Psychopathological symptoms. Major psychopathological symptoms, syndromes and conditions

Major psychopathological syndromes

A syndrome is a set of symptoms. Psychopathological syndrome - a complex more or less typical set of internally (pathogenetically) interconnected psychopathological symptoms, in particular clinical manifestations which finds expression in the volume and depth of damage to mental functions, the severity and massiveness of the effect on the brain of pathogenic harmfulness.

Psychopathological syndromes are the clinical expression of various kinds mental pathology, which include mental illnesses of psychotic (psychosis) and non-psychotic (neurosis, borderline) types, short-term reactions and persistent psychopathological conditions.

6.1. Positive psychopathological syndromes

A unified view of the concept of positive, and, accordingly, negative, syndromes is currently practically absent. Syndromes are considered positive if they are qualitatively new, absent in the norm, symptom complexes (they are also called pathological positive, “plus” - disorders, “irritation” phenomena), indicating the progression of a mental illness, qualitatively changing mental activity and patient behavior.

6.1.1. asthenic syndromes. Asthenic syndrome - a state of neuropsychic weakness - 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 actually mental asthenia. There are two main variants of asthenic syndrome - emotional-hyperesthetic weakness (hypersthenic and hyposthenic).

With emotional-hyperesthetic weakness, short-term emotional reactions discontent, irritability, anger for minor reasons (symptom of "matches"), emotional lability, weakness of mind; patients are capricious, gloomy, dissatisfied. Inclinations are also labile: appetite, thirst, food attachments, decreased libido and potency. Characterized by hyperesthesia to loud sound, bright light, touch, smells, etc., intolerance and poor tolerance expectations. Replaced by the exhaustion of voluntary attention and its concentration, distractibility, absent-mindedness increase, concentration becomes difficult, a decrease in the amount of memorization and active memory appears, which is combined with difficulties in comprehension, speed and originality in solving logical and professional problems. All this makes it difficult and neuropsychic performance, there is fatigue, lethargy, passivity, the desire for rest.

Typically, an abundance of somato-vegetative disorders: headaches, hyperhidrosis, acrocyanosis, lability of the cardiovascular system, sleep disturbances, mostly superficial sleep with an abundance of everyday dreams, frequent awakenings up to persistent insomnia. Often the dependence of somato-vegetative manifestations on meteorological factors, overwork.

In the hyposthenic variant, predominantly physical asthenia, lethargy, fatigue, weakness, fast fatiguability, pessimistic mood with a drop in performance, increased drowsiness with lack of satisfaction from sleep and feeling of bruising, heaviness in the head in the morning.

Asthenic syndrome occurs in somatic (infectious and non-infectious) diseases, intoxications, organic and endogenous mental illness, neuroses. It is the essence of neurasthenia (asthenic neurosis), going through three stages: hypersthenic, irritable weakness, hyposthenic.

6.1.2. affective syndromes. Syndromes of affective disorders are very diverse. The modern classification of affective syndromes is based on three parameters: the actual affective pole (depressive, manic, mixed), the structure of the syndrome (harmonious - disharmonious; typical - atypical) and the severity of the syndrome (non-psychotic, psychotic).

Typical (harmonious) syndromes include a uniformly depressive or manic triad of obligatory stgmptoms: pathology of emotions (depression, mania), change in the course of the associative process (slowdown, acceleration) and motor-volitional disorders / lethargy (substupor) - disinhibition (excitation), hypobulia-hyperbulia /. The main (core) among them are emotional. Additional symptoms are: low or high self-esteem, impaired self-consciousness, obsessive, overvalued or delusional ideas, oppression or increased cravings, suicidal thoughts and actions in depression. In the most classic form, endogenous affective psychoses are found and, as a sign of endogeneity, they include the somato-vegetative symptom complex of V.P. Protopopov ( arterial hypertension, tachycardia, constipation, miosis, hyperglycemia, impaired menstrual cycle, change in body weight), daily fluctuations in affect (improvement in well-being in the second half of the day), seasonality, periodicity and autochthonous.

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 such disorders that seem to be introduced from the opposite triad (for example, motor excitation with the affect of melancholy - depressive excitation).

There are also subaffective (subdepression, hypomania; they are also non-psychotic), classic affective and complex affective disorders (affective-delusional: depressive-paranoid, depressive-hallucinatory-paranoid, depressive-paraphrenic or manic-paranoid. Manic-hallucinatory-paranoid , matsnakal-para-raffin).

6.1.2.1. depressive syndromes. The classic depressive syndrome includes the depressive triad: pronounced melancholy, depressed gloomy mood with a touch of vitality; intellectual or motor retardation. Hopeless longing is often experienced as heartache, accompanied by painful sensations of emptiness, heaviness in the region of the heart, mediastinum or epigastric region. Additional symptoms - a pessimistic assessment of the present, past and future, reaching the degree of holothymic overvalued or delusional ideas of guilt, self-humiliation, self-accusation, sinfulness, low self-esteem, impaired self-awareness of activity, vitality, simplicity, identity, suicidal thoughts and actions, sleep disorders in the form of insomnia, sleep agnosia, superficial sleep with frequent awakenings.

Subdepressive (non-psychotic) syndrome is represented by not pronounced melancholy with a hint of sadness, boredom - spleen, depression, pessimism. Other main components include hypobulia in the form of lethargy, fatigue, fatigue and decreased productivity and slowing of the associative process in the form of difficulty in finding words, reduced mental activity, memory impairment. Of the additional symptoms - obsessive doubts, low self-esteem, impaired self-awareness of activity.

Classic depressive syndrome is characterized by endogenous depressions(manic-depressive psychosis, schizophrenia); subdepression in reactive psychoses, neuroses.

Atypical depressive syndromes include subdepressive ones. relatively simple and complex depressions.

Among the subdepressive syndromes, the most common are:

Astheno-subdepressive syndrome - low mood, spleen, sadness, boredom, combined with a feeling of loss of vitality and activity. The symptoms of physical and mental fatigue, exhaustion, weakness, combined with emotional lability, mental hyperesthesia predominate.

Adynamic subdepression includes low mood with a hint of indifference, hypodynamia, lethargy, lack of desire, a feeling of physical impotence.

Anesthetic subdepression - low mood with a change in "affective resonance, the disappearance of a sense of closeness, sympathy, antipathy, empathy, etc. with a decrease in motivation for activity and a pessimistic assessment of the present and future.

Masked (managed, latent, somatized) depression (MD) is a group of atypical subdepressive syndromes in which facultative symptoms (senestopathy, algia, paresthesia, intrusiveness, vegetative-visneral, drug addiction, sexual disorders) come to the fore, and affective ones (subdepressive manifestations erased, inexpressive, appear in the background.The structure and severity of facultative symptoms determine various options 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); Agripnic, vegetative-visceral, obsessive-phobic, psychopathic, drug-addicted, variants of MD with sexual disorders.

Algic-senestopathic variants of MD. Optional symptoms are represented by a variety of senestopathies, paresthesias, algias in the region of the heart (cardialgic), in the head (cephalgic), in the epigastric region (abdominal), in the joints (arthralgic), various “walking” (panalgic). They were the main content of complaints and experiences of patients, and subdepressive manifestations are assessed as secondary, insignificant.

Agripnic variant of MD is represented by pronounced sleep disturbances: difficulty falling asleep, superficial sleep, early awakening, lack of a sense of rest from sleep, etc., while experiencing fatigue, decreased mood, lethargy.

The vegetative-visceral variant of MD includes painful diverse manifestations of vegetative-visceral disorders: pulse lability, increased blood pressure, dipnea, tachypnea, hyperhidrosis, chills or fever, subfebrile temperature, dysuric disorders, false urge to defecate, flatulence, etc. By structure and in character they resemble diencephalic or hypothalamic paroxysms, episodes bronchial asthma or vasomotor allergic disorders.

The psychopathic variant is represented by behavioral disorders, most often in adolescence and youth: periods of laziness, spleen, leaving home, periods of disobedience, etc.

The addictive variant of MD is manifested by episodes of alcohol or drug intoxication with subdepression without a clear connection with external causes and causes 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 only facultative symptoms, and only a special questioning allows us to identify the leading and obligatory symptoms, but they are often evaluated as secondary personal reactions to the disease. But all variants of MD are characterized by the obligatory presence in clinical picture in addition to somato-vegetative manifestations, senestopathies, paresthesias, algias, affective disorders in the form of subdepression; signs of endogeneity (daily hypotensive disorders of both leading and obligatory symptoms, and (optional; periodicity, seasonality, autochthonous 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 are found in neuroses, cyclothymia, cyclophrenia, schizophrenia, involutional and reactive depressions, and organic diseases of the brain.

Common depressions include:

Adynamic depression is a combination of melancholy with weakness, lethargy, impotence, lack of motives and desires.

Anesthetic depression - the predominance of mental anesthesia, painful insensitivity with their painful experience.

Tearful depression - depressed mood with tearfulness, weakness and asthenia.

Anxious depression, in which, against the background of melancholy, anxiety with obsessive doubts, fears, and ideas of attitude predominates.

Complex depression is a combination of depression with symptoms of other psychopathological syndromes.

Depression with delusions of enormity (Cotard's syndrome) - a combination of dreary depression with nihilistic delusions of megalomaniac fantastic content and delusions of self-accusation, 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 melancholy or anxious depression in combination with delusions of persecution and poisoning.

Depressive-paranoid_mindromas, in addition to the above, include depressive-hallucinatory-paranoid, depressive-paraphrenic. In the first case, in combination with dreary, less often anxious depression, there are verbal true or pseudo-hallucinations of an accusing, condemning and blasphemous content with. phenomena of mental automatism, delusions of persecution and influence. Depressive-paraphrenic, in addition to the listed symptoms, includes megalomaniac delusional ideas of nihilistic, cosmic and apoplectic content up to depressive oneiroid.

Characteristic of affective psychosis, schizophrenia, psychogeny, organic and infectious mental illness.

6.1.2.2. manic syndromes. The classic manic syndrome includes a pronounced mania with a feeling of immense happiness, joy, delight, ecstasy (obligatory symptoms - manic hyperbulia with many plans, their extreme instability, significant distractibility, which is due to a violation of the productivity of thinking, an acceleration of its pace, a "leap" of ideas, inconsistency logical operations, and increased motor activity, they take on a lot of things, not bringing any of them to the end, they are long-winded, they talk incessantly.Additional symptoms are an overestimation of the qualities of their personality, reaching unstable holothymic ideas of greatness, disinhibition and increased drives.

Hypomanic (non-psychotic) syndrome includes a confidently pronounced increase in mood with a predominance of a sense of joy of being, fun, cheerfulness; with a subjective feeling of a creative upsurge and increased productivity, some acceleration of the pace of thinking, with a fairly productive activity, although with elements of distraction, the behavior does not suffer grossly,

Atypical manic syndromes. Unproductive mania includes an 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 an elevated mood with incontinence, irritability, captiousness with a transition to anger; inconsistency of thinking and activity.

Complex mania_ - a combination of mania with other non-affective syndromes, mostly delusional. Crazy ideas of persecution, relationship, poisoning (manic-paranoid), verbal true and pseudo-hallucinations, 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 excitement up to depressive raptus with increased suicidal danger.

Dysphoric depression, when a feeling of melancholy, displeasure is replaced by irritability, grumbling, spreading to everything around and to one's well-being, outbursts of rage, aggression against others and auto-aggression.

Manic stupor occurs at the height of manic excitation or a change from a depressive phase to a manic one, when the growing mania is accompanied (or replaced) by persistent motor and intellectual retardation.

Meet at endogenous psychoses, infectious, somatogenic, intoxication and organic mental diseases.

6.1.3. neurotic syndromes. It is necessary to distinguish between the actual neurotic syndromes and the neurotic level of disorders. The neurotic level of the disorder (borderline neuropsychiatric disorders), according to most domestic psychiatrists, also includes asthenic syndromes, non-psychotic affective disorders (subdepression, hypomania).

The actual neurotic syndromes include obsessive (obsessive-phobic, obsessive-compulsive disorder syndrome), senestopathic and hypochondriacal, hysterical syndromes, as well as depersonalization-derealization syndromes, syndromes of overvalued ideas.

6.1.3.1. Syndromes of obsessive states. The most common are obsessive and phobic syndromes.

6.1.3.1.1. obsessive syndrome includes as main symptoms obsessive doubts, memories, ideas, obsessive feelings of antipathy (blasphemous and blasphemous thoughts), "mental chewing gum", obsessive drives and associated motor rituals. Additional symptoms include emotional stress, a state of mental discomfort, impotence and helplessness in the fight against obsessions. In a “pure” form, affectively neutral obsessions are rare and are represented by obsessive sophistication, counting, obsessive recall of forgotten terms, formulas, phone numbers, etc.

There is an obsessive syndrome (without phobias) with psychopathy, sluggish schizophrenia, and organic diseases of the brain.

6.1.3.1.2. phobic syndrome represented mainly by a variety of obsessive fears. The most unusual and senseless fears may arise, but most often at the beginning of the disease, a distinct monophobia is observed, which gradually acquires “like a snowball” with more and more new phobias. For example, agarophobia, claustophobia, thanatophobia, phobophobia, etc. join cardiophobia. Social phobias can be isolated for a long time.

The most frequent and diverse nosophobias are: cardiophobia, carcinophobia, AIDSphobia, alienophobia, etc. Phobias are accompanied by numerous somato-vegetative disorders: tachycardia, increased blood pressure, hyperhidrosis, persistent red dermographism, peristalsis and antiperistalsis, diarrhea, vomiting, etc. Very quickly join 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-hypochondriac 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 the development of the syndrome, numerous senestopathies occur in various parts of the body, accompanied by dull depriming, anxiety, and slight anxiety. Gradually, a monothematic overvalued idea of hypochondriacal content emerges and forms on the basis of senestolatiums. Based on unpleasant, painful, extremely painful sensations and the experience of communication, diagnosis and treatment, medical workers develop a judgment: using senestopathies and real circumstances to explain and form a pathological “concept of the disease”, which occupies a significant place in the experiences and behavior of the patient and disorganizes mental activity .

Overvalued ideas can be replaced by obsessive doubts, fears about cenestopathy, with the rapid addition of obsessive fears and rituals.

They are found in various forms of neurosis, sluggish schizophrenia, organic diseases of the brain. With hypochondriacal personality development, sluggish schizophrenia, senestopathic disorders with hypochondriacal overvalued ideas gradually transform into a 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. Most indistinctly distinguished in general psychopathology. Symptoms and partly syndromes of violation of self-consciousness 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, it includes violations of self-awareness of activity, unity and constancy of the “I”, light blurring of the boundaries of existence (allopsychic depersonalization). In the future, the blurring of the boundaries of self-consciousness, the impenetrability of the “I” (autopsychic depersonalization) and vitality (somatopsychic depersonalization) becomes more complicated. But rough changes in the boundaries of self-consciousness, alienation of the “I” and stability of the “I” in time and space are never observed. It occurs in the structure of neuroses, personality disorders, neurosis-like schizophrenia, cyclothymia, and residual organic diseases of the brain.

6.1.3.3.2. Derealization syndrome includes a distorted perception of the surrounding world as a leading symptom, the environment is perceived by patients as “ghostly”, unclear, indistinct, “as if in a fog”, colorless, frozen lifeless, decorative, unreal. Individual metamorphopsias can also be observed (impaired perception of individual parameters of objects - shape, size, color, quantity, relative position, etc.).

It is usually accompanied by various symptoms of impaired self-consciousness, subdepression, confusion, fear. It is most often found in organic diseases of the brain, as part of epileptic paroxysms, and intoxications.

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 highly variable symptoms and syndromes of disorders of the psyche, motility, sensitivity, speech and somatovegetation. 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 (“great simulator” of other diseases and syndromes), the ability to extract external or “internal” benefits from one’s painful states that are poorly realized or generally unconscious by the patient (“flight into the disease”, “desirability or conditional pleasantness” of the manifestations of the disease).

Mental disorders: severe asthenia with physical and mental fatigue, phobias, subdepressions, amnesia, hypochondriacal experiences, pathological deceit and fantasies, emotional lability, weakness of mind, sensitivity, impressionability, demonstrativeness, suicidal statements and demonstrative preparations for suicide.

Movement disorders: classic grand hysterical seizure (“motor storm”, “hysterical arc”, clowning, etc.), hysterical paresis and paralysis, both spastic and sluggish; paralysis of the vocal cords (aphonia), stupor, contractures (trismus, 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.

Sensitivity disorders: various paresthesias, decreased sensitivity and anesthesia of the type “gloves”, “stockings”, “underpants”, “jackets”, etc.; painful sensations (pain), loss of function of the sense organs - amaurosis (blindness), hemianopsia, scotomas, deafness, loss of smell, 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 (disorders, passage of the esophagus), paresis of the gastrointestinal tract, simulating intestinal obstruction, constipation, urinary retention. There are vomiting, hiccups, regurgitation, nausea, anorexia, flatulence. Frequent disorders of cardio-vascular system: pulse lability, fluctuations in blood pressure, hyperemia or pallor skin, acrocyanosis, dizziness, fainting, pain in the heart, simulating heart disease.

Occasionally there are vicarious bleeding (from intact skin, uterine and throat bleeding), sexual dysfunction, false pregnancy. As a rule, hysterical disorders are caused by psychogenic diseases, but they also occur in schizophrenia, organic diseases of the brain.

6.1.3.5. anorectic syndrome (syndrome of "anorexia nervosa") It is characterized by a progressive restriction of oneself in food, selective consumption of food by the patient, combined with little intelligible arguments about the need to "lose weight", "lose fat", "correct the figure". Less common is the bulimic variant of the syndrome, when patients consume a lot of food, then induce vomiting. Often associated with dysmorphomanic syndrome. It occurs in neurotic conditions, schizophrenia, endocrine diseases.

Closely related to this group of syndromes is psychopathic syndromes, which can include both positive and negative symptoms (see section 5.2.4.).

6.1.3.6. Heboid Syndrome. As core disorders in this syndrome, drive disorders are considered in the form of painful amplification and especially their perversion. Exaggeration and perversion of affective-personal features characteristic of adolescence are observed, exaggerated oppositional tendencies, negativism, aggressive manifestations appear, there is a loss, or weakening, or slowness in the development of higher moral attitudes (the concepts of good and evil, permitted and prohibited, etc.), sexual perversions, tendencies to vagrancy, to the use of alcohol and drugs are observed. Occurs in psychopathy, schizophrenia.

APATHY (indifference). On the early stages development of apathy, there is some weakening of hobbies, the patient reads or watches TV mechanically. With psycho-affective indifference, during interrogations, he expresses appropriate complaints. With a shallow emotional decline, for example, with schizophrenia, he calmly reacts to events of an exciting, unpleasant nature, although in general the patient is not indifferent to external events.

In some 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 hardly touched even own situation and family affairs. Sometimes there are complaints about "stupidity", "indifference". The extreme degree of apathy is characterized by complete indifference. The facial expression of the patient is indifferent, there is indifference to everything, including his appearance and cleanliness of the body, to stay in the hospital, to the appearance of relatives.

ASTHENIA (increased fatigue). With minor phenomena, fatigue occurs more often with increased load usually in the afternoon. In more pronounced cases, even with relatively simple activities, a feeling of fatigue, weakness quickly appears, an objective deterioration in the quality and pace of work; rest helps a little. Asthenia is noticeable at the end of a conversation with a doctor (for example, the patient talks sluggishly, tends to lie down as soon as possible or lean on something). Autonomic disorders are dominated by excessive sweating, pallor of the face. Extreme degrees of asthenia are characterized by severe weakness up to prostration. Tired of any activity, movement, short-term conversation. Rest doesn't help.

MOOD DISORDERS characterized by instability (lability) of mood, a change in affect towards oppression (depression) or rise (manic state). At the same time, the level of intellectual and motor activity changes, various somatic equivalents of the state are observed.

Affective lability (increased emotional reactivity). With unexpressed disorders, the range of situations and reasons in connection with which an affect arises or mood changes is somewhat expanded compared to the individual norm, but nevertheless these are quite intense emotional factors (for example, real failures). Usually affect (anger, despair, resentment) occurs rarely and in intensity largely corresponds to the situation that caused it. With more pronounced affective disorders, mood often changes for minor and varied reasons. The intensity of the disorders does not correspond to the real significance of psychogeny. At the same time, affects can become significant, arise for completely insignificant reasons or without perceptible external cause, change several times in a short time, which makes it extremely difficult to purposefully work.

Depression. With minor depressive disorders, the patient sometimes has a noticeably sad expression on his face, sad intonations in conversation, but at the same time, facial expressions are quite diverse, speech is modulated. The patient manages to distract, cheer. There are complaints of "feeling sad" or "lack of vigor" and "boredom". Most often, the patient is aware of the connection of his condition with psychotraumatic influences. Pessimistic experiences are usually limited conflict situation. There is some overestimation of real difficulties, but the patient hopes for a favorable resolution of the situation. A critical attitude towards the disease was maintained. With a decrease in psycho-traumatic influences, the mood normalizes.

With the aggravation of depressive symptoms, facial expressions become more monotonous: not only the face, but also the posture express despondency (shoulders are often lowered, the gaze is directed into space or down). Sad sighs, tearfulness, a pathetic, guilty smile are possible. The patient complains of a depressed "decadent" mood, lethargy, discomfort in the body. He considers his situation gloomy, does not notice anything positive in it. It is almost impossible to distract and amuse the patient.

With severe depression, a "mask of sorrow" is noted on the patient's face, the face is elongated, grayish-cyanotic in color, lips and tongue are dry, the eyes are suffering, expressive, there are usually no tears, blinking is rare, sometimes the eyes are half-closed, the corners of the mouth are lowered, lips are often compressed. Speech is not modulated, down to an unintelligible whisper or silent movements of the lips. The posture is hunched, with the head lowered, the knees shifted. Raptoid states are also possible: the patient groans, sobs, rushes about, seeks self-harm, breaks his arms. Complaints about "unbearable melancholy" or "despair" predominate. He considers his situation hopeless, hopeless, hopeless, existence unbearable.

A special type of depression is the so-called hidden (masked, larvated) or somatized depression. With its development, in patients observed mainly in general somatic institutions, against the background of a slight change in affect, various somatovegetative (viscerovegetative) disorders develop, imitating various diseases of organs and systems. At the same time, actually depressive disorders recede, as it were, into the background, and the patients themselves in most cases object to the assessment of their condition as " depression". Somatic examination in these cases does not reveal significant disorders that could explain the persistent and massive complaints of the patient. By eliminating one or another prolonged somatic suffering, taking into account the phase of the course of somatovegetative disorders (including daily fluctuations with a significant deterioration in the morning ), revealing latent, atypical anxiety and depression with the help of clinical and psychodiagnostic studies, and most importantly, observing the effect when prescribing an antidepressant, one can make a final conclusion about the presence of latent depression.

Manic state. With the development of a manic state, a barely noticeable elation of mood first appears, in particular, a revival of facial expressions. The patient notes cheerfulness, tirelessness, good health, "is in great shape", somewhat underestimates the real difficulties. Subsequently, there is a clear revival of facial expressions, the patient smiles, his eyes shine, often prone to humor, witticisms, in some cases declares that he feels a "special surge of strength", "younger", unreasonably optimistic, events with unfavorable considers all difficulties to be easy to overcome.

With a pronounced manic state, a generalized, non-purposeful motor and ideational excitation occurs, with an extreme severity of affect - to the point of frenzy. The face often turns red, hoarseness of voice joins, nevertheless the patient notes "unusually good health".

DELUSION 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, which 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 attitude and persecution are distinguished (the patient’s pathological conviction that he is a victim of persecution), greatness (belief in a high, divine destiny and special self-importance), changes own body(belief in a physical, often bizarre change in body parts), the appearance of a serious illness (hypochondriac delirium, in which, on the basis of real somatic sensations or without them, concern develops, and then a belief in the development of a particular disease in the absence of its obvious signs), jealousy (usually a painful conviction of a spouse's infidelity is formed on the basis of a complex emotional state). There are also primary delusions, the content of which and the actions of the patient arising from it cannot be associated with the history of his life and personality traits, and secondary delusions, conditionally "following" from other mental disorders (for example, from hallucinations, affective disorders, etc.). In terms of dynamics, relative specificity of signs of mental illness and prognosis, there are three main types of delusions - paranoid, paranoid and paraphrenic.

In paranoid delusions, the content of pathological experiences stems from ordinary life situations; as a rule, it is logically constructed, argued and is not absurd and fantastic. The delusions of reformism and invention, jealousy, etc. are typical. In some cases, there is a tendency to constantly expand delusional constructions, when new real ones life circumstances as if "strung" on the pathological "rod" of a painful representation. This contributes to the systematization of nonsense.

paranoid rave less logical. More often, ideas of persecution and influence are characteristic, often combined with pseudo-hallucinations and phenomena of mental automatism.

Paraphrenic delusions are usually fantastic and completely absurd. More often than not, it's a delusion of grandeur. Patients consider themselves the rulers of enormous wealth, the creators of civilization. Usually they are in high spirits, often there are false memories (confabulation).

ATTRACTION, DISTURBANCES. The pathology of attraction reflects the weakening as a result of various causes (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 sensual need" for the realization of impulses and the strengthening of various drives. Among the clinical manifestations of disorders of attraction are bulimia (a sharp increase in the food instinct), dromomania (attraction to vagrancy), pyromania (attraction to arson), kleptomania (attraction to theft), dipsomania (alcoholic binges), hypersexuality, various variants of the perversion of sexual desire and etc. Pathological attraction may have a character intrusive thoughts and actions, be determined by mental and physical discomfort (dependence), and also occur acutely as impulsive reactions. Unlike other options, in the latter case, there is often no critical assessment of the situation in which the patient is trying to implement an action determined by pathological attraction.

Violation of attraction can be observed in various mental disorders, their differential diagnostic assessment is built, as in other cases, taking into account the whole complex of painful manifestations and personality-typological characteristics of the patient.

HALLUCINATORY SYNDROMES. Hallucinations - really felt sensory perception that occurs in the absence of an external object or stimulus, displacing real irritations and proceeding without the phenomena of disturbed consciousness. There are auditory, visual, olfactory, tactile (sensation of crawling under the skin of insects) and others. hallucinations. A special place belongs verbal hallucinations, which can be commentary or imperative, appear as a monologue or dialogue. Hallucinations can occur in healthy people in a state of drowsiness ( 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, they can be both acute and chronic. As a rule, hallucinations are combined with other mental disorders; most often various variants of the hallucinatory-paranoid syndrome are formed.

DELIRIUM- a nonspecific syndrome characterized by a combined disorder of consciousness, perception, thinking, memory, sleep-wake rhythm, motor excitation. The delirious state is transient and fluctuating in intensity. It is observed against the background of various intoxication 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 violations of higher cortical functions, including memory, thinking, orientation, understanding of what is happening around, the ability to learn. At the same time, consciousness is not changed, there are violations of behavior, motivation, emotional response. It is characteristic of Alzheimer's disease, cerebrovascular and other diseases that primarily or secondarily affect the brain.

HYPOCHONDRIC SYNDROME It is characterized by unjustifiably increased attention to one's health, extreme preoccupation with even a minor ailment, conviction that there is a serious illness in the absence of its objective signs. Hypochondria is usually integral part more complex senestopathic-hypochondriac, anxiety-hypochondriac and other syndromes, and is also combined with obsessions, depression, paranoid delusions. THINKING, VIOLATION. Characteristic symptoms are thoroughness of thinking, mentism, reasoning, obsessions (obsessions), increased distractibility. At first, these symptoms are almost imperceptible, they have little effect on the productivity of communication, social contacts. However, as the disease progresses, they become more pronounced and permanent, which makes it difficult to communicate with the patient. With their greatest severity, productive contact with patients is practically impossible due to the development of significant difficulties in their expedient behavior and decision-making.

MEMORY, DISTURBANCE. With a mild degree of hypomnesia for current events, the patient generally remembers the events of the next 2-3 days, but sometimes he makes minor mistakes or uncertainty when remembering certain facts (for example, he does not remember the events of the first days of his stay in the hospital). With an increase in memory impairment, the patient cannot remember which of the procedures he took 1-2 days ago; only when reminded, he agrees that he had already talked with the doctor today; does not remember the dishes that he received during yesterday's dinner or today's breakfast, confuses the dates of the next meetings with relatives.

With severe hypomnesia, there is a complete or almost complete absence of memory of upcoming events.

Hypomnesia for past events begins with the fact that the patient experiences minor difficulties, if necessary, to remember the dates of his biography, as well as the dates of well-known events. In this case, sometimes there is a mixture of events in time or dates are called approximately, some of them the patient refers to the corresponding year, but does not remember the month and day. Marked memory disorders practically do not interfere with the implementation of normal activities. However, as the disease develops, the patient already finds it difficult to remember the dates of most well-known events or remembers with great difficulty only some of them. At the same time, the memory of events in his personal life is grossly violated, he answers questions approximately or after complex calculations. With severe hypomnesia, there is a complete or almost complete lack of memory of past events, the patients answer the appropriate questions "I do not remember." In these cases, they are socially helpless and disabled.

PSYCHO-ORGANIC (organic, encephalopathic) SYNDROME- a state of fairly stable mental weakness, expressed in the most mild form increased exhaustion, emotional lability, instability of attention and other manifestations of asthenia, and in more severe cases - also psychopathic disorders, memory loss, increasing mental helplessness. basis pathological process in case of a psychoorganic syndrome, the current disease of the brain of an organic nature (traumatic disease, tumor, inflammation, intoxication lesion) or its consequences are determined. Nonspecific psychopathological symptoms are often combined with focal brain lesions with corresponding neurological and mental disorders. Among the variants of the syndrome, asthenic with a predominance of physical and mental exhaustion is distinguished; explosive, determined by affective lability; euphoric, accompanied by increased mood, complacency, a decrease in a critical attitude towards oneself, as well as affective outbursts and bouts of anger, culminating in tearfulness and helplessness; apathetic, characterized by a decrease in interests, indifference to the environment, weakening of memory and attention.

IRRITABILITY INCREASED

Characteristics of the main apathetic disorders: apathy, asthenia, autism, affective and delusional disorders. Pathology of attraction, its clinical manifestations. hallucinatory syndromes. Manifestations of depression, sleep disorders. Manic state.

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Psychopathological manifestations (symptoms, syndromes)

Apathy(indifference). At the initial stages of the development of apathetic disorders, there is some weakening of hobbies, desires and aspirations. With psycho-affective indifference during questioning, the patient makes appropriate complaints. With a shallow emotional decline, for example, with schizophrenia, he calmly reacts to events of an exciting, unpleasant nature, although in general the external events are not indifferent to the patient.

In some 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 touched 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 to everything. The patient's facial expression is indifferent, there is indifference, including to one's appearance and cleanliness of the body, to staying in the hospital, to the appearance of relatives.

Asthenia(increased fatigue). With minor phenomena, fatigue occurs with increased stress, usually in the afternoon.

In more pronounced cases, even with relatively simple activities, there is a feeling of fatigue, weakness, an objective deterioration in the quality and pace of work, rest helps little. Asthenia is noticeable at the end of a conversation with a doctor (for example, the patient talks sluggishly, tends to lie down as soon as possible or lean on something). Among vegetative disorders, excessive sweating and pallor of the face predominate. Extreme degrees of asthenia are characterized by severe weakness. Tired of any activity, movement, short-term conversation. Rest doesn't help.

Autism(“immersion” in oneself). The patient exists in his inner world”, the words of those around him and the events taking place around him, as if they do not reach him or acquire a special, symbolic meaning.

affective disorders characterized by instability (lability) of mood, a change in affect towards oppression (depression - see below) or rise (manic state - see below). At the same time, the level of intellectual and motor activity changes, various somatic equivalents of the state are observed.

affective lability(increased emotional reactivity). With unexpressed disorders, the range of situations and reasons in connection with which an affect arises or mood changes is somewhat expanded compared to the individual norm, but still it is quite intense. emotional factors(e.g. actual failures). Usually affect (anger, despair, resentment) occurs rarely and in intensity largely corresponds to the situation that caused it.

With more pronounced affective disorders, mood often changes for minor and varied reasons. The intensity of the disorders does not correspond to the real significance of psychogeny. At the same time, affects can become significant, arise for completely insignificant reasons or without a perceptible external cause, change several times in a short time, which makes it extremely difficult to purposeful activity.

Delusional disorders. Delusion is 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, which 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, they distinguish delusions of relationship and persecution(pathological conviction of the patient that he is a victim of persecution), greatness(belief in a high, divine purpose and special self-importance), changes in one's own body(belief in physical, often bizarre, alteration of body parts) onset of severe illness(hypochondriac delirium, in which, on the basis of real somatic sensations or without them, concern develops, and then a belief in the development of a particular disease in the absence of its obvious signs), jealousy(usually a painful conviction of a spouse's infidelity is formed on the basis of a complex emotional state). There are also primary delusions, the content of which and the actions of the patient arising from it cannot be connected with the history of his life and personality traits, and secondary delusion, conditionally "following" from other mental disorders (for example, from hallucinations, affective disorders, etc.). From the point of view of dynamics, the relative specificity of signs of mental illness and prognosis, there are three main types of delusions - paranoid, paranoid and paraphrenic.

At paranoid delusions the content of pathological experiences follows from ordinary life situations, it is, as a rule, logically constructed, argued and is not absurd and fantastic. typical delirium of reformism and invention, jealousy, etc. In some cases, there is a tendency for a constant expansion of delusional constructions, when new real life circumstances are, as it were, "strung" on the pathological "rod" of a painful representation. This contributes to the systematization of nonsense.

paranoid delusions less logical. More often, ideas of persecution and influence are characteristic, often combined with pseudo-hallucinations and phenomena of mental automatism.

paraphrenic delirium usually fantastic and completely absurd. More often than not, it's a delusion of grandeur. Patients consider themselves the owners of enormous wealth, the creators of civilization. Usually they are in high spirits, often there are false memories (confabulation).

Attractions (violations). The pathology of attraction reflects the weakening as a result of various causes (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 sensual need" for the realization of impulses and the strengthening of various drives. Clinical manifestations of attraction disorders include bulimia(a sharp increase in food instinct), dromania(desire to wander) pyromania(striving for arson) kleptomania(the desire to steal), hypersexuality, various variants of perversion of sexual desire, etc. Pathological attraction can have the character of obsessions, be determined by mental and physical discomfort (dependence), and also occur acutely, like impulsive reactions. Unlike other options, in the latter case, there is often no critical assessment of the situation in which the patient is trying to implement an action determined by pathological attraction.

Violation of drives can be observed in various mental disorders, their differential diagnostic assessment is built, as in other cases, taking into account the whole complex of painful manifestations and personality-typological characteristics of the patient.

hallucinatory syndromes. Hallucinations are a really felt sensory perception that occurs in the absence of an external object or stimulus, displacing real irritations and proceeding without phenomena of disturbed consciousness. Distinguish auditory, visual, olfactory, tactile(feeling of crawling under the skin of insects) and other hallucinations are not specific psychopathological manifestations of endogenous or other mental illnesses. A special place belongs to verbal hallucinations, which can be commentary or imperative, appear in the form of a monologue or dialogue. Hallucinations can occur in healthy people in a state of drowsiness (hypnagogic hallucinations). They are observed in schizophrenia, epilepsy, intoxication, organic and other psychoses, can be both acute and chronic. As a rule, hallucinations are combined with other mental disorders; most often various variants of the hallucinatory-paranoid syndrome are formed.

Delirium- a nonspecific syndrome characterized by a combined disorder of consciousness, perception, thinking, memory, rhythm sleep - wakefulness, motor excitation. The delirious state is transient and fluctuating in intensity. It is observed against the background of various intoxication 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 is a decrease in cognitive, intellectual activity, memory, thinking, orientation, understanding of what is happening are disturbed, control over impulses and emotions is lost. At the same time, consciousness is not formally changed, there are violations of behavior, motivation, and emotional response. It is characteristic of Alzheimer's disease, cerebrovascular and other diseases that primarily or secondarily affect the brain.

Depression. With minor depressive disorders, the patient sometimes has a noticeably sad expression on his face, sad intonations in conversation, but at the same time, facial expressions are quite diverse, speech is modulated, the patient can be distracted, cheered up. There are complaints of "feeling sad" or "lack of vigor" and "boredom". Most often, the connection of one's condition with psychotraumatic influences is realized. 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. The critical attitude and the desire to fight against the "painful shock" have been preserved. With a decrease in psycho-traumatic influences, the mood normalizes.

With the aggravation of depressive symptoms, facial expressions become more monotonous: not only the face, but also the posture express despondency (shoulders are often lowered, the gaze is directed into space or down). There may be sorrowful sighs, tearfulness, a pathetic, guilty smile. The patient complains of a depressed "decadent" mood, lethargy, discomfort in the body. He considers his situation gloomy, does not notice anything positive in it. It is almost impossible to distract and amuse the patient.

With severe depression, the patient’s face has a “mask of sorrow”, the face is elongated, grayish-cyanotic in color, the lips and tongue are dry, the eyes are suffering, expressive, there are usually no tears, blinking is rare, sometimes the eyes are half-closed, the corners of the mouth are lowered, the lips are often compressed. Speech is not modulated to the point of unintelligible whispers or silent lip movements. A hunched posture with a lowered head, shifted knees. Raptoid states are also possible: the patient groans, sobs, rushes about, tends to self-harm, breaks his arms. Complaints about "unbearable melancholy" or "despair" predominate. He considers his situation hopeless, hopeless, hopeless, existence unbearable.

A special type of depression is the so-called hidden (masked, larvated, somatized depression). With its development in patients, mainly observed in general somatic institutions, against the background of a slight change in affect, various somatovegetative (viscerovegetative) disorders develop, imitating various diseases of organs and systems. At the same time, the actual depressive disorders seem to fade into the background, and the patients themselves, in most cases, object to assessing their condition as “depression”. Somatic examination in these cases does not reveal significant disorders that could explain the persistent and massive complaints of the patient. By excluding one or another prolonged somatic suffering, taking into account the phase nature of the course of somatovegetative disorders (including daily fluctuations with significant deterioration in the mornings), revealing, with the help of clinical and psychodiagnostic studies, the presence of a hidden, atypical anxiety and depression, and most importantly, by observing the effect of prescribing an antidepressant, one can conclude that there is a latent depression.

Hypochondriacal disorders are characterized by unjustifiably increased attention to their health, extreme concern for even a minor ailment, conviction in the presence of a serious illness in the absence of its objective signs. Hypochondria is usually a component of more complex senestopathic-hypochondriac, anxiety-hypochondriac and other syndromes, and can also be combined with obsessions, depression, paranoid delusions.

Manic state. With the development of a manic state, a barely noticeable elation of mood first appears, in particular, a revival of facial expressions. The patient notes cheerfulness, tirelessness, good health, "is in excellent shape", somewhat underestimates the real difficulties. Subsequently, a clear revival of facial expressions is observed, the patient smiles, his eyes shine, often prone to humor, witticisms, in some cases he declares that he feels “a special surge of strength”, “younger”, is unreasonably optimistic, considers events with an unfavorable value to be trifling, all difficulties - - easily overcome. The posture is unconstrained, unnecessarily sweeping gestures, sometimes in a conversation - an elevated tone.

With a pronounced manic state, a generalized, non-purposeful motor and ideational excitation occurs, with an extreme severity of affect - to the point of frenzy. The face often turns red, hoarseness of the voice joins, nevertheless the patient notes "unusually good health."

Thinking (violations). Characteristic symptoms are thoroughness of thinking, mentism, reasoning, obsessions (obsessions), increased distractibility. At first, these symptoms are almost imperceptible, they have little effect on the productivity of communication, social contacts. However, as the disease progresses, they become more pronounced and permanent, which makes it difficult to communicate with the patient. With their greatest severity, productive contact with patients is practically impossible.

Memory (violations). With mild hypomnesia for current events the patient generally remembers the events of the next 2-3 days, but sometimes makes minor mistakes or uncertainty when remembering certain facts (for example, he does not remember the events of the first days of his stay in the hospital). With an increase in memory impairment, the patient cannot remember which of the procedures he took 1-2 days ago; only when reminded, he agrees that he had already talked with the doctor today; does not remember the dishes that he received during yesterday's dinner or today's breakfast, confuses the dates of the next meetings with relatives.

With severe hypomnesia, there is a complete or almost complete absence of memory of upcoming events.

Hypomnesia for past events begins with the fact that the patient experiences minor difficulties, if necessary, to remember the dates of his biography, as well as the timing of well-known events. In this case, sometimes there is a shift in events in time or dates are called approximately, some of them the patient refers to the corresponding year, but does not remember the month and day. Marked memory disorders practically do not interfere with the implementation of normal activities. However, as the disease progresses, the patient already finds it difficult to remember the dates of most well-known events, or remembers with great difficulty only some of them. At the same time, the memory of events in his personal life is grossly violated, he answers questions approximately or after complex calculations. With severe hypomnesia, there is a complete or almost complete lack of memory of past events, the patients answer the relevant questions “I don’t remember”. In these cases, they are socially helpless and disabled.

psycho-organic(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 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. Among the variants of the syndrome, asthenic with a predominance of physical and mental exhaustion is distinguished; explosive, determined by affective lability; euphoric, accompanied by increased mood, complacency, a decrease in a critical attitude towards oneself, as well as affective outbursts and bouts of anger, culminating in tearfulness and helplessness; apathetic, characterized by a decrease in interests, indifference to the environment, weakening of memory and attention.

Irritability is increased. In the early stages of the disease occurs in connection with a specific emotionally significant situation. The patient sometimes looks irritated and gloomy, but more often irritability is revealed only during questioning, there is no fixation on it, a critical attitude and the ability to cooperate with others remain.

Gradually, however, increased irritability can become almost permanent. It occurs under the action of not only emotionally significant, but also indifferent stimuli (bright light, loud conversation). The patient outwardly looks tense, with difficulty restrains the affect of anger. He assesses the external situation as "outrageous", it is difficult to attract him to cooperation.

The most pronounced forms of increased irritability are characterized by rage, fragmentary screams, abuse that occurs at the slightest pretext. At the same time, attacks on the object of anger are possible, with extreme severity, a narrowing of consciousness occurs, there is no consistent self-esteem.

Confusion. In the beginning, uncertainty appears, an unreasonable silence in conversation, a “puzzled” facial expression are characteristic. Sometimes the patient reports that he is confused, confused. Believes that the external situation or internal state generally understandable, but still strange, obscure, baffling, requiring clarification. With the development of confusion, the patient looks with interest and listens to the situation or becomes thoughtful, immersed in himself. At the same time, speech loses consistency, becomes inconsistent, the patient does not finish the phrase, which, however, does not exclude the possibility of establishing a productive contact. There is an expression of surprise on his face, he wrinkles his forehead, his eyebrows are raised, his gaze is wandering, searching, movements and gestures are uncertain, incomplete, contradictory. Often throws up his hands, shrugs his shoulders, asks "to clarify the incomprehensible."

Severe confusion is accompanied by facial expressions of bewilderment or (in case of autopsychic confusion) "enchantment" with a frozen face, "attention turned inward", often the patient's eyes are wide open, shiny eyes. Speech is chaotic, broken to incoherence, interrupted by silence.

Senestopathic disorders. The most typical manifestation in various parts body of unpleasant and painful sensations of pain, burning, constriction, which are unusual, sometimes pretentious. Doctors, examining the patient, do not identify the “aching” organ or part of the body and do not find an explanation unpleasant sensations. With the stabilization of senestopathic disorders, they largely determine the style of the patient's behavior, which requires comprehensive additional and, as a rule, inconclusive studies. Senestopathic sensations as psychopathological manifestations should be carefully differentiated from the initial symptoms of various somatic and neurological diseases. Senestopathies in mental illness are usually combined with other mental disorders characteristic of schizophrenia, the depressive phase of manic-depressive psychosis and other diseases. Most often, senestopathies are part of a more complex senestopathic-hypochondriac syndrome.

Sleep (disturbances). Sleep disturbances, disturbances in the depth and duration of sleep, awakening disorders, and daytime sleepiness are characteristic.

Sleep disorders At first, occasionally, especially with fatigue, there is a delay in the onset of sleep within 1 hour. At the same time, paradoxical doubt is sometimes noted (the feeling of drowsiness dissipates when trying to fall asleep), prosonic hyperesthesia of hearing, smell, not disturbing. With difficulty falling asleep, the patient remains in bed, usually does not pay attention to the existing violations, noting them only during special inquiries.

With more severe violations almost always there are disorders of falling asleep, disturbing the patient. The delay in the onset of sleep is within 2 hours, while along with paradoxical somnesia and drowsy hyperesthesia, a feeling internal stress, anxiety, various autonomic disorders. The patient with difficulty falling asleep sometimes gets out of bed.

Severe sleep disturbances are characterized by a constantly tormenting, exhausting inability to fall asleep for several hours. Sometimes during this period there is a complete absence of drowsiness. In these cases, the patient lies in bed with open eyes and is trying to sleep. There may be anxiety, phobias, severe autonomic disorders, often hyperesthesia, hypnagogic hallucinations. The patient is anxious, waiting for the night with fear, if it is impossible to fall asleep, he tries to change the daily rhythm of sleep, actively seeks help.

Violations of the depth and duration of night sleep.Sometimes, more often with fatigue, there are sudden nocturnal awakenings. After which sleep comes again. In some cases, intrasomnic disorders are of a different nature and are expressed in the appearance of periods of superficial sleep with abundant and vivid dreams. The total duration of night sleep is usually not changed. In the presence of these disorders at night, the patient continues to stay in bed, without attaching serious importance to them.

In more severe cases, there are almost always night sleep disturbances in the form of awakenings (dissociated, fragmented night sleep, usually accompanied by senestopathies, phobias, vegetative disorders). Awakenings are painful for the patient, after them for a long time he cannot sleep again. In a number of cases, intrasomnic disorders are expressed in a superficial state of half-sleep filled with dreams, which does not bring a feeling of cheerfulness and freshness in the morning. The total duration of night sleep, as a rule, decreases by 2-3 hours (sleep duration is 4-5 hours).

These disorders are difficult for the patient, he seeks help, seeks to comply with medical recommendations.

With extreme degrees of violations of the depth and duration of sleep, painful, almost daily insomnia is noted, when sleep does not occur at all throughout the night or short periods superficial sleep are replaced by frequent awakenings. Sometimes intrasomnic disorders are accompanied by frequent sleep-talking, somnambulism, pronounced night terrors. The patient often has a fear of insomnia (agrypnophobia), he is anxious, irritable, actively looking for medical care. The duration of night sleep is reduced in these cases, usually by 4-5 hours (the duration of sleep is sometimes only 2-3 hours).

Awakening disorders. In mild cases, occasionally, with fatigue, after somato- and psychogenic, there is a delay in awakening, when the patient cannot find a feeling of cheerfulness and freshness for several minutes. During this period, there is marked drowsiness. Another type of awakening disorder is an extremely rapid, sudden awakening in the morning with unpleasant autonomic disorders. Awakening disturbances do not cause concern to the patient; they can usually be found out about their presence only with a special questioning.

With the complication of symptoms, disturbances in awakening are almost constant; in the mornings, there is no feeling of freshness and cheerfulness characteristic of a rested person. With difficulty awakening, along with severe drowsiness, prosonic disorientation is sometimes noted. Awakening disturbances can be expressed in the form of extremely rapid, instantaneous awakening with significant autonomic reactions (palpitations, fear, tremor, etc.). The patient is concerned about disturbances in awakening; when it slows down in the morning, he is usually lethargic and drowsy.

The most pronounced awakening disorders are characterized by painful, almost constant disturbances in the form of a long-term impossibility after sleep to engage in vigorous activity, a feeling of fatigue, and a complete lack of vigor and freshness. During prosonic states, illusory and hypnosomnic hallucinatory disorders, disorientation, and dysphagia are noted. After waking up in the morning, the patient experiences constant lethargy, drowsiness. Along with difficulty waking up, there may be a sudden awakening with a feeling of lack of sleep (denial former dream). A pronounced feeling of weakness, lethargy, lack of vigor and freshness are extremely disturbing to the patient.

Increased sleepiness.The first manifestations of increased drowsiness are found only during questioning, the number of hours of sleep per day is slightly increased (no more than 1 hour). The existing drowsiness is easily overcome by the patient, is not relevant for him. In more pronounced cases, in the morning the patient sleeps for a long time, wakes up with difficulty, complains of drowsiness during the day, which he cannot overcome. In a conversation, a “sleepy” facial expression is noticeable (relaxed facial expressions, slightly lowered eyelids). In addition to night sleep, he usually sleeps or naps during the day for 3-4 hours.

The greatest drowsiness is characterized by the fact that the patient sleeps or dozes almost all day, vigorous activity because of this, it is extremely difficult for him. When addressing the patient, he hardly answers simple questions. At the same time, a typically "sleepy", somewhat swollen face, eyelids are lowered, the muscles of the face and the whole body are relaxed.

Anxiety. At first, a feeling of vague anxiety arises only at times, more often in specific subjectively significant situations. At the same time, the movements and posture of the patient are outwardly calm, but at times the facial expressions change, a moving restless look appears, speech becomes somewhat confused, with slips of the tongue, stammers or excessive detail. At the same time, there is a critical attitude towards anxious mood, which is assessed as "internal discomfort, slight excitement" and is often successfully suppressed. Purposeful activity is not disturbed more often, perhaps even an increase in working capacity.

These violations may become permanent. In a conversation, small extra movements are noticeable; with fear associated with the external situation, the patient is tense, alert, distrustful, shudders, looks around. The condition is assessed as "internal restlessness" or "tension", "constraint". Almost constant thoughts about danger, threatening situation, disturbing events expected in the near future. Purposeful activity is disturbed, tremor, sweating, rapid pulse appear.

With pronounced anxiety and panic fear, there is a sharp motor excitation, most often erratic throwing, stampede, the desire to hide. Sometimes, on the contrary, there is a general “stiffness”. Pupils and palpebral fissures are dilated, pallor is noted, cold sweat shortness of breath, sometimes involuntary urination. It is impossible to obtain a consistent report on the state, the speech is in the nature of inarticulate fragmentary cries: “Save! .. What to do? ..” The patient groans, at times begs him to hide, protect; experiencing fear, panic.

Neurotic and neurosis-like syndromes

Conditions that manifest functional (reversible) non-psychotic disorders. They may be of different nature. A patient suffering from a neurosis (psychogenic disorder) experiences constant emotional stress. His resources, defenses, are depleted. The same thing happens in a patient suffering from almost any somatic disease. Therefore, many of the symptoms seen in neurotic and neurosis-like syndromes are similar. This is fatigue with a feeling of psychological and physical discomfort, accompanied by anxiety, restlessness with internal tension. At the slightest occasion, they intensify. They are accompanied by emotional lability and increased irritability, early insomnia, distractibility, etc.

Neurotic syndromes are psychopathological syndromes in which disorders characteristic of neurasthenia, obsessive-compulsive disorder or hysteria are observed.

1. ASTHENIC SYNDROME (ASTHENIA) - a state of increased fatigue, irritability and unstable mood, combined with vegetative symptoms and sleep disturbances.

Increased fatigue with asthenia is always combined with a decrease in productivity at work, especially noticeable during intellectual workload. Patients complain of poor intelligence, forgetfulness, unstable attention. They find it difficult to focus on just one thing. They try to force themselves to think about a certain subject by an effort of will, but soon notice that completely different thoughts appear in their head, involuntarily, that have nothing to do with what they are doing. The number of representations is reduced. Their verbal expression is difficult: it is not possible to find the right words. The ideas themselves lose their clarity. The formulated thought seems to the patient to be inaccurate, poorly reflecting the meaning of what he wanted to express with it. Patients are annoyed at their failure. Some take breaks from work, but a short rest does not improve their well-being. Others strive by an effort of will to overcome the difficulties that arise, they try to analyze the issue as a whole, but in parts, but the result is either even greater fatigue, or dispersion in classes. The work begins to seem overwhelming and insurmountable. There is a feeling of tension, anxiety, conviction of one's intellectual insolvency

Along with increased fatigue and unproductive intellectual activity with asthenia, mental balance is always lost. The patient easily loses his temper, becomes irritable, quick-tempered, grouchy, picky, absurd. The mood fluctuates easily. Both unpleasant and joyful events often entail the appearance of tears (irritable weakness).

Hyperesthesia is often observed, i.e. intolerance loud sounds and bright light. Fatigue, mental imbalance, irritability are combined with asthenia in various proportions.

Asthenia is almost always accompanied by vegetative disorders. Often they can occupy a predominant position in the clinical picture. The most common disorders of the cardiovascular system: fluctuations

level blood pressure, tachycardia and pulse lability, various

discomfort or just pain in the heart area.

Ease of redness or blanching of the skin, a feeling of heat at normal body temperature, or, conversely, increased chilliness. Especially often there is increased sweating - either local (palms, feet, armpits), or generalized.

Often dyspeptic disorders - loss of appetite, pain along the intestines, spastic constipation. Men often experience a decrease in potency. In many patients, headaches of various manifestations and localization can be identified. Often complain of a feeling of heaviness in the head, compressing headaches.

Sleep disorders in the initial period of asthenia are manifested by difficulty falling asleep, superficial sleep with an abundance of disturbing dreams, awakenings in the middle of the night, difficulty in falling asleep later, and early awakening. After sleep they do not feel rested. There may be a lack of sleep at night, although in fact, patients sleep at night. With the deepening of asthenia, and especially during physical or mental stress, there is a feeling of drowsiness in the daytime, without, however, at the same time improving night sleep.

As a rule, the symptoms of asthenia are less pronounced or even (in mild cases) are completely absent in the morning and, on the contrary, intensify or appear in the afternoon, especially in the evening. One of the reliable signs of asthenia is a condition in which there is a relatively satisfactory state of health in the morning, deterioration occurs at work and reaches a maximum in the evening. In this regard, to perform any homework, the patient must first rest.

The symptomatology of asthenia is very diverse, which is due to a number of reasons. Manifestations of asthenia depend on which of the main disorders included in its structure is predominant.

If the picture of asthenia is dominated by irascibility, explosiveness, impatience, a feeling of internal tension, inability to restrain, i.e. symptoms of irritation - talk about asthenia with hypersthenia. This is the most mild form asthenia.

In cases where fatigue and a feeling of impotence dominate in the picture, asthenia is defined as hyposthenic, the most severe asthenia. An increase in the depth of asthenic disorders leads to a successive change from milder hypersthenic asthenia to more severe stages. With the improvement of the mental state, hyposthenic asthenia is replaced by more light forms asthenia.

The clinical picture of asthenia is determined not only by the depth of existing disorders, but also by such two important factors as the constitutional characteristics of the patient and the etiological factor. Often these two factors are closely intertwined. So, in individuals with epileptoid character traits, asthenia is characterized by pronounced excitability and irritability; persons with traits of anxious suspiciousness have various disturbing fears or obsessions.

Asthenia is the most common and most common mental disorder. It can be found in any mental and somatic disease. It is often combined with other neurotic syndromes. Asthenia must be differentiated from depression. In many cases, it is very difficult to distinguish between these conditions, and therefore the term astheno-depressive syndrome is used.

2. OBESSIVE SYNDROME (obsessive-compulsive disorder syndrome) - a psychopathological condition with a predominance of obsessive phenomena (i.e. painful and unpleasant thoughts, ideas, memories, fears, drives, actions that arise involuntarily in the mind, to which a critical attitude and the desire to resist them are maintained) .

As a rule, it is observed in anxious and suspicious individuals during the period of asthenia and is perceived critically by patients.

Obsessional syndrome is often accompanied by subdepressive mood, asthenia and autonomic disorders. Obsessions in obsessional syndrome can be limited to one kind, for example, obsessive counting, obsessive doubts, mental chewing phenomena, obsessive fears (phobias), etc. In other cases, obsessions that are very different in their manifestations coexist at the same time. The occurrence and duration of obsessions are different. They can develop gradually and exist continuously for a long time: obsessive counting, phenomena of mental chewing, etc.; they can appear suddenly, last a short period of time, in some cases appear in series, thus resembling paroxysmal disorders.

Obsessional syndrome, in which obsessive phenomena occur in the form of distinct attacks, is often accompanied by pronounced vegetative symptoms: blanching or redness of the skin, cold sweat, tachycardia or bradycardia, a feeling of lack of air, increased intestinal motility, polyuria, etc. There may be dizziness and feelings of lightheadedness.

Obsessive syndrome is a common disorder in borderline mental illness, adult personality disorder (obsessive-compulsive personality disorder), depression in anxious and suspicious individuals.

3. HYSTERIC SYNDROME - a symptom complex of mental, autonomic, motor and sensory disorders, often occurs in immature, infantile, egocentric individuals after a mental trauma. Often these are personalities of an artistic warehouse, prone to posturing, deceit, demonstrativeness.

Such faces strive to always be in the center of attention and be noticed by others. They do not care what feelings they evoke in others, the main thing is not to leave anyone indifferent around.

Mental disorders are manifested, first of all, by the instability of the emotional sphere: violent, but quickly replacing each other feelings of indignation, protest, joy, hostility, sympathy, etc. Facial expressions and movements are expressive, overly expressive, theatrical.

A figurative, often pathetically passionate speech is characteristic, in which the “I” of the patient is in the foreground and the desire at any cost to convince the interlocutor of the truth of what they believe and what they want to prove.

Events are always presented in such a way that the listeners should have the impression that the reported facts are the truth. Most often, the information presented is exaggerated, often distorted, in some cases it is a deliberate lie, in particular in the form of a slander. Untruth can be well understood by the sick, but often they believe in it as an indisputable truth. The latter circumstance is associated with increased suggestibility and self-suggestibility of patients.

Hysterical symptoms can be any and appear according to the type of "conditional desirability" for the patient, i.e. brings him a certain benefit (for example, getting out of a difficult situation, avoiding reality). In other words, we can say that hysteria is “an unconscious flight into illness.”

Tears and crying, sometimes passing quickly, are frequent companions of the hysterical syndrome. Vegetative disorders are manifested by tachycardia, changes in blood pressure, shortness of breath, sensations of constriction of the throat - the so-called. hysterical lump, vomiting, redness or blanching of the skin, etc.

A large hysterical seizure is very rare, and usually with a hysterical syndrome that occurs in people with organic lesions of the central nervous system. Usually, motor disorders in hysterical syndrome are limited to tremors of the limbs or the whole body, elements of astasia-abasia - buckling of the legs, slow subsidence, difficulty walking.

There are hysterical aphonia - complete, but more often partial; hysterical mutism and stuttering. Hysterical mutism can be combined with deafness - deafness.

Occasionally, hysterical blindness can be encountered, usually in the form of loss of individual visual fields. Disorders of skin sensitivity (hypesthesia, anesthesia) reflect the "anatomical" ideas of patients about the zones of innervation. Therefore, disorders capture, for example, whole parts or a whole limb on one and the other halves of the body. The hysterical syndrome is most pronounced in hysterical reactions within the framework of psychopathy, hysterical neurosis and reactive states. In the latter case, the hysterical syndrome can be replaced by states of psychosis in the form of delusional fantasies, puerilism and pseudodementia.

Psychopathological symptoms. Major psychopathological symptoms, syndromes and conditions

Characteristics of the main apathetic disorders: apathy, asthenia, autism, affective and delusional disorders. Pathology of attraction, its clinical manifestations. hallucinatory syndromes. Manifestations of depression, sleep disorders. Manic state.

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