Psychopathological disorders. Psychopath-like syndrome: symptoms and treatment

single symptom acquires diagnostic value only in aggregate and interrelation with other symptoms, that is, in the symptom complex syndrome. The syndrome is a set of symptoms united by a single pathogenesis. From the syndromes and their successive changes, the clinical picture of the disease and its development are formed.

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PSYCHOPATHOLOGICAL SYNDROMES

Recognition of any disease, including mental, begins with a symptom (a sign that reflects certain disorders of one or another function). However, the symptom-sign has many meanings and it is impossible to diagnose the disease on its basis. An individual symptom acquires diagnostic value only in the aggregate and in interrelation with other symptoms, that is, in a syndrome (symptom complex). A syndrome is a set of symptoms united by a single pathogenesis. From the syndromes and their successive changes, the clinical picture of the disease and its development are formed.

Neurotic (neurosis-like) syndromes

Neurotic syndromes are observed with neurasthenia, hysterical neurosis, neurosis obsessive states; neurosis-like - in diseases of an organic and endogenous nature and correspond to the mildest level of mental disorders. Common to all neurotic syndromes is the presence of criticism of one's condition, the absence of pronounced phenomena of maladjustment to ordinary living conditions, the concentration of pathology in the emotional-volitional sphere.

Asthenic syndrome- characterized by a noticeable decrease in mental activity, increased sensitivity to ordinary stimuli (mental hyperesthesia), rapid fatigue, difficulty in the flow of mental processes, incontinence of affect with rapidly onset fatigue (irritating weakness). There are a number of somatic functional disorders with vegetative disorders.

obsessive-compulsive disorder(anancaste syndrome) - manifested by obsessive doubts, ideas, memories, various phobias, obsessive actions, rituals.

hysterical syndrome- a combination of egocentrism, excessive self-suggestiveness with increased affectation and instability emotional sphere. An active desire for recognition from others by demonstrating one's own superiority or seeking sympathy or pity for oneself. The experiences of patients and behavioral reactions are characterized by exaggeration, hyperbolization (of the merits or severity of their condition), increased fixation on painful sensations, demonstrativeness, mannerisms, exaggerations. This symptomatology is accompanied by elementary functional somato-neurological reactions, which are easily fixed in psychogenic situations; functional disorders of the motor apparatus (paresis, astasia-abasia), sensitivity, activity of internal organs, analyzers (deafness, aphonia).

Syndromes affective disorders

Dysphoria - grouchy-irritable, angry and gloomy mood with increased sensitivity to any external stimulus, aggressiveness and explosiveness. Accompanied by unfounded accusations of others, scandalousness, cruelty. There are no disturbances of consciousness. The equivalents of dysphoria can be binge drinking (dipsomania) or aimless wandering (dromomania).

Depression - melancholy, depressive syndrome - a suicidal state, which is characterized by an oppressed, depressed mood, deep sadness, despondency, melancholy, ideational and motor retardation, agitation (agitated depression). In the structure of depression, there are possible depressive delusional or overvalued ideas (of low value, worthlessness, self-accusation, self-destruction), a decrease in attraction, a vital oppression of self-perceptions. Subdepression is a mild depressive affect.

Cotard's syndrome - nihilistic-hypochondriac nonsense combined with ideas of enormity. It is most common in involutional melancholia, much less frequently in recurrent depression. There are two variants of the syndrome: hypochondriacal - characterized by a combination of anxious-melancholic affect with nihilistic-hypochondriac delirium; depressive - characterized by anxious melancholy with predominantly depressive delusions and ideas of denial of the outside world of a megalomaniac nature.

Masked (larvated) depression- characterized by a feeling of general indefinite diffuse somatic discomfort, vital senestopathic, algic, vegetodistonic, agripnic disorders, anxiety, indecision, pessimism without clear depressive changes in affect. Often found in somatic practice.

Mania (manic syndrome) - a painfully elevated joyful mood with increased drives and tireless activity, acceleration of thinking and speech, inadequate joy, cheerfulness and optimism. The manic state is characterized by distractibility of attention, verbosity, superficiality of judgments, incompleteness of thoughts, hypermnesia, overvalued ideas of overestimation of one's own personality, lack of fatigue. Hypomania is a mildly pronounced manic state.

Affective syndromes (depression and mania) are the most common mental disorders and are observed at the onset of mental illness, may remain the predominant disorders throughout the course of the disease.

When diagnosing depression, it is necessary to focus not only on the complaints of patients: sometimes there may be no complaints of a decrease in mood, and only a targeted questioning reveals depression, loss of interest in life (“satisfaction with life” - taedium vitae), a decrease in overall vitality, boredom, sadness, anxiety, etc. In addition to purposeful questioning about mood changes proper, it is important to actively identify somatic complaints that can mask depressive symptoms, signs of sympathicotonia (dryness of mucous membranes, skin, a tendency to constipation, tachycardia - the so-called "Protopopov's sympathicotonic symptom complex"), characteristic of endogenous depression. depressive "omega" (fold between the eyebrows in the form of the Greek letter "omega"), Veraguta fold (oblique fold on the upper eyelid). Physical and neurological examination reveals objective signs of sympathicotonia. Paraclinically clarify the nature of depression allow such biological tests as therapy with tricyclic antidepressants, dexamethasone test. Clinical and psychopathological examination using standardized scales (Zung's scale, Spielberger's scale) allows to quantify the severity of depression and anxiety.

Hallucinatory and delusional syndromes

hallucinosis syndrome- influxes of verbal hallucinations such as different "voices" (conversations) against the background of the relative preservation of consciousness.

paranoid syndrome- primary systematized nonsense (jealousy, reformism, "struggle for justice", etc.), is distinguished by the plausibility of the plot, the system of evidence for the "correctness" of one's statements, and the fundamental impossibility of correcting them. The behavior of patients in the implementation of these ideas is characterized by sthenicity, persistence (delusional behavior). There are no perceptual disturbances.

paranoid syndrome- characterized by secondary sensory delusions (persecution, relationships, influences), occurs acutely, against the background of emotional disorders (fear, anxiety) and perception disorders (illusions, hallucinations). Delirium is unsystematized, inconsistent, may be accompanied by impulsive unmotivated actions and actions.

Syndrome of mental automatism Kandinsky-Clerambaultconsists of pseudo-hallucinations, delusional ideas of influence and various mental automatisms, belief in impartiality, involuntary occurrence, subjective coercion, violence of mental processes (thinking, speech, etc.)

paraphrenic syndrome- a combination of meaningless delusional ideas of greatness of fantastic content with the phenomena of mental automatism, hallucinations, euphoria.

To identify hallucinatory-delusional disorders, it is important not only to take into account the spontaneous complaints of patients, but also to be able to conduct a targeted questioning, which allows you to clarify the nature of painful experiences. Objective signs of hallucinations, delusional behavior, which is revealed during observation, significantly complement the clinical impression.

Disturbed Consciousness Syndromes

All syndromes of impaired consciousness have a number of common features, first described by K. Jaspers:

1. Alienation from the environment, fuzzy, fragmentary perception of it.

2. Disorientation in time, place, situation, and in the most difficult cases, in one's own personality.

3. More or less incoherent thinking, with weakness or impossibility of judgment and speech disorders.

4. Full or partial amnesia of the period of disorder of consciousness.

Coma - complete shutdown of consciousness with the loss of conditioned and unconditioned reflexes, the absence of chopping activity.

Sopor - obscuration of consciousness with the preservation of defensive and other unconditional reactions.

Stun - a relatively mild form of clouding of consciousness. It is characterized by a fuzzy orientation in the environment, a sharp increase in the threshold for all external stimuli, slowing down and difficulty of mental activity.

Obnubilation - slight clouding of consciousness with the preservation of all types of orientation and the ability to carry out ordinary actions, while there are difficulties in understanding the complexity of the situation, the content of what is happening, the content of someone else's speech.

Delirious syndrome- a form of confused consciousness, which is characterized by disorientation in place, time and situation, an influx of vivid true visual hallucinations, visual illusions and pareidolia, a sense of fear, figurative delirium and movement disorders. Delirium is accompanied by autonomic disorders.

amental syndrome- a form of confused consciousness with a sharp inhibition of mental activity, complete disorientation, fragmentary perception, inability to comprehend the situation, erratic motor activity, followed by complete amnesia of the experienced.

Oneiroid (sleep-like) syndrome- a form of confused consciousness with an influx of involuntarily arising fantastic dream-like delusional ideas; accompanied by partial or complete alienation from the environment, a disorder of self-awareness, depressive or manic affect, signs of catatonia, the preservation of the content of experiences in the mind during amnesia of the environment.

twilight syndrome- characterized by a sharp narrowing of the volume of consciousness and complete disorientation. An unproductive twilight state is manifested in the implementation of a number of ordinary automated and externally ordered actions in an inappropriate situation for this in the waking state (ambulatory automatism) and during sleep (somnambulism). Productive twilight is characterized by an influx of true extremely frightening hallucinations, the affect of fear and anger, destructive actions and aggression.

Syndromes due to gross organic pathology of the brain

convulsive syndrome- manifested by a variety of generalized and focal seizures (suddenly onset, rapidly passing states with impaired consciousness up to its loss and convulsive involuntary movements). More or less pronounced changes (decrease) in personality and intelligence are often intertwined in the structure of the convulsive syndrome.

Korsakovsky amnestic syndrome - characterized by a complete loss of the ability to remember current events, amnestic disorientation, memory twisting with relative preservation of memory for the past, and a diffuse decrease in all components of mental functioning.

Psycho-organic syndrome- a more or less pronounced state of general mental helplessness with a decrease in memory, a weakening of understanding, incontinence of affect (Walter-Bühel triad).

Intellectual Defect Syndromes

Mental retardation- congenital total mental underdevelopment with a predominant insufficiency of intelligence. Degrees: mild, moderate, severe, profound mental retardation.

Dement Syndrome- acquired persistent defect of intelligence, which is characterized by the inability to acquire new and the loss of previously acquired knowledge and skills. Lacunar (dysmnestic) dementia is a cellular intellectual defect with partial preservation of criticism, professional skills and the "core of personality". Total dementia - a violation of all components of the intellect with a lack of criticism and the collapse of the "core of the personality" (moral and ethical properties).

Mental insanity- an extreme degree of disintegration of the psyche with the extinction of all types of mental activity, loss of language, helplessness.

Syndromes with predominantly motor-volitional disorders

Apatico-abulic syndrome- a combination of indifference (apathy) and a significant weakening of motives for activity (aboulia).

catatonic syndrome- manifests itself in the form of a catatonic stupor or in the form of stereotypical impulsive arousal. During stupor, patients freeze in an immobile state, increases muscle tone(rigidity, catalepsy), negativism appears, speech and emotional reactions are absent. During arousal, senseless, absurdly foolish behavior with impulsive actions, speech disorders with the phenomena of fragmentation, grimacing, stereotypes are noted.

Other syndromes

Depersonalization Syndrome- a disorder of self-consciousness with a feeling of alienation of some or all mental processes (thoughts, ideas, memories, attitudes to the outside world), which is recognized and painfully experienced by the patient himself.

Derealization syndrome- a disorder of mental activity, which is expressed in a painful feeling of unreality, the illusory nature of the surrounding world.

Irritable Weakness Syndrome- characterized by a combination of affective lability and irritability with a decrease in working capacity, a weakening of concentration and increased fatigue.

hebephrenic syndrome- motor and speech disorders with senseless, mannered-foolish behavior, unmotivated gaiety, emotional devastation, impoverishment of motives, fragmentation of thinking with progressive disintegration of the personality.

Heboid syndrome- a combination of affective-volitional disorders with the relative preservation of intellectual functions, which is manifested by rudeness, negativism, weakening of self-control, a distorted nature of emotional reactions and drives and leads to pronounced social maladjustment and antisocial behavior.

withdrawal syndrome- a condition that occurs as a result of a sudden cessation of the intake (introduction) of substances that caused substance abuse or after the introduction of their antagonists; characterized by mental, vegetative-somatic and neurological disorders; the clinical picture depends on the type of substance, dose and duration of its use.

hypochondriacal syndrome- consists in the patient's erroneous (overvalued or delusional) belief that he has a severe somatic disease, in reassessment (dramatization) of the severity of his morbid condition. The syndrome consists of senestopathies and emotional disorders in the form of depressive mood, fear, and anxiety. Hypochondriacal fixation - excessive focus on the state of one's health, one or another of its slightest deviations, complications that threaten one's own health.

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Syndrome (from the Greek syndrome - accumulation, confluence) - a set of symptoms united by a single pathogenesis, a regular combination of productive and negative symptoms. Syndrome - "joint run of symptoms". The term “symptom complex” was proposed by the German psychiatrist K. Kalbaum (1863) when describing catatonia. At the time he considered catatonia separate disease, but later it became clear that this is the most typical variant of the symptom complex.

The German psychiatrist W. Griesinger owns the idea, which later became the basis of the “single psychosis”, that all manifestations of mental illness are stages of the same process, at the first stages affective disorders and more often melancholy are observed, then delusional symptoms occur and as an outcome - dementia.

Domestic psychiatrists S. S. Korsakov and V. P. Serbsky sought to study psychoses in dynamics. V. P. Serbsky wrote that both catatonia and hebephrenia have common signs and result in dementia praecox, which E. Kraepelin considered as an independent disease.

At the beginning of the century, I. G. Orshansky, in the study of acute psychoses, came to the conclusion that the patient's condition at each moment is determined not just by a set of symptoms, but by a complex of symptoms united by common patterns, and with the development of the disease, these complexes become more complex from simpler to more complex , i.e., the author, as it were, repeated the position of V. Griesinger, without establishing a single sequence for all mental illnesses.

In connection with the influenza pandemic of 1888-1889. a large number of works appeared describing amental and delirious states, and since 1908 - a series of works by the German psychiatrist K. Bongeffer, who, under the name "exogenous type of reaction", combined syndromes various etiologies. K. Bongeffer believed that the brain had fewer opportunities for responses than various harmful factors that affect the body, so there are reactions of the same type that form into syndromes.

Under the name "exogenous types of reactions" K. Bongeffer singled out the following psychopathological syndromes: delirium, epileptiform excitation, twilight confusion, hallucinosis and amentia. In the process of studying, he either expanded or narrowed the set of these syndromes. Ultimately, the most typical exogenous types of reactions were delirium and Korsakov's syndrome.

Opponents of K. Bongeffer, criticizing his concept, believed that the exogenous type of reaction is due to the rapid pace of development of symptoms in response to massive harm, and they saw confirmation of this in a decrease in the number, depth and duration of states of clouded consciousness in infectious and somatic diseases in connection with active therapy antibiotics.

The English neuropathologist Jackson formulated the doctrine of the “layered” construction of mental activity. He considered mental disorders from the standpoint of “dissolution” - disintegration, at first the defeat of the highest, most differentiated layers of the psyche, and believed that psychosis depends on 4 factors: the degree of dissolution depth, personality traits, dissolution rate and other somatic and other exogenous conditions.

Jackson emphasized that the faster the dissolution occurs, the more pronounced is the activity of the layers directly affected by the disease process. He expressed the idea that mental illnesses consist of productive disorders, which are caused by the activity of intact layers of the nervous system, and negative ones, associated with and caused by the pathological process itself.

If “minus symptoms”, or negative disorders, are associated with an etiological factor representing the nosological characteristic of the disease, then positive or productive symptoms represent a reaction of the body, less specific and does not carry diagnostic information about the causes that caused these disorders. Clinically, dissolution is manifested by psychopathological symptoms.

These ideas were used in clinical syndromology by A. V. Snezhnevsky. According to the increase in the severity of the syndromes, they identified 9 circles for productive (positive) syndromes: 1) emotional-hyperesthetic, asthenic disorders; 2) affective; 3) neurotic and depersonalization; 4) paranoid and hallucinosis; 5) hallucinatory-paranoid, paraphrenic and catatonic; 6) clouding of consciousness; 7) paramnesia; eight) convulsive syndromes; 9) psycho-organic.

For negative disorders, A. V. Snezhnevsky singled out 10 circles: 1) exhaustion of mental activity; 2) subjectively perceived change; 3) objectively determined personality changes; 4) personality disharmony, including schizoidization; 5) reduction of energy potential; 6) decrease in the level of personality; 7) personality regression; 8) amnestic disorders; 9) total dementia; 10) mental insanity).

A. V. Snezhnevsky wrote that when clinical analysis Syndromes are artificially isolated and abstracted, but in fact there are no insurmountable boundaries between them, each syndrome expresses only one period of continuous development of the disease.

The syndrome as a stage of the disease can be the same with various diseases. This is due to the fact that adaptation to the changed conditions of life (disease) is achieved using the same type of response methods. This manifests itself in the form of symptoms and syndromes, which, as the disease progresses, become more complex and turn from simple to complex or from small to large.

At various diseases their clinical picture changes in a certain sequence, that is, there is a stereotype of development characteristic of each disease.

Allocate a general pathological stereotype of development, characteristic of all diseases, and a nosological stereotype, which is typical for individual diseases (IV Davydovsky).

The general pathological stereotype of the development of diseases provides for the presence of general patterns in all these diseases. Even W. Griesinger tried to identify these patterns for mental illness, believing that each disease begins with depression, then delusional symptoms appear and all ends with dementia.

It was found that at the initial stages with progressive mental illness more often neurotic disorders are found, then affective, delusional and psycho-organic ones appear. In other words, with progressive mental illness, the clinical picture is steadily becoming more complex and deepening. A typical example is the formation of clinical manifestations in schizophrenia: at the initial stages, neurotic disorders, asthenic, phobic disorders are detected, then affective disorders appear, delusional symptoms, complicated by hallucinations and pseudohallucinations, Kandinsky-Clerambault syndrome, paraphrenic delirium and outcome in apathetic dementia.

An attempt was made to model the correlation of general pathological syndromes and nosological units using a system of circles reflecting the dynamics of productive and negative syndromes (A. V. Snezhnevsky). So, productive disorders, including asthenic, affective, neurotic, delusional and catatonic circles, were assessed as characteristic of schizophrenia, and negative schizophrenic disorders are represented by circles, including personality disharmony (and schizoidization), a decrease in energy potential and a decrease in the level of personality (IV, V, VI circles in the scheme of A.V., Snezhnevsky). Nosological diagnosis takes into account the unity of productive and negative disorders.

General pathological patterns in the development of mental illness reveal the main trends. Neither productive nor negative disorders have an absolute nosological specificity; these patterns rather extend to the kind of diseases or groups of diseases, such as psychogenic, endogenous and exogenous-organic.

It should be noted that in each of these groups of diseases, all the identified productive symptoms occur. So, in psychogenic diseases, asthenic and neurotic syndromes characteristic of neurosis and neurotic personality development, affective, delusional, hallucinatory, motor - for reactive psychoses (depression, paranoia, stuporous states), transient intellectual and mnestic disorders - for hysterical psychoses (pseudo-dementia, mental regression syndrome).

With endogenous and exogenous-organic diseases, all of the listed syndromes are present, however, there is a certain preference for them, consisting in the highest frequency and severity for a particular group of diseases.

Negative mental disorders, despite the general pathological patterns of the formation of a personality defect in connection with the disease, have ambiguous trends in groups of diseases.

Negative disorders are usually presented the following syndromes: asthenic or cerebroasthenic (exhaustion of mental activity, in the terminology of Snezhnevsky), personality changes, including psychopathic disorders, and in psychogenic diseases, these are pathocharacterological disorders, manifested by the loss of the individual's ability to control his emotions and behavior when adapting to the environment. With exogenous organic diseases, negative disorders are characterized by psychopathic personality changes, which are manifested by excessive saturation of experiences, inadequacy in strength and severity of emotional reactions, exclusivity and aggressiveness of behavior.

At endogenous diseases, especially in schizophrenia, personality changes have opposite tendencies compared to exogenous organic disorders and are characterized by emotional impoverishment and dissociation of emotional manifestations, their disorder and inadequacy. Such a character emotional disturbances called "glass and wood".

The next level of negative disorders is characterized by a decrease in productive activity due to intellectual-mnestic and affective disorders.

In endogenous and exogenous-organic diseases, these disorders are also different. If in exogenous organic diseases there is a direct decrease in memory and impoverishment intellectual activity, then in schizophrenia these disorders are due to the depth of affective disorders, apathy, abulia, and dementia itself is called apathetic dementia.

It is generally accepted that patients with schizophrenia do not suffer from memory, but there are well-known cases when patients, being in the department for a long time, do not know the name of the attending physician, roommates, find it difficult to give dates. However, these memory disorders are not true, but caused by affective disorders. In situations in which patients have an interest, memory is preserved.

APATHY (indifference). At the initial stages of the 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 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. The facial expression of the patient is indifferent, there is indifference to everything, including his own 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). Among vegetative disorders, excessive sweating and pallor of the face predominate. 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 a perceptible external cause, change several times in a short time, which makes it extremely difficult to purposeful activity.

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 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 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 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.

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 trifling, all difficulties - easily overcome. The posture is laid-back, unnecessarily sweeping gestures, in a conversation an elevated tone sometimes slips.

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).

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.

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.

Special place belongs to verbal hallucinations, which can be commentary or imperative, appear in the form of a monologue or dialogue. Hallucinations can appear 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 an integral part of a more complex senestopathic-hypochondriac, anxious-hypochondriac and other syndromes, and is also combined with obsessions, depression, and 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. 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 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. basis pathological process with a psychoorganic syndrome, the current brain disease is determined organic nature(traumatic disease, tumor, inflammation, intoxication) or its consequences.

Nonspecific psychopathological symptoms are often combined with focal lesions brain with associated neurological and psychiatric 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.

What are the syndromes

If the presence of maladjustment is obvious, then the following sequence is assumed when establishing a diagnosis:

1. detection of symptoms,

2. identification of their typical combinations (syndromes),

3. determination of the diagnosis, taking into account the specificity of the identified symptoms and syndromes

Kryga of possible etiological and pathogenetic factors, analysis of anamnestic information to determine the dynamics of the disease and, finally, the formulation of a nosological diagnosis. This sequence can be significantly shorter if symptoms are found that are characteristic of only one or a few diseases. Therefore, of greatest interest to the diagnostician are h o c o s p e digital symptoms and syndromes .

There are several common features that determine the specificity of symptoms and syndromes,

1. the severity of the disorder,

2. its reversibility,

3. the degree of damage to the basic functions of the psyche.

Psychopathological symptoms

A SYMPTOM of a mental disorder is a phenomenon that is repeated in different patients, indicating a pathology, a painful deviation from the natural course of mental processes, leading to maladaptation.
Symptoms are the basis of diagnosis, but their diagnostic value can vary greatly. In psychiatry, there are practically no pathognomonic symptoms - only some of the painful phenomena can be considered quite specific. Thus, the feeling of reading thoughts, transmitting them at a distance, the feeling of their forcible insertion and withdrawal are quite characteristic of paranoid schizophrenia. Most of the signs in psychiatry are nonspecific. For example, sleep disorders, decreased mood, anxiety, restlessness, increased fatigue are found in almost any mental illness, delirium and hallucinations - only in severe illnesses, however, they are not specific enough, since they can occur with many psychoses.

Thus, the main diagnostic value of symptoms is realized through the syndromes formed from them. In this case, the symptoms differ depending on their position in the structure of the syndrome.

In this case, the symptom may be obli symptomatic, syndrome-forming sign . So, a decrease in mood is an obligate sign of depression, fixative amnesia is a central disorder in Korsakoff's syndrome. On the other hand, one has to take into account optional symptoms , indicating the features of the course of the disease in this patient. So, the appearance of anxiety and psychomotor agitation as part of a depressive syndrome is not typical, but it must be taken into account in the diagnosis, since this may indicate high probability suicide.

Sometimes a symptom directly indicates to the doctor the need for special measures: for example, psychomotor agitation usually indicates a high severity of the condition and serves as an indication for hospitalization, regardless of the proposed nosological diagnosis. Refusal to eat, active desire for suicide require active action by the doctor even before the final diagnosis is established.

The concepts of neurotic and psychotic levels are not associated with any specific disease. Moreover, with the same disease, the state of a person in different periods neurotic or psychotic is sometimes described. It should be noted that in some diseases throughout the life of the patient, the symptoms do not go beyond the neurotic level (the group of neuroses proper clothymia, low-grade forms of schizophrenia, psychopathy)

The division of disorders into productive and negative is of extreme importance for establishing a diagnosis and for prognosis.

Productive symptomatology (positive symptomatology, PLUS-symptom) is a new disease phenomenon, some new function that has appeared as a result of the disease and is absent in healthy people. Examples of productive disorders are delusions and hallucinations, epileptiform paroxysms, psychomotor agitation, obsessions, strong feeling anguish in depression, inadequate joy in mania.

Negative symptoms (defect, minus # symptom), on the contrary, are the damage that the disease causes to the natural healthy functions of the body, the disappearance of any ability. Examples of negative symptoms are loss of memory (amnesia), intellect (dementia), the ability to experience vivid emotional feelings (apathy).

The selection of these concepts belongs to the English neuropathologist J.H. Jackson (l835# 1911), who believed that negative symptoms are due to destruction or temporary inactivity of brain cells, and productive symptoms are a manifestation of pathological activity

living cells and tissues surrounding the painful focus and therefore working in an unnatural, upset mode. In this sense, negative symptoms, as it were, indicate which brain structures are destroyed. It is closely related to the etiology of the disease and is more significant for nosological diagnosis than productive. Productive disorders, in turn, are a nonspecific response of healthy tissues to irritant effect hearth and therefore can be common for various diseases.

Psychiatrists apply the concept of negative and productive symptoms to more than just focal lesions. Productive symptoms are highly dynamic.

For physicians, the provision on the persistence and irreversibility of negative symptoms is important, however, in clinical practice, rare cases of regression of some negative symptoms are known. Such dynamics is very typical for memory disorders in acute Korsakov's psychosis. Cases of the regression of negative symptoms of schizophrenia have been repeatedly discussed in the literature. Apparently, it should be considered that the loss of function does not necessarily mean death. brain structures performing this role, in some cases the defect is due only to their temporary inactivity. So in acute psychoses, excitement and confusion prevent patients from concentrating, they cannot count correctly, decide logical tasks. However, after gaining calmness and getting rid of productive symptoms, it becomes obvious that these abilities have not been irretrievably lost. Therefore, the depth and severity of negative SYMPTOMS should be assessed only after an acute illness has passed.
So, the main properties of productive and negative disorders can be represented as follows:
Productive Disorders

one. . manifest new functions that did not exist before the disease;

2. . non-specific, as they are the product of living functioning brain cells;

3. . reversible, well controlled by drugs, may resolve without treatment;

four. . indicate the severity of the process.

Negative disorders (defect)

one. . expressed in the loss of healthy functions and abilities;

2. . quite specific, indicating a specific affected locus;

3. . usually irreversible (with the exception of disorders in acute period disease);

four. . indicate the outcome of the disease.

**********************

1.2 Major psychopathological syndromes

Syndrome - a complex of symptoms.

Psychopathological syndrome - a complex, a more or less typical set of internally (pathogenetically) interconnected psychopathological symptoms, in the specific 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 find their expression.

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

1.2.1 Positive psychopathological syndromes

A unified view of the concept of positive, and, accordingly, negative, syndromes is currently practically absent.

positive consider syndromes that are qualitatively new, absent in the norm, symptom complexes (they are also called pathological positive, “plus” - disorders, “irritation” phenomena), indicating progression mental illness, qualitatively changing the mental activity and behavior of the patient.

1.2.1.1 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

1. hypersthenic and

2. hyposthenic.

At emotional-hyperesthetic weakness short-term emotional reactions of discontent, irritability, anger on minor occasions arise easily and quickly (symptom of “matches”), emotional lability, weak-mindedness; 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 of expectation. 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.

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

Asthenic syndrome occurs when

1. somatic (infectious and non-infectious) diseases,

2. intoxications,

3. organic and endogenous mental illnesses,

4. neuroses.

He makes up the essence of neurasthenia (asthenic neurosis) by doing three steps:

▪ hypersthenic,

▪ irritable weakness,

▪ hyposthenic.

1.2.1.2 affective syndromes.

Syndromes of affective disorders are very diverse. At the core modern classification affective syndromes lie three parameters:

1. proper affective pole (depressive, manic, mixed),

2. the structure of the syndrome (harmonious - disharmonious; typical - atypical) and

3. the severity of the syndrome (non-psychotic, psychotic).

Typical (harmonious) syndromes include a uniformly depressive or manic triad mandatory symptoms:

1. pathology of emotions (depression, mania),

2. change in the course of the associative process (slowdown, acceleration) and

3. motor-volitional disorders / lethargy (substupor) - disinhibition (excitation), hypobulia-hyperbulia/.

The main (core) among them are emotional.

Additional symptoms are:

1. low or high self-esteem,

2. violations of self-consciousness,

3. obsessive, overvalued or delusional ideas,

4. oppression or strengthening of inclinations,

5. suicidal thoughts and actions in depression.

In the most classical form there are endogenous affective psychoses and as a sign of endogeneity include somato-vegetative symptom complex of V. P. Protopopov (

· arterial hypertension,

tachycardia,

· constipation,

hyperglycemia,

violation of the menstrual cycle,

· change body weight),

daily fluctuations of affect (improvement of well-being in the second half of the day), seasonality, periodicity and autochthonous.

For atypical affective syndromes predominance of facultative symptoms (.

1. anxiety,

3. senestopathies,

5. obsessions,

6. derealization,

7. depersonalization,

8. delirium of a non-holothymic nature,

9. hallucinations,

10. catatonic symptoms)

over the main affective syndromes.

To mixed affective syndromes include such disorders that, as it were, are being introduced from the opposite triad (for example, motor excitation with the affect of melancholy - depressive excitation).

There are also

1. subaffective.(

◦ subdepression,

◦ hypomania; they are non-psychotic)

2. classical affective and

3. complex affective-disorders (affective-delusional:

a) depressive-paranoid,

b) depressive-hallucinatory-paranoid,

c) depressive-paraphrenic or manic-paranoid.

d) manic-hallucinatory-paranoid,

e) manic-paraphrenic).

1.2.1.2.1 depressive syndromes.

classic depressive syndrome includes the depressive triad:

1. expressed longing,

2. depressed gloomy mood with a touch of vitality;

3. intellectual or motor retardation.

Hopeless longing is often experienced as mental pain, 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 longing 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 down the associative process in the form of difficulty in choosing words, decreased mental activity, and memory impairment. From additional symptoms- obsessive doubts, low self-esteem, impaired self-awareness of activity.

The classic depressive syndrome is characteristic of endogenous depressions (manic-depressive psychosis, schizophrenia); subdepression in reactive psychoses, neuroses.

To atypical depressive syndromes are subdepressive. relatively simple and complex depressions.

Among the subdepressive syndromes, the most common are:

Similar information.

Karaganda State Medical University

LECTURE

Topic:

Discipline "Neurology, psychiatry, narcology"

Specialty 051301 – General Medicine

Time (duration) 1 hour

Karaganda 2011

Approved at the methodological meeting of the department

May 07, 2011 Protocol #10

psychology, psychiatry and narcology

Candidate of Medical Sciences, Associate Professor M.Yu.Lyubchenko

Topic : Major psychopathological syndromes

• 
  The goal is to familiarize students with the classification of mental illness
• 
  Lecture plan

2. Asthenic syndrome

3. Hallucinosis Syndrome

4. Paranoia

5. Paranoid syndrome.

6. Syndrome of mental automatism

7. Paraphrenic syndrome

8. Syndromes of disturbed consciousness

9. Korsakov's syndrome

10. Psycho-organic syndrome

A syndrome is a stable combination of symptoms that are closely related and united by a single pathogenetic mechanism and characterizing the current state of the patient.

So, the peripheral sympathicotonia characteristic of depression leads to the appearance of tachycardia, constipation, pupil dilation. However, the connection between symptoms can be not only biological, but also logical. Thus, the inability to remember current events in fixative amnesia naturally leads to disorientation in time and confusion in a new, unfamiliar environment.

The syndrome is the most important diagnostic category in psychiatry, while the syndromic diagnosis is not considered as one of the stages in establishing a nosological diagnosis. When solving many practical problems in psychiatry, a correctly described syndrome means much more than a correctly made 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 guided by the leading syndrome. So, 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 the syndromes do not directly indicate a nosological diagnosis, they are divided into more and less specific ones. 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.

Syndromes are divided into simple (small) and complex (large). An example of the first is asthenic syndrome, manifested by a combination of irritability and fatigue. Usually, simple syndromes do not have nosological specificity and occur in various diseases. Over time, the complication of the syndrome is possible, i.e. attachment to it of more rough symptoms in the form of delirium, 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. In patients, irritable weakness is observed, expressed by increased excitability and exhaustion quickly following it, 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 representations. There may also be influxes of extraneous thoughts and memories that involuntarily appear in the mind of the patient.

Headaches, sleep disturbance, vegetative manifestations are often observed.

It is possible to change the patient's condition depending on the level of barometric pressure (Pirogov's meteopathic syndrome).

Asthenic syndrome is the most nonspecific of all psychopathological syndromes. It can be observed with cyclothymia, symptomatic psychosis, organic brain damage, neuroses, intoxication psychoses.

The occurrence of asthenic syndrome is associated with the depletion of the functional capabilities of the nervous system during its overstrain, 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 the activity of various body systems with the subsequent possibility of restoring their function.

^ SYNDROMES OF HALLUCINOSIS.

Hallucinosis is manifested by numerous hallucinations (often simple), constituting the main and almost the only manifestation of psychosis. Allocate visual, verbal, tactile, olfactory hallucinosis. Hallucinosis can be acute (lasting weeks) or chronic (lasting for years).

The most typical causes of hallucinosis are exogenous hazards (intoxication, infection, trauma) or somatic diseases (cerebrovascular atherosclerosis). Some intoxications are distinguished by special variants of hallucinosis. So, alcoholic hallucinosis is more often manifested by verbal hallucinations of a judgmental nature. With tetraethyl lead poisoning, there is a sensation of the presence of hair in the mouth. With cocaine intoxication - tactile hallucinosis with a feeling of crawling under the skin of insects.

With schizophrenia this syndrome occurs in the form of pseudohallucinosis.

^ PARANOYAL SYNDROME.

Paranoid syndrome is manifested by primary, interpretative monothematic, systematized delirium. The predominant content of delusional ideas is reformism, relationships, jealousy, and the special significance of one's own personality. Hallucinatory disorders are absent. Crazy ideas are formed as a result of a paralogical interpretation of the facts of reality. The manifestation of delusions may be preceded by a long existence of overvalued ideas. Paranoid syndrome tends to be chronic and difficult to treat with psychotropic drugs.

The syndrome occurs in schizophrenia, involutional psychosis, decompensation of paranoid psychopathy.

^ PARANOID SYNDROME

The paranoid syndrome is characterized by systematized ideas of persecution. Hallucinations join delusions, more often these are auditory pseudohallucinations. The emergence of hallucinations determines the emergence of new delirium plots - 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, the paranoid syndrome coincides with the concept of the syndrome of mental automatism. The latter does not include only variants of the paranoid syndrome, accompanied by true gustatory or olfactory hallucinations and delusions of poisoning. At paranoid syndrome there is a certain tendency towards the collapse of the crazy system, nonsense acquires the features of pretentiousness, absurdity. These features become especially pronounced during the transition to the paraphrenic syndrome.

SYNDROME OF MENTAL AUTOMATISM (Kandinsky-Clerambault syndrome).

This syndrome consists of delusions of persecution and influence, pseudo-hallucinations and phenomena of mental automatism. The patient may feel the effects of different ways- from witchcraft and hypnosis, to the action of cosmic rays and computers.

There are 3 types of mental automatism: ideational, sensory, motor.

Ideational automatisms are the result of an imaginary impact on the processes of thinking and other forms of mental activity. Manifestations of this type of automatisms are mentism, “sounding” of thoughts, “withdrawal” or “insertion” of thoughts, “made” dreams, a symptom of unwinding memories, “made” moods and feelings.

Sensory automatisms usually include extremely unpleasant sensations that arise in patients also as a result of the influence of an extraneous force.

Motor automatisms include disorders in which patients have a belief that the movements they make are made against their will under the influence from outside, as well as motor speech automatisms.

An inverted version of the syndrome is possible, the essence of which lies in the fact that the patient himself allegedly has the ability to influence others, recognize their thoughts, influence their mood, feelings and actions.

^ PARAPHRENIC SYNDROME.

This state 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, leaders of states, etc. When presenting the content of nonsense, they use figurative and grandiose comparisons. As a rule, patients do not seek to prove the correctness of statements, referring to the indisputability of their convictions.

The phenomena of psychic automatism also have a fantastic content, which is expressed in mental communication with outstanding representatives of humanity or with creatures inhabiting other planets. Often there is a syndrome of a positive or negative twin.

In the syndrome, pseudohallucinations and confabulatory disorders can occupy a significant place. In most cases, the mood of patients is elevated.

^ SYNDROMES OF DISTURBED CONSCIOUSNESS.

Criteria for disturbed consciousness have been developed (Karl Jaspers):

1. 
   Detachment from the surrounding reality. The external world is not perceived or is perceived in fragments.
2. 
   Disorientation in the environment
3. 
   Thinking disorder
4. 
   Amnesia of the period of disturbed consciousness, complete or partial

1. 
   blackout syndromes
2. 
   confused syndromes

Syndromes of clouded consciousness: delirium, amentia, oneiroid, twilight disorder of consciousness.

Delirium can 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, experiences frightening visual true hallucinations. Often these are zoohallucinations: insects, lizards, snakes, scary monsters. The behavior of the patient is largely determined by psychopathological experiences. Delirium is accompanied by multiple somatovegetative disorders (rising blood pressure, tachycardia, hyperhidrosis, tremor of the body and limbs). In the evening and at night, all these manifestations are intensified, and in the daytime they usually weaken somewhat.

At the end of psychosis, partial amnesia is observed.

The course of psychosis is characterized by a number of features. Symptoms increase in a certain sequence. Until the full formation of psychosis, it takes from several days to 2 days. Early signs of developing psychosis are anxiety, restlessness, hyperesthesia, insomnia, against which hypnogogic hallucinations appear. As the psychosis progresses, illusory disorders appear, turning into complex hallucinatory disorders. This period is characterized by intense fear and psychomotor agitation. The delirium lasts from 3 to 5 days. Termination of psychosis occurs after prolonged sleep. After recovery from psychosis, residual delusions may persist. Abortive delirium lasts for several hours. However, severe forms of delirium are not uncommon, leading to a gross organic defect (Korsakov's syndrome, dementia).

A sign of an unfavorable prognosis are occupational and mushing delirium.

Oneiroid(dream-like) clouding of consciousness. Differs in extreme fantasticness of psychotic experiences.

Oneiroid is a kind of fusion of real, illusory and hallucinatory perception of the world. A person is transferred 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 rocking, mutism, negativism, waxy flexibility, impulsivity. Patients are disoriented in place, time and self. A symptom of a double false orientation is possible, when patients consider themselves patients in a psychiatric hospital and at the same time participants in fantastic events. Often there are sensations of rapid movement, movement in time and space.

Oneiroid - most often a manifestation acute attack schizophrenia. The formation of psychosis occurs relatively quickly, but can take several weeks. Psychosis begins with sleep disturbance and anxiety, anxiety quickly reaching the point of confusion. There is an acute sensual delirium, the phenomena of derealization. Then the fear is replaced by the 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 oneiroid state is gradual. First, hallucinations are leveled, then catatonic phenomena. Ridiculous statements and actions sometimes persist for quite a long time.

Oneiroid experiences that develop against the background of exogenous and somatogenic factors are referred to as manifestations fantastic delirium. Among exogenous psychoses most of all, the picture of a typical oneiroid corresponds to the phenomena observed with the use of hallucinogens (LSD, hashish, ketamine) and hormonal drugs (corticosteroids).

Amenia - gross clouding of consciousness with incoherent thinking, complete inaccessibility for contact, fragmentary deceptions of perception and signs of severe physical exhaustion. The patient in the amental state usually lies down despite chaotic excitement. His movements sometimes resemble some actions indicating the presence of hallucinations, but often completely meaningless, stereotyped. Words are not linked into phrases and are fragments of speech (incoherent thinking). The patient responds to the words of the doctor, but cannot answer questions, does not follow instructions.

Amentia occurs most often as a manifestation of prolonged debilitating somatic diseases. If it is possible to save the life of patients, a pronounced organic defect is formed as an outcome (dementia, Korsakoff's syndrome, protracted asthenic conditions). Many psychiatrists consider amentia as one of the variants of severe delirium.

^ Twilight clouding 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 disturbed consciousness.

The perception of the environment at the moment of clouding of consciousness is fragmentary, patients snatch random facts from the surrounding stimuli and react to them in an unexpected way. The affect is often characterized by malice, aggressiveness. Possible antisocial behavior. The symptomatology loses all connection with the personality of the patient. Possible productive symptoms in the form of delusions and hallucinations. At the end of psychosis, there is no memory of psychotic experiences. Psychosis usually ends in deep sleep.

There are variants of twilight clouding of consciousness with bright productive symptoms (delusions and hallucinations) and with automated actions (outpatient automatisms).

^ Ambulatory automatisms are manifested by short periods of stupefaction without a sharp excitation with the ability to perform simple automated actions. Patients can take off their clothes, dress, go outside, give brief, not always relevant answers to questions from others. On exit from psychosis, complete amnesia is noted. The varieties of ambulatory automatisms include fugues, trances, somnambulism.

Twilight confusion is a typical sign of epilepsy and other organic diseases (tumors, cerebral atherosclerosis, head injuries).

should be distinguished from epileptic hysterical twilight conditions arising immediately after the action of mental trauma. At the time of psychosis, the behavior of patients may differ in foolishness, infantilism, helplessness. Amnesia can capture large intervals preceding psychosis or following its cessation. However, fragmentary memories of what happened may remain. The resolution of a traumatic situation usually leads to the restoration of health.

^ KORSAKOV SYNDROME

This is a state in which memory disorders for present events (fixation amnesia) predominate, while it is preserved for past events. 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, retrograde amnesia is also noted.

One of the characteristic symptoms is amnestic disorientation. Memory gaps are filled with paramnesia. Confabulatory confusion may develop.

The occurrence of Korsakov's syndrome as a result of acute brain damage in most cases allows us to hope for some positive dynamics. Although a complete recovery of memory is impossible in most cases, during the first months after treatment, the patient can fix individual repeated facts, the names of doctors and patients, and navigate the department.

^ PSYCHO-ORGANIC SYNDROME

A state of general mental helplessness with a decrease in memory, ingenuity, with a weakening of the will and affective stability, a decrease in working capacity and other adaptation possibilities. In mild cases, psychopathic states of organic genesis are revealed, mildly pronounced asthenic disorders, affective lability, weakening of the initiative. Psycho-organic syndrome can be a residual condition, occur during progressive diseases of organic origin. In these cases, psychopathological symptoms are combined with signs of organic brain damage.

Allocate 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, irritable weakness, hyperesthesia, affective lability, intellectual dysfunctions are slightly expressed. There is a slight decrease in intellectual productivity, mild dysmnestic disorders.

For explosive variant a combination of affective excitability, irritability, aggressiveness with unsharply pronounced dysmnestic disorders and a decrease in adaptation is characteristic. A tendency to overvalued paranoid formations and querulant tendencies is characteristic. Quite frequent alcoholization is possible, leading to the formation of alcohol dependence.

As with asthenic and explosive variants of the syndrome, decompensation of the condition is expressed due to intercurrent diseases, intoxications and mental trauma.

Painting euphoric version syndrome is determined by an increase in mood with a touch of euphoria, complacency, stupidity, sharp decline criticism of one's condition, dysmnestic disorders, increased drives. Anger and aggressiveness are possible, giving way to helplessness, tearfulness. Signs of a particular severity of the condition are the development in patients of symptoms of violent laughter and violent crying, in which the cause that caused the reaction is amnestic, and the grimace of laughter or crying is preserved for a long time in the form of a mimic reaction devoid of affect content.

^ Apathetic variant syndrome is characterized by aspontaneity, a sharp narrowing of the circle of interests, indifference to the environment, including own destiny and the fate of their loved ones and significant dysmnestic disorders. Attention is drawn to the similarity of this condition with apathetic pictures observed in schizophrenia, however, the presence of mnestic disorders, asthenia, spontaneously arising syndromes of violent laughter or crying, helps to distinguish these pictures from similar conditions in other nosological units.

The listed variants of the syndrome are often the stages of its development, and each of the variants reflects a different depth and a different amount of damage to mental activity.

Illustrative material (slides - 4 pcs.)

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  Literature