symptoms, three types of stupor are distinguished: 1) with phenomena of waxy flexibility, 2) negativistic, 3) with muscle numbness. The listed options are not independent disorders, but represent stages of stuporous syndrome, replacing one another in the specified sequence with the worsening of the patient’s condition.
Catatonic excitation is senseless, undirected, sometimes taking on a motor character. The patient’s movements are monotonous and are essentially subcortical hyperkinesis; aggressiveness, impulsive actions, echopraxia, negativism are possible. Facial expressions often do not match poses; sometimes paramimic expression is observed: the facial expressions of the upper part of the face express joy, the eyes laugh, but the mouth is angry, the teeth are clenched, the lips are tightly compressed and vice versa. Facial asymmetries can be observed. In severe cases, there is no speech, the excitement is mute, or the patient growls, hums, shouts out individual words, syllables, or pronounces vowels.
Some patients exhibit an uncontrollable desire to speak. At the same time, the speech is pretentious, stilted, speech stereotypies, perseveration, echolalia, fragmentation, verbigeration are noted - the meaningless stringing of one word onto another. Transitions from catatonic excitation to a stuporous state or from stupor to a state of excitation are possible.
Catatonia is divided into lucid and oneiric. Lucid catatonia occurs without clouding of consciousness and is expressed by stupor with negativism or numbness or impulsive excitement. Oneiric catatonia includes oneiric stupor, catatonic agitation with confusion, or stupor with waxy flexibility. Catatonic syndrome is more often diagnosed with schizophrenia, sometimes with epilepsy or exogenous-organic psychoses.
Hebephrenic syndrome is close to catatonic both in origin and in manifestations. Characterized by excitement with mannerisms, pretentiousness of movements and speech, foolishness. Fun, antics and jokes do not infect others. Patients tease, grimace, lisp, distort words and phrases, tumble, dance.
As part of sluggish schizophrenia, adolescents are sometimes diagnosed with heboidism - an incompletely developed hebephrenic state, manifested by a touch of foolishness, swagger in behavior, impaired drives and antisocial tendencies.
V. NEUROTIC SYNDROMES This pathology is distinguished by the partiality of mental disorders, a critical attitude towards them, the presence of consciousness of the disease, an adequate assessment of the environment and abundant somatovegetative symptoms accompanying the weakness of mental functions. Characterized by the absence of gross violations of cognition of the environment. In the structure of neurotic syndromes there are no disorders of objective consciousness, delusional ideas, hallucinations, dementia, manic state, stupor, or agitation.
With true neurotic disorders, the personality remains intact. Moreover, the effect of external harmfulness is mediated by the patient’s personality, its reactions, which characterize the personality itself, its social essence. All of these features make it possible to qualify this type of disorder as a borderline mental pathology, a pathology located on the border between normality and pathology, between somatic and mental illnesses.
Neurasthenic (asthenic) syndrome is characterized by irritable weakness. Due to acquired or congenital insufficiency of internal inhibition, excitement is not limited in any way, which is manifested by irritability, impatience, increased exhaustion of attention, sleep disturbances (superficial sleep, with frequent awakenings).
There are hyper- and hyposthenic variants of asthenia. With hypersthenic asthenia, the preservation of the excitatory process and the weakness of the inhibitory process leads to the propensity for explosive, explosive reactions coming to the fore. With hyposthenic asthenia, there are all signs of weakness not only of the inhibitory, but also of the excitatory process: extreme fatigue during mental and physical stress, low performance and productivity, memory impairment.
Obsessive-phobic syndrome manifests itself as psychopathological products in the form of various obsessions and phobias. During this period, anxiety, suspiciousness, and indecision intensify, and signs of asthenia are revealed.
Hypochondriacal syndrome in its content can be: 1) asthenic, 2) depressive, 3) phobic, 4) senestopathic, 5) delusional.
In neurotic conditions we are talking about simple, non-delusional hypochondria, expressed by exaggerated attention to one’s health and doubts about its well-being. Patients are fixated on unpleasant sensations in their body, the source of which can be the neurotic state itself and the somatovegetative changes caused by it, depression with its sympathicotonia and other reasons. Patients often seek help from various specialists and are examined extensively. Favorable research results calm patients for a while, and then anxiety increases again, thoughts about a possible serious illness return. The occurrence of hypochondriacal symptoms may be associated with iatrogenicity.
Hysterical syndrome is a combination of symptoms of any disease, if in origin these symptoms are a consequence of increased suggestibility and self-hypnosis, as well as personality traits such as egocentrism, demonstrativeness, mental immaturity, increased imagination and emotional lability. The condition is characteristic of hysterical neurosis, hysterical personality development, hysterical psychopathy.
Psychopathic syndrome. This is a persistent syndrome of socially maladaptive disharmony in the emotional and volitional spheres of the patient, which is an expression of character pathology. Disorders do not concern the cognitive process. Psychopathic syndrome is formed in certain conditions of the social environment on the basis of congenital (psychopathy) and acquired (post-processual state) changes in higher nervous activity. Pathology is considered borderline in psychiatry.
Variants of the psychopathic syndrome correspond to clinical forms of psychopathy and are manifested by excitable traits or reactions of increased inhibition. The first case is characterized by emotional incontinence, anger, conflict, impatience, quarrelsomeness, instability of will, and a tendency to abuse alcohol and use drugs.
A feature of the other option is weakness, exhaustion of personality reactions, insufficient activity, low self-esteem, and a tendency to doubt.
All the many syndromes in psychopathology increasingly do not occur independently. In most cases, syndromes are combined into complex, difficult-to-diagnose complexes. When caring for “complex” patients, every doctor must take into account that a somatic illness can often be a manifestation of one or another psychopathological syndrome
APATHY (indifference). At the initial stages of the development of apathy, there is a slight weakening of hobbies; the patient reads or watches TV mechanically. In case of psycho-affective indifference, during questioning he expresses relevant complaints. With a shallow emotional decline, for example in schizophrenia, the patient calmly reacts to events of an exciting, unpleasant nature, although in general the patient is not indifferent to external events.
In a number of cases, the patient’s facial expressions are impoverished, he is not interested in events that do not concern him personally, and almost does not participate in entertainment. Some patients are little affected even by their own situation and family affairs. Sometimes there are complaints about “stupidity”, “indifference”. The extreme degree of apathy is characterized by complete indifference. The patient's facial expression is indifferent, there is indifference to everything, including his appearance and cleanliness of his body, to his stay in the hospital, to the appearance of relatives.
ASTHENIA (increased fatigue). With minor symptoms, fatigue occurs more often with increased load, usually in the afternoon. In more pronounced cases, even with relatively simple types of activity, a feeling of fatigue, weakness, and an objective deterioration in the quality and pace of work quickly appear; rest doesn't help much. Asthenia is noticeable at the end of a conversation with a doctor (for example, the patient talks sluggishly, tries to quickly lie down or lean on something). Among vegetative disorders, excessive sweating and pallor of the face predominate. Extreme degrees of asthenia are characterized by severe weakness up to prostration. Any activity, movement, short-term conversation is tiring. Rest doesn't help.
AFFECTIVE DISORDERS characterized by instability (lability) of mood, a change in affect towards depression (depression) or elevation (manic state). At the same time, the level of intellectual and motor activity changes, and various somatic equivalents of the condition are observed.
Affective lability (increased emotional reactivity). With unexpressed disorders, the range of situations and reasons in connection with which affect arises or mood changes are somewhat expanded compared to the individual norm, but these are still quite intense emotiogenic factors (for example, actual failures). Usually, affect (anger, despair, resentment) occurs rarely and its intensity largely corresponds to the situation that caused it. With more severe affective disorders, mood often changes for minor and varied reasons. The intensity of the disorders does not correspond to the real significance of psychogenicity. In this case, affects can become significant, arise for completely insignificant reasons or without a perceptible external reason, change several times within a short time, which makes goal-directed activity extremely difficult.
Depression. With minor depressive disorders, the patient sometimes develops a noticeably sad expression on his face and sad intonations in conversation, but at the same time his facial expressions are quite varied and his speech is modulated. The patient manages to be distracted and cheered up. There are complaints of “feeling sad” or “lack of cheerfulness” and “boredom.” Most often, the patient is aware of the connection between his condition and traumatic influences. Pessimistic experiences are usually limited to a conflict situation. There is some overestimation of real difficulties, but the patient hopes for a favorable resolution of the situation. A critical attitude towards the disease has been maintained. With a decrease in psycho-traumatic influences, the mood normalizes.
As depressive symptoms worsen, facial expressions become more monotonous: not only the face, but also the posture expresses despondency (shoulders are often slumped, the gaze is directed into space or down). There may be sad sighs, tearfulness, a pitiful, guilty smile. The patient complains of a depressed, “decadent” mood, lethargy, and unpleasant sensations in the body. He considers his situation gloomy and does not notice anything positive in it. It is almost impossible to distract and cheer up the patient.
With severe depression, a “mask of grief” is observed on the patient’s face; the face is elongated, grayish-cyanotic in color, the lips and tongue are dry, the gaze is suffering, expressive, there are usually no tears, blinking is rare, sometimes the eyes are half-closed, the corners of the mouth are downturned, the lips are often compressed. Speech is not modulated, up to an unintelligible whisper or silent lip movements. The pose is hunched over, with head down, knees together. Raptoid states are also possible: the patient groans, sobs, rushes about, tends to self-harm, and breaks his arms. Complaints of “unbearable melancholy” or “despair” predominate. He considers his situation hopeless, hopeless, hopeless, his existence unbearable.
Manic state. With the development of a manic state, a barely noticeable elation of mood appears at first, in particular the revival of facial expressions. The patient notes vigor, tirelessness, good health, “is in excellent shape,” and somewhat underestimates the real difficulties. Subsequently, there is a clear revival of facial expressions, the patient smiles, his eyes sparkle, he is often prone to humor and witticisms, in some cases he states that he feels a “special surge of strength”, “rejuvenated”, is unreasonably optimistic, considers events with an unfavorable meaning to be trivial, all difficulties - easily overcome. The pose is relaxed, the gestures are excessively sweeping, and sometimes a raised tone slips into the conversation.
In a pronounced manic state, generalized, non-targeted motor and ideational excitation occurs, with extreme expression of affect - to the point of frenzy. The face often turns red and the voice becomes hoarse, but the patient notes “unusually good health.”
DELUSIONAL SYNDROMES. Rave- a false, but not amenable to logical correction, belief or judgment that does not correspond to reality, as well as to the social and cultural attitudes of the patient. Delusions must be differentiated from delusional ideas that characterize erroneous judgments expressed with excessive persistence. Delusional disorders are characteristic of many mental illnesses; as a rule, they are combined with other mental disorders, forming complex psychopathological syndromes. Depending on the plot, delusions of relation and persecution are distinguished (the patient’s pathological conviction that he is a victim of persecution), grandeur (the belief in a high, divine purpose and special personal importance), changes in one’s own body (the belief in physical, often bizarre changes in body parts ), the appearance of a serious illness (hypochondriacal delusion, in which, on the basis of real somatic sensations or without them, concern develops, and then a belief in the development of a particular disease in the absence of its obvious signs), jealousy (usually a painful conviction of a spouse’s infidelity is formed on the basis complex emotional state).
ATTRACTION, DISORDERS. The pathology of desire reflects a weakening as a result of various reasons (hypothalamic disorders, organic disorders of the central nervous system, states of intoxication, etc.) of volitional, motivated mental activity. The consequence of this is a “deep sensory need” for the realization of impulses and the strengthening of various drives. Clinical manifestations of desire disorders include bulimia (a sharp increase in the food instinct), dromomania (an attraction to vagrancy), pyromania (an attraction to arson), kleptomania (an attraction to theft), dipsomania (alcoholic binges), hypersexuality, various types of perversion of sexual desire and etc. Pathological attraction can have the nature of obsessive thoughts and actions, be determined by mental and physical discomfort (dependence), and also arise acutely as impulsive reactions.
HALLUCINATIVE SYNDROMES. Hallucinations are a truly felt sensory perception that occurs in the absence of an external object or stimulus, displaces actual stimuli and occurs without phenomena of impaired consciousness. There are auditory, visual, olfactory, tactile (the sensation of insects crawling under the skin) and others. hallucinations.
A special place belongs to verbal hallucinations, which can be commentary or imperative, manifesting themselves in the form of a monologue or dialogue. Hallucinations can appear in healthy people while half asleep (hypnagogic hallucinations). Hallucinations are not specific psychopathological manifestations of endogenous or other mental illnesses. They are observed in schizophrenia, epilepsy, intoxication, organic and other psychoses, and can be both acute and chronic. As a rule, hallucinations are combined with other mental disorders; most often various variants of hallucinatory-paranoid syndrome are formed.
DELIRIUM- a nonspecific syndrome characterized by a combined disorder of consciousness, perception, thinking, memory, sleep-wakefulness rhythm, and motor agitation. The delirious state is transient and fluctuating in intensity. It is observed against the background of various intoxicating effects caused by alcohol, psychoactive substances, as well as liver diseases, infectious diseases, bacterial endocarditis and other somatic disorders.
DEMENTIA- a condition caused by a disease, usually of a chronic or progressive nature, in which there are disturbances in higher cortical functions, including memory, thinking, orientation, understanding of what is happening around, and the ability to learn. At the same time, consciousness is not changed, disturbances in behavior, motivation, and emotional response are observed. Characteristic of Alzheimer's disease, cerebrovascular and other diseases that primarily or secondary affect the brain.
HYPOCHONDRIC SYNDROME characterized by unjustifiably increased attention to one’s health, extreme preoccupation with even minor ailments, and the belief in the presence of a serious illness in the absence of its objective signs. Hypochondria is usually a component of more complex senestopathic-hypochondriacal, anxiety-hypochondriacal and other syndromes, and is also combined with obsessions, depression, and paranoid delusions.
THINKING, VIOLATION. Characteristic symptoms are thorough thinking, mentalism, reasoning, obsessions, and increased distractibility. At first, these symptoms are almost invisible and have little effect on the productivity of communication and social contacts. However, as the disease progresses, they become more pronounced and permanent, which makes it difficult to communicate with the patient. When they are most severe, productive contact with patients is practically impossible due to the development of significant difficulties in them in appropriate behavior and decision-making.
MEMORY, VIOLATION. With a mild degree of hypomnesia for current events, the patient generally remembers the events of the next 2-3 days, but sometimes makes minor errors or uncertainty when remembering individual facts (for example, he does not remember the events of the first days of his stay in the hospital). With increasing memory impairment, the patient cannot remember which procedures he took 1-2 days ago; only when reminded does he agree that he already talked to the doctor today; does not remember the dishes he received during yesterday's dinner or today's breakfast, and confuses the dates of his next visits with relatives.
With severe hypomnesia, there is a complete or almost complete absence of memory about immediate events. At the same time, the memory of events in his personal life is grossly impaired; he answers questions approximately or after complex calculations. With severe hypomnesia, there is a complete or almost complete absence of memory of past events; patients answer “I don’t remember” to the relevant questions. In these cases, they are socially helpless and disabled.
PSYCHOORGANIC (organic, encephalopathic) SYNDROME- a state of fairly stable mental weakness, expressed in the mildest form by increased exhaustion, emotional lability, instability of attention and other manifestations of asthenia, and in more severe cases - also by psychopathic-like disorders, memory loss, and increasing mental helplessness. The basis of the pathological process in psychoorganic syndrome is determined by the current disease of the brain of an organic nature (traumatic disease, tumor, inflammation, intoxication) or its consequences.
Nonspecific psychopathological symptoms are often combined with focal brain lesions with corresponding neurological and mental disorders. Variants of the syndrome include asthenic with a predominance of physical and mental exhaustion; explosive, determined by affective lability; euphoric, accompanied by increased mood, complacency, decreased critical attitude towards oneself, as well as affective outbursts and bouts of anger, ending in tearfulness and helplessness; apathetic, characterized by a decrease in interests, indifference to the environment, weakening of memory and attention.
