The main psychopathological syndromes table. Psychopathological syndromes
I. HALLUCINATORIAL AND DELUSIOUS SYNDROMES Hallucinosis is a condition characterized by an abundance of hallucinations within one analyzer and is not accompanied by clouding of consciousness. The patient is anxious, restless or, conversely, inhibited. The severity of the condition is reflected in the behavior and attitude of the patient to hallucinations.
Verbal auditory hallucinosis: voices are heard talking among themselves, arguing, condemning the patient, agreeing to destroy him. Auditory hallucinosis is determined by the clinical picture of the alcoholic psychosis of the same name; the syndrome can be isolated in other intoxication psychoses, in neurosyphilis, in patients with vascular lesions of the brain.
It is noted in psychoses of late age, with organic damage to the central nervous system. Patients with tactile hallucinosis feel the crawling of insects, worms, microbes on the skin and under the skin, touching the genitals; criticism of what is experienced is usually absent.
Visual hallucinosis - a common form of hallucinosis in the elderly and people who have suddenly lost their sight, it also happens with somatogenic, vascular, intoxication and infectious psychoses. With the hallucinations of Charles Bonnet, BLIND (blinded during life or from birth) patients suddenly begin to see bright landscapes on the wall, in the room, lawns lit by the sun, flower beds, playing children, or simply abstract, bright “images”.
Usually, with hallucinosis, the patient's orientation in place, time and his own personality is not disturbed, there is no amnesia of painful experiences, that is, there are no signs of clouding of consciousness. However, in acute hallucinosis life threatening the patient's content sharply increases the level of anxiety, and in these cases, consciousness can be affectively narrowed.
Paranoid syndrome is a syndrome of delirium, characterized by the delirious interpretation of the facts of the surrounding reality, the presence of a system of evidence used to “substantiate” errors of judgment. The formation of delirium is facilitated by personality traits, which are manifested by significant strength and rigidity of affective reactions, and in thinking and actions - by thoroughness and a tendency to detail. In terms of content, this is litigious nonsense, inventions, jealousy, persecution.
Paranoid syndrome may be the initial stage in the development of schizophrenic delusions. At this stage, there are no hallucinations and pseudo-hallucinations, there are no phenomena of mental automatism. Paranoid syndrome exhausts the psychopathological symptoms of paranoid psychopathy, alcoholic paranoid
Hallucinatory-paranoid syndromes, in which hallucinatory and delusional disorders are presented in different proportions, organically related to each other. With a significant predominance of hallucinations, the syndrome is called hallucinatory, with the dominance of delusional ideas - paranoid.
The paranoid syndrome also refers to the paranoid stage in the development of delusions. At this stage, the previous system of erroneous conclusions corresponding to paranoid delusions can be preserved, but signs of its collapse are found: absurdities in behavior and statements, dependence of delusions on the leading affect and on the content of hallucinations (pseudo-hallucinations), which also appear at the paranoid stage.
The syndrome of mental automatism of Kandinsky - Clerambault is a special case of hallucinatory-paranoid syndrome and includes pseudohallucinations, phenomena of alienation of mental acts - automatisms and delusions of influence. Being in the power of perceptual disturbances, the patient is sure of their violent origin, of their being made - this is the essence of automatism.
Automatism can be ideational, sensory or motor. The patient believes that his thoughts are controlled, "made" them parallel, they make him mentally utter curses, they put other people's thoughts into his head, take them away, read them. In this case, we are talking about ideptor automatism. This type of automatism includes pseudohallucinations.
Sensory automatism relates more to violations of sensory cognition and corresponds to the statements of patients about "doneness": Feelings - "cause" indifference, lethargy, a feeling of anger, anxiety Sensations - "make" pain in different parts of the body, sensation of electric current passing, burning, itching. With the development of motor automatism, the patient becomes convinced that he is losing the ability to control his movements and actions: by someone else's will, a smile appears on his face, limbs move, complex actions are performed, for example, suicidal acts.
There are chronic and acute hallucinatory-paranoid syndromes. Chronic hallucinatory-paranoid syndrome gradually becomes more complicated, the initial symptoms acquire new ones, and a developed syndrome of mental automatism is formed.
Acute hallucinatory-paranoid syndromes can be reduced under the influence of treatment and can quickly transform into other psychopathological syndromes. In the structure of an acute hallucinatory-paranoid syndrome, there are acute sensory delusions, delusional perception of the environment, confusion or significant saturation of affect;
Acute hallucinatory-paranoid syndrome often turns out to be a stage in the development of acute paraphrenia and a oneiroid state. Hallucinatory-paranoid syndromes can be diagnosed in all known psychoses, except for manic-depressive.
II. SYNDROMES OF INTELLECTUAL DISORDERS Intellect is not a separate, independent mental sphere. It is considered as the ability for mental, cognitive and creative activity, for the acquisition of knowledge, experience and their application in practice. With intellectual disabilities, the following abilities turn out to be insufficient: to analyze the material, to combine, to guess, to carry out the thought processes of synthesis, abstraction, to create concepts and conclusions, to draw conclusions. the formation of skills, the acquisition of knowledge, the improvement of previous experience and the possibility of its application in activities.
Dementia (dementia) is a persistent, difficult-to-recover loss of intellectual abilities caused by a pathological process, in which there are always signs of a general impoverishment of mental activity. There is a decrease in intelligence from the level acquired by a person during life, its reverse development, impoverishment, accompanied by a weakening of cognitive abilities, impoverishment of feelings and a change in behavior.
With acquired dementia, memory, attention are sometimes disturbed, and the ability to make judgments often decreases, the core of the personality, criticism and behavior remain intact for a long time. Such dementia is called partial, or lacunar (partial, focal dysmnesic). In other cases, dementia is immediately manifested by a decrease in the level of judgments, violations of criticism, behavior, leveling of the patient's characterological features. Such dementia is called complete, or total, dementia (diffuse, global).
Organic dementia is lacunar and total. Lacunar dementia is observed in patients with cerebral atherosclerosis, syphilis of the brain (vascular form), Total - with progressive paralysis, senile psychosis, with Pick and Alzheimer's diseases.
Epileptic (concentric) dementia is characterized by an extreme sharpening of characterological features, rigidity, stiffness in the course of all mental processes, slowing down of thinking, its thoroughness, difficulty switching attention, impoverishment vocabulary, a tendency to use the same stamped expressions. In character, this is manifested by vindictiveness, vindictiveness, petty punctuality, pedantry, and along with this - hypocrisy, explosiveness.
With the steady progression of the pathological process, the increase in rigidity and thoroughness, a person becomes less and less capable of diverse social functioning, gets bogged down in trifles, the circle of his interests and activities narrows more and more (hence the name of dementia - "concentric").
Schizophrenic dementia is characterized by a decrease in energy potential, emotional impoverishment, reaching a degree of emotional dullness. An uneven disturbance of intellectual processes is found: in the absence of noticeable memory disorders, a sufficient level of formal knowledge, the patient turns out to be completely socially maladapted, helpless in practical matters. Autism is noted, a violation of the unity of the mental process (signs of a splitting of the psyche) in combination with inactivity and unproductiveness.
III. AFFECTIVE SYNDROMES Manic syndrome in its classic version includes a triad of psychopathological symptoms: 1) increased mood; 2) the acceleration of the flow of ideas; 3) motor speech excitation. These are obligate (basic and constantly present) signs of the syndrome. Increased affect affects all aspects of mental activity, which is manifested by secondary, non-permanent (optional) signs of a manic syndrome.
There is an unusual brightness of the perception of the environment, in the processes of memory there are phenomena of hypermnesia In thinking - a tendency to overestimate one's capabilities and one's own personality, short-term delusional ideas of greatness In emotional reactions - anger In the volitional sphere - increased desires, drives, quick switching of attention appearance the patient expresses joy.
The depressive syndrome is manifested by a triad of obligate symptoms: a decrease in mood, a slowdown in the flow of ideas, and motor speech retardation. Optional signs of a depressive syndrome: In perception - hypesthesia, illusory, derealization and depersonalization phenomena In the mnestic process - a violation of the feeling of familiarity In thinking - overvalued and delusional ideas of hypochondriacal content, self-accusation, self-abasement, self-incrimination In the emotional sphere - reactions of anxiety and fear; motor-volitional disorders include oppression of desires and inclinations, suicidal tendencies Mournful facial expression and posture, low voice.
Anxiety-depressive syndrome (syndrome of agitated depression), manic stupor and unproductive mania in their origin are the so-called mixed states, transitional from depression to mania and vice versa.
The psychopathological triad traditional for classical depression and mania is violated here, effective syndrome loses some of its properties and acquires signs of a polar opposite affective state. So, in the syndrome of agitated depression, instead of motor inhibition, there is excitation, which is characteristic of a manic state.
Manic stupor syndrome is characterized by motor retardation with elevated mood; in patients with unproductive mania, an elevated mood, motor disinhibition, combined with a slowdown in the pace of thinking, are noted.
Depressive-paranoid syndrome is referred to as atypical states for the affective level. A feature is the intrusion into the affective syndrome corresponding to manic-depressive psychosis, symptoms from other nosological forms of schizophrenia, exogenous and exogenous-organic psychoses.
Paraphrenic delusions of enormity, described by Kotard, can also be attributed to atypical affective states: hypochondriacal experiences, which are based on a feeling of self-change in depression, take on a grotesque character with the patient's confidence in the absence internal organs, with the denial of the external world, life, death, with the ideas of doom to eternal torment. Depression with hallucinations, delusions, clouding of consciousness is described as a fantastic melancholy. Darkening of consciousness at the height of a manic state gives grounds to speak of confused mania.
Asthenodepressive syndrome. Some authors consider this concept of a syndrome to be theoretically untenable, believing that we are talking about a combination of two simultaneously existing syndromes - asthenic and depressive. At the same time, attention is drawn to the clinical fact that asthenia and depression are mutually exclusive states: the higher the proportion of asthenic disorders, the less the severity of depression; with the increase of asthenia, the suicidal risk decreases, motor and ideational retardation disappears.
In the practice of a doctor, astheno-depressive syndrome is diagnosed as one of the most frequent in the framework of borderline mental pathology. Manic and depressive syndromes can be a stage in the formation of psychopathological symptoms of any mental illness, but in their most typical manifestations they are presented only in manic-depressive psychosis.
IV. SYNDROMES OF MOTOR AND VOLITIONAL DISORDERS Catatonic syndrome is manifested by catatonic stupor or catatonic excitation. These states, so different outwardly, are actually united in their origin and turn out to be only different phases of one and the same phenomenon.
In accordance with the research of I.P. Pavlov, the symptomatology of catatonia is a consequence of painful weakness nerve cells, for which ordinary stimuli are superstrong. The inhibition that develops in the cerebral cortex is protective and transcendental. If inhibition covers not only the entire cortex, but also the subcortical region, symptoms of a catatonic stupor appear. The patient is inhibited, does not serve himself, does not respond to speech addressed to him, does not follow instructions, mutism is noted.
Some patients lie motionless, turned to the wall, in a uterine position with the chin brought to the chest, with arms bent at the elbows, bent at the knees and legs pressed to the stomach for days, weeks, months or years.
The fetal posture testifies to the release of more ancient reactions characteristic of an early age period of development, which in an adult are inhibited by later, higher-order functional formations. Very characteristic is also another posture - lying on your back with your head raised above the pillow - a symptom of an air cushion.
Disinhibition of the sucking reflex leads to the appearance of a symptom of the proboscis; touching the lips, they fold into a tube and protrude; in some patients, this position of the lips is permanent. The grasping reflex is also disinhibited (normally typical only for newborns): the patient grabs and tenaciously holds everything that accidentally touched his palm.
With incomplete stupor, echo symptoms are sometimes observed: echolalia - the repetition of the words of someone around, echopraxia - copying the movements of other people. Echosymptoms are based on the disinhibition of the imitative reflex characteristic of children and contributing to them. mental development. The release of stem postural reflexes is expressed by catalepsy (waxy flexibility): the patient retains the position given to his body and limbs for a long time.
Phenomena of negativism are observed: the patient either does not fulfill what is required at all (passive negativism), or actively resists, acts opposite to what is required of him (active negativism). In response to a request to show his tongue, the patient tightly compresses his lips, turns away from the hand extended to him for a handshake and removes his hand behind his back; turns away from a plate of food placed in front of him, resists an attempt to feed him, but grabs the plate and pounces on the food when trying to remove it from the table. I. P. Pavlov considered this to be an expression of phase states in the central nervous system and associated negativism with the ultraparadoxical phase
In the paradoxical phase, weaker stimuli can cause a stronger response. Thus, patients do not respond to questions asked in a normal, loud voice, but answer questions asked in a whisper. At night, when the flow of impulses to the central nervous system from the outside sharply decreases, some stuporous patients become disinhibited, begin to move quietly, answer questions, eat, wash; with the onset of morning and an increase in the intensity of irritations, the stupor returns. Patients with stupor may not have other symptoms, but hallucinations, a delusional interpretation of the surroundings, occur more often. This is found out when the patient is disinhibited.
Depending on the nature of the leading symptoms, three types of stupor are distinguished: 1) with phenomena of waxy flexibility, 2) negativistic, 3) with muscle numbness. The listed options are not independent disorders, but represent the stages of the stuporous syndrome, replacing one another in the indicated sequence with the aggravation of the patient's condition.
Catatonic excitation is meaningless, non-purposeful, sometimes taking on the character of a motor. The movements of the patient are monotonous and, in fact, are subcortical hyperkinesis; aggressiveness, impulsive actions, echopraxia, negativism are possible. Facial expression often does not match postures; sometimes paramimia is observed: the facial expressions of the upper part of the face express joy, the eyes laugh, and the mouth is angry, the teeth are clenched, the lips are tightly compressed and vice versa. Mimic asymmetries can be observed. In severe cases, there is no speech, mute excitement or the patient growls, grunts, shouts out individual words, syllables, pronounces vowels.
Some patients show an irrepressible urge to speak. At the same time, speech is pretentious, high-flown, there are: stereotypes of speech, perseveration, echolalia, fragmentation, verbigeration - a senseless stringing of one word onto another. Transitions from catatonic excitation to a stuporous state or from stupor to a state of excitation are possible.
Catatonia is subdivided into lucid and oneiroid. Lucid catatonia proceeds without clouding of consciousness and is expressed by stupor with negativism or stupor or impulsive arousal. Oneiroid catatonia includes oneiroid clouding of consciousness, catatonic agitation with confusion, or stupor with waxy flexibility. Catatonic syndrome is more often diagnosed with schizophrenia, sometimes with epilepsy or exogenous organic psychoses.
Hebephrenic syndrome is close to catatonic both in origin and manifestations. It is characterized by excitement with mannerisms, pretentiousness of movements and speech, foolishness Fun, antics and jokes do not infect others. Patients tease, grimace, lisp, distort words and phrases, tumble, dance.
As part of sluggish schizophrenia, adolescents are sometimes diagnosed with heboidity - an incompletely unfolded hebephrenic state, manifested by a touch of foolishness, swagger in behavior, disturbances of desires and asocial tendencies.
V. NEUROTIC SYNDROMES This pathology is distinguished by the partiality of mental disorders, a critical attitude towards them, the presence of consciousness of the disease, an adequate assessment of the environment and concomitant weakness of mental functions, abundant somatovegetative symptoms. The absence of gross violations of cognition of the environment is characteristic. In the structure of neurotic syndromes there are no object consciousness disorders, delusions, hallucinations, dementia, manic state, stupor, arousal.
With true neurotic disorders, a person remains intact. Moreover, the effect of external harmfulness is mediated by the patient's personality, its reactions that characterize the personality itself, its social essence. All of the above features make it possible to qualify such violations as borderline violations. mental pathology, which is a pathology on the border between the norm and pathology, between somatic and mental illnesses.
Neurasthenic (asthenic) syndrome is characterized by irritable weakness. Due to acquired or congenital insufficiency of internal inhibition, excitation is not limited by anything, which is manifested by irritability, impatience, increased exhaustion of attention, sleep disturbances (superficial sleep, with frequent awakenings).
There are hyper- and hyposthenic variants of asthenia. With hypersthenic asthenia, the preservation of the excitatory and weakness inhibitory process leads to the propensity for explosive, explosive reactions to come to the fore. With hyposthenic asthenia, there are all signs of weakness of not only the inhibitory, but also the excitatory process: extreme fatigue during mental and physical stress, low performance and productivity, and memory impairment.
Obsessive-phobic syndrome is manifested by psychopathological products in the form of various obsessions and phobias. During this period, anxiety, suspiciousness, indecision intensify, signs of asthenia are found.
Hypochondriacal syndrome in its content can be: 1) asthenic, 2) depressive, 3) phobic, 4) senestopathic, 5) delusional.
In neurotic states, we are talking about simple, non-delusional hypochondria, expressed by exaggerated attention to one's health and doubts about his well-being. Patients are fixed on unpleasant sensations in their body, the source of which may be the neurotic state itself and the somatovegetative shifts caused by it, depression with its sympathicotonia, and other causes. Patients often turn to various specialists for help, they are examined a lot. Favorable research results calm the patients for a while, and then the anxiety grows again, thoughts about the possible serious illness are returning. The occurrence of hypochondriacal symptoms may be associated with iatrogenesis.
Hysterical syndrome is a combination of symptoms of any diseases, if by their origin these symptoms are the result of increased suggestibility and self-suggestion, as well as such personality traits as egocentrism, demonstrativeness, mental immaturity, increased imagination and emotional lability. The condition is characteristic of hysterical neurosis, hysterical personality development, hysterical psychopathy.
psychopathic syndrome. This is a persistent syndrome of socially maladaptive patient disharmony in the emotional and volitional spheres, which is an expression of character pathology. Disorders do not concern cognitive process. The psychopathic syndrome is formed in certain conditions of the social environment on the basis of congenital (psychopathy) and acquired (post-procedural state) changes in higher nervous activity. Pathology refers to the borderline in psychiatry.
Variants of the psychopathic syndrome correspond to clinical forms psychopathy and are manifested by excitable traits or reactions of increased inhibition. In the first case, emotional incontinence, anger, conflict, impatience, quarrelsomeness, strong-willed instability, a tendency to abuse alcohol and drug use are characteristic.
A feature of another option is weakness, exhaustion of personality reactions, its lack of activity, low self-esteem, and a tendency to doubt.
All that many syndromes in psychopathology are increasingly not found on their own. In most cases, the syndromes are combined into complex, difficult-to-diagnose complexes. When managing "difficult" patients, each doctor must take into account that a somatic disease can often be a manifestation of one or another psychopathological syndrome.
Syndrome- a stable set of symptoms united by a single pathogenetic mechanism.
"Recognition of any disease, including mental, begins with a symptom. However, a symptom is a multi-valued sign, and it is impossible to diagnose a disease on its basis. An individual symptom acquires diagnostic value only in the aggregate and in conjunction with other symptoms, that is, in a symptom complex - a syndrome" ( A.V. Snezhnevsky, 1983).
The diagnostic value of the syndrome is due to the fact that the symptoms included in it are in a natural internal connection. The syndrome is the status of the patient at the time of examination.
Modern syndrome classification are built on the principle of levels or "registers", first put forward by E. Kraepelin (1920). According to this principle, syndromes are grouped depending on the severity of pathological processes. Each level includes several syndromes that are different in their external manifestations, but the level of depth of the disorders underlying them is approximately the same.
According to the severity, 5 levels (registers) of syndromes are distinguished.
Neurotic and neurosis-like syndromes.
asthenic
obsessive
hysterical
affective syndromes.
depressive
manic
Apato-Abulic
Delusional and hallucinatory syndromes.
paranoid
paranoid
mental automatism syndrome (Kandinsky-Clerambault)
paraphrenic
hallucinosis
Syndromes of disturbed consciousness.
delirious
oneiroid
amental
twilight clouding of consciousness
amnestic syndromes.
psycho-organic
Korsakov's syndrome
dementia
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 autonomic 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 to loud sounds and bright lights. 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 violations are of cardio-vascular system: oscillation
level blood pressure, tachycardia and pulse lability, various
discomfort or just pain in the heart area.
Ease of redness or blanching skin, a feeling of heat at normal body temperature or, on the contrary, 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) 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 milder forms of 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.
Obsessional syndrome is a common disorder in borderline mental illness, adult personality disorder (obsessive-compulsive personality disorder), and 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 seen 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, a way out of a difficult situation, an escape from 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, drops 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 found, 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.
Syndromes of the neurotic register, or neurotic syndromes, are a group of psychopathological syndromes, in the structure of which there are no phenomena that are unusual for the psyche healthy person. The essence of the neurotic level of pathology lies in the painful fixation (due to a constantly acting stress factor) of certain mental phenomena that do not qualitatively go beyond the psychological.
Neurotic disorders, unlike psychotic ones, are functional, reversible, since they do not have physical damage to the parts of the nervous system as their basis. The experiences of a patient with a neurosis are meaningful and dynamically associated with objective circumstances, as a rule, are the result of a violation of significant personality relationships, the impossibility of constructively overcoming a traumatic situation. With neurosis, there is always a critical attitude towards the disease.
The painful nature of neurotic disorders is primarily determined by the high stability (fixation) of initially adequate negative experiences, the involvement of various body systems in the painful process with the formation of functional somatovegetative disorders, the patient's experience of alienation and burdensomeness of symptoms, often insufficient awareness of the causes and difficulties in overcoming suffering on their own, a clear tendentiousness in assessment by the patient of himself, those around him and the content of the psychotraumatic situation.
Neurotic states are accompanied by a feeling of tension, anxiety, discomfort, egocentric fixation on unpleasant physical sensations, and therefore, regardless of the dominant manifestations, hypochondria is always included in the structure of neurotic syndromes.
In case of neurotic disorders, the clinical picture is limited to symptoms of emotional disturbances, gross disorders of cognitive activity (hallucinations, delirium, intellectual decline) are never observed. At the same time, emotional disorders in neurotic states should be distinguished from endogenous affective disorders, which are characterized by the absence of psychologically understandable connections between the experiences of the patient and life situation, pathological involvement of the cognitive and motor spheres, lack of criticism of the disease state.
A significant part of neurotic disorders is the object of medical supervision due to the fact that in the structure of the neurotic syndrome the phenomena of somatovegetative disorders occupy a dominant position (the so-called somatoform disorders), however, often neurotic disorders are the reason for contacting a psychologist, and here it is especially important for him to realize the limits of his competence: neurosis is a disease, and therefore a patient with neurosis needs not only psychocorrection, which a psychologist can offer, but also treatment carried out only by a doctor.
Asthenic syndrome - a state of neuropsychic weakness - is the most common psychopathological syndrome observed in patients with both neuropsychiatric and somatic diseases. At the same time, this is the simplest syndrome, characterized mainly by quantitative disorders of mental activity. Manifestations of asthenic syndrome correspond to states of pronounced physical and mental fatigue, however, unlike them, the asthenic condition is not stopped even by a long rest. Depending on the individual psychological characteristics of the patient, asthenia can manifest itself in the form of:
- emotional-hyperesthetic weakness (irritable weakness);
- hyposthenic state.
At emotional-hyperesthetic weakness against the background of increased fatigue and neuropsychic exhaustion, short-term emotional reactions of discontent, irritability, anger for minor reasons, emotional lability, weakness of mind easily arise; patients are capricious, gloomy, dissatisfied. Inclinations are also labile: appetite, thirst, food preferences. Often there is a decrease in libido and potency. Characterized by intolerance to intense stimulation (loud sounds, bright lights, energetic touches, etc.), impatience, high irritability in waiting situations. In the process of increasing neuropsychic exhaustion, physical and mental performance decreases, increased distractibility, absent-mindedness develop, concentration and voluntary memorization become difficult, the speed and originality of solving logical and professional problems decrease, stubborn fatigue, lethargy, and a desire for rest appear.
An abundance of somatovegetative disorders is typical: headaches, sweating, "vascular spots" on the skin, sensations of the activity of the cardiovascular system, sleep disturbances. Sleep is predominantly superficial with an abundance of everyday dreams, frequent awakenings up to persistent insomnia. Often the dependence of somatovegetative manifestations on meteorological factors.
At hyposthenic variant predominantly physical weakness, lethargy, fatigue, fatigue, fatigue, pessimistic mood with a drop in efficiency, increased drowsiness and lack of satisfaction from sleep, a feeling of weakness, heaviness in the head in the morning come to the fore. According to the figurative expression of K. Obukhovsky, asthenic syndrome resembles a hangover that never ends.
Asthenic syndrome occurs in neuroses (in particular, it forms the core of neurasthenia - asthenic neurosis), somatic (infectious and non-infectious) diseases, intoxications, organic and endogenous mental illnesses. In fact, a drop in the energy potential accompanies any disease and is largely protective in nature, signaling the depletion of human adaptation resources and the need to restore psychophysiological balance.
In a group obsessive-compulsive disorder syndromes most often distinguished:
- obsessional syndrome;
- phobic syndrome.
The content of these syndromes, their axial sign - the phenomenon of obsession. Obsessions characterized by the forcible intrusion into the content of a person's experiences by thoughts, impulses, or affects that are not subject to conscious control and, although felt as one's own mental processes(not imposed from outside) are perceived as burdensome and burdensome.
- thoughts - violent thinking about something, obsessive ideas, images;
- affects - primarily fears that arise in certain circumstances or spontaneously when a person realizes their groundlessness;
- actions - simple movements and complex sequences of actions (rituals), the failure to perform which is accompanied by a painful feeling of incompleteness, anxiety, expectation of adverse events.
obsessive syndrome includes as the main symptoms: obsessive doubts, memories, ideas, images, thoughts (including contrasting content - blasphemous), reasoning, obsessive drives and motor rituals associated with them. Additional symptoms include emotional stress, a state of mental discomfort, impotence and helplessness in the fight against obsessions. Obsessional syndrome (without phobias) occurs in psychopathy, sluggish schizophrenia, and organic diseases of the brain.
phobic syndrome It is represented mainly by obsessive fears of various content. Obsessive fears tend to cluster around the most significant relationships of the individual. So, the fear of death is typical, which has a wide variety of manifestations and can be expressed, in particular, in a person's concern for his health. The structure of a sociophobic disorder is dominated by the fear of interacting with other people, for example, the fear of losing control or appearing in an unfavorable light in front of others, the fear of evaluation, condemnation, rejection, and rejection. Individual experience and the specificity of the system of human relations can determine the development of fear of the most diverse and, from the point of view of a healthy person, absolutely harmless objects and situations with the formation of so-called isolated phobias.
It should be noted that with phobias, it is fear that is experienced, and not thoughts about fear. This condition has a distinct somatovegetative accompaniment (palpitations, shortness of breath, sweating, urge to discharge physiological needs, dizziness, nausea, etc.). Sometimes fear is complicated by motor rituals, which leads to the formation of an obsessive-phobic syndrome. Phobic syndrome occurs in all forms of neuroses, schizophrenia, and organic diseases of the brain.
For the neurotic level, senestoiatic-iochondriacal
A typical syndrome is a combination of senestopathies with overvalued ideas or obsessions of a specific (health-related) content. At the initial stage of the development of the syndrome, various unpleasant sensations of an unclear nature (senesgopathies) arise, the reaction to which is fears, obsessive or overvalued ideas of the presence of a disease (usually life-threatening and hopeless). Against the background of painful sensations and physical discomfort, when the experience of examinations, treatment and communication with other patients is included, a system of ideas is formed that determines the content of the pathological "concept of the disease", which begins to occupy a central place in the experiences and behavior of the patient.
Depersonalization-derealization syndromes. The syndrome of depersonalization at the neurotic level includes violations of self-awareness, activity, unity and constancy of the "I", slight blurring of the boundaries of existence: the patient experiences his change, alienation from the outside world, insufficient "inclusion" in his own life, loss of his own "I", loss of vividness of emotions and feelings of one's own body. Such experiences arise mainly in subjectively significant, traumatic situations. At the same time, unlike psychotic states, there are never gross changes in the boundaries of self-consciousness, alienation of the “I” and stability of the “I” in time and space. Depersonalization occurs in neuroses, personality disorders, neurosis-like schizophrenia, affective disorders, organic diseases of the brain.
The derealization syndrome includes, as a leading symptom, a distorted perception of the world around. The environment appears in the mind of the patient as something “ghostly”, unclear, indistinct, colorless, frozen, lifeless, decorative, unreal. Usually accompanied by symptoms of emotional disturbances. At the same time, however, there is no violation of orientation or gross distortions in the reflection of reality.
Hysterical syndromes- a group of functional polymorphic and extremely variable syndromes of motor disorders, sensitivity, speech and somatovegetative disorders in the absence of objectively recorded organic disorders of the nervous system and internal organs.
anorectic syndrome(syndrome of "anorexia nervosa") is characterized by progressive and purposeful self-restriction in food, inadequately selective consumption of food by patients in combination with irrational arguments about the need to lose weight even when severe thinness is achieved. In anorexia nervosa, there is a conscious avoidance of "filling" food, the use of "cleansing" techniques (vomiting induction, excessive physical exercise), a distortion of body image with an obsessive fear of obesity. Most often the disorder occurs in girls adolescence and young women and can have severe somatic complications, including death. Occurs in neurotic conditions, schizophrenia.
Major psychopathological syndromes
A syndrome is a set of symptoms. A psychopathological syndrome is a complex, a more or less typical set of internally (pathogenetically) interconnected psychopathological symptoms, in the 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 are a clinical expression of various types of mental pathology, which include psychotic (psychosis) and non-psychotic (neuroses, borderline) types of mental illness, 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 behavior of the patient.
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 of discontent, irritability, anger for minor reasons (symptom of "matches"), emotional lability, weakness of mind easily and quickly arise; 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.
In the hyposthenic variant, predominantly physical asthenia, lethargy, fatigue, weakness, fatigue, 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 come to the fore.
Asthenic syndrome occurs in somatic (infectious and non-infectious) diseases, intoxications, organic and endogenous mental illnesses, 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: reduced or increased 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 encountered and, as a sign of endogeneity, include the somato-vegetative symptom complex of V.P. second half of the day), seasonality, periodicity and autochthonous.
Atypical affective syndromes are characterized by a predominance of optional symptoms (anxiety, fear, senestopathy, 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 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 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 down the associative process in the form of difficulty in choosing words, decreased mental activity, and memory impairment. Of the 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.
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 the various variants of MD (Desyatnikov V. F., Nosachev G. N., Kukoleva I. I., Pavlova I. I., 1976).
The following variants of MD have been identified: 1) algic-senestopathic (cardialgic, cephalgic, abdominal, arthralgic, panalgic); 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.
The agripnic variant of MD is represented by severe sleep disturbances: difficulty falling asleep, superficial sleep, early awakening, lack of a sense of rest from sleep, etc., while experiencing fatigue, decreased mood, and lethargy.
The vegetative-visceral variant of MD includes painful diverse manifestations of vegetative-visceral disorders: pulse lability, increased blood pressure, dipnea, tachypnea, hyperhidrosis, 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 of 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 reasons and without signs of alcoholism or drug addiction.
A variant of MD with disorders in the sexual sphere (periodic and seasonal impotence or frigidity) against the background of subdepression.
Diagnosis of MD presents significant difficulties, since complaints are 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 the clinical picture, in addition to somato-vegetative manifestations, senestopathies, paresthesias, and 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 for affective psychoses, 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 one's 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 pseudohallucinations, phenomena of mental automatism with delusions of influence (manic-hallucinatory-paranoid), fantastic delusions and delusions of grandeur - (manic-paraphrenic) up to oneiroid.
Manic syndromes are observed in cyclophrenia, schizophrenia, epilepsy, symptomatic, intoxication and organic psychoses.
6.1.2.3. Mixed affective syndromes. Agitated depression is characterized by an anxious affect combined with fussy anxiety and delusional ideas of condemnation and self-blame. Fussy anxiety can be replaced by motor 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 with endogenous psychosis, infectious, somatogenic, intoxication and organic mental illness.
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 the 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.
Meet at different forms 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 at organic lesions 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 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's syndrome, pseudodementia, puerilism (see section 5.1.6.3.1.1.).
Common to hysterical symptoms are egocentrism, a clear connection with a traumatic situation and the degree of its personal significance, demonstrativeness, external deliberateness, great suggestibility and autosuggestibility 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 greatest 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 the cardiovascular system: lability of the pulse, fluctuations in blood pressure, hyperemia or pallor of the 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 are also found 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. There is an exaggeration and perversion of affective-personal characteristics characteristic of adolescence, 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.
English psychopathological syndromes) - a set of individual symptoms of mental disorders and mental states. The manifestation of certain S. p. depends on the age of the person, the characteristics of his mental make-up, the stage of the disease, etc.
S.'s combination p. creates a clinical picture of various mental illnesses. However, each disease is characterized by a certain set and a typical sequence (change) of syndromes. Highlight the trace. S. p., most common in mental illness: apathetic, asthenic, hallucinatory-paranoid, depressive, hypochondriacal, catatonic, Korsakovsky (amnestic), manic, paraphrenic, paranoid, paralytic, pseudoparalytic.
Apathetic syndrome is characterized by lethargy, indifference to the environment, lack of desire for activity.
With asthenic syndrome, general weakness, increased exhaustion, irritability are observed; attention is disturbed, memory disorders may be observed (see Memory disorders).
Hallucinatory-paranoid syndrome is characterized by the presence of hallucinations and delusions (see Delirium). The behavior of patients is determined by their hallucinatory-delusional experiences. This syndrome occurs with alcoholic psychosis, schizophrenia and other diseases.
With a depressive syndrome, mental activity is inhibited, the affective sphere is disturbed. The extreme expression of inhibition is a depressive stupor ( complete absence movement and speech).
Hypochondriacal syndrome is characterized by increased unreasonable fear for the state of one's health. This syndrome is characteristic of neuroses, reactive states, presenile and senile psychoses.
The catatonic syndrome is characterized by the presence of a state of general arousal and subsequent stupor. The state of general arousal of the patient manifests itself in the form of sudden motor and speech restlessness, sometimes reaching frenzy. Patients are in constant motion, commit unmotivated, ridiculous acts, their speech becomes incoherent.
Stupor - a state of, against, arousal. Characterized by a decrease muscle tone("numbness"), in which a person maintains the same posture for a long time. Even the strongest stimuli do not affect the behavior of the patient. In some cases, there are phenomena of "wax flexibility", expressed in the fact that individual muscle groups or parts of the body for a long time retain the position that they are given (see Rigidity).
Korsakov's (amnestic) syndrome is characterized by a disorder in the memorization of current events with a relative preservation of memory for distant events. Memory gaps are filled with events that actually happened or could happen, but not at the time that is being told. Memory for past events and skills is retained. Korsakov's syndrome is observed with the so-called. Korsakov's (polyneuric, alcoholic) psychosis, brain tumors, and other organic lesions of c. n. With.
Manic syndrome - a combination of elevated (euphoric) mood with the acceleration of thinking (to the jump of ideas) and increased activity. Various combinations and combinations of these 3 disorders are possible, various degrees the severity of one of them, for example, the predominance of motor excitation or disturbances in thinking, etc. Disturbances in purposeful activity are characteristic.
Paraphrenic syndrome - one of the variants of the delusional syndrome - is characterized by the presence of systematized delusions of grandeur, influence and persecution. Experiences often take on a "cosmic scale". Patients consider themselves, for example, "transformers of the world", "rulers of the universe", etc.
Paranoid syndrome is a kind of delusional syndrome. Characterized by the presence of systematized delusions of invention, persecution, jealousy. Often combined with detailed rigid thinking. Hallucinations are usually absent.
The paralytic syndrome is characterized by total dementia, a persistent increase in mood (euphoria), a sharp violation of criticality and behavior, and a deep disintegration of the personality.
Pseudo-paralytic syndrome is characterized by euphoric mood, ridiculous delusions of grandeur in the absence of serological evidence of progressive paralysis. (E. T. Sokolova.)
