Karaganda State Medical University
Department of Psychology, Psychiatry and NarcologyLECTURE
Subject:
Discipline "Neurology, psychiatry, narcology"
Specialty 051301 – General medicine
Time (duration) 1 hour
Karaganda 2011
Approved at a methodological meeting of the department
05/07/2011 Protocol No. 10
Head of the departmentpsychology, psychiatry and narcology
Candidate of Medical Sciences, Associate Professor M.Yu.Lyubchenko
Subject : Main psychopathological syndromes
The goal is to familiarize students with the classification of mental illnesses
Lecture outline
2. Asthenic syndrome
3. Hallucinosis syndrome
4. Paranoid syndrome
5. Paranoid syndrome.
6. Mental automatism syndrome
7. Paraphrenic syndrome
8. Syndromes of impaired consciousness
9. Korsakoff syndrome
10.Psycho-organic syndrome
A syndrome is a stable combination of symptoms that are closely related to each other and united by a single pathogenetic mechanism and characterize the current condition of the patient.
Thus, peripheral sympathicotonia characteristic of depression leads to the appearance of tachycardia, constipation, and pupil dilation. However, the connection between symptoms can be not only biological, but also logical. Thus, the lack of the ability to remember current events with fixation amnesia naturally leads to disorientation in time and confusion in a new, unfamiliar environment.
Syndrome is the most important diagnostic category in psychiatry, while syndromic diagnosis is not considered as one of the stages in establishing a nosological diagnosis. When solving many practical issues in psychiatry, a correctly described syndrome means much more than a correctly stated nosological diagnosis. Since the causes of most mental disorders have not been determined, and the main drugs used in psychiatry do not have a nosologically specific effect, the prescription of therapy in most cases is focused on the leading syndrome. Thus, a pronounced depressive syndrome suggests the presence of suicidal thoughts, and therefore indicates to the doctor the need for urgent hospitalization, careful supervision and the use of antidepressants.
Some diseases are characterized by significant polymorphism of symptoms.
Although syndromes do not directly indicate a nosological diagnosis, they are divided into more and less specific. Thus, apathetic-abulic states and the syndrome of mental automatism are quite specific for paranoid schizophrenia. Depressive syndrome is extremely nonspecific and occurs in a wide range of endogenous, psychogenic, somatogenic and exogenous-organic diseases.
There are simple (small) and complex (large) syndromes. An example of the first is asthenic syndrome, manifested by a combination of irritability and fatigue. Typically, simple syndromes do not have nosological specificity and occur in various diseases. Over time, the syndrome may become more complicated, i.e. the addition of more severe symptoms in the form of delusions, hallucinations, pronounced personality changes, i.e. formation of a complex syndrome.
^ ASTHENIC SYNDROME.
This condition is manifested by increased fatigue, weakening or loss of the ability for prolonged physical and mental stress. Patients experience irritable weakness, expressed by increased excitability and quickly followed by exhaustion, affective lability with a predominance of low mood. Asthenic syndrome is characterized by hyperesthesia.
Asthenic states are characterized by the phenomena of asthenic or figurative mentism, manifested by a stream of vivid figurative ideas. There may also be influxes of extraneous thoughts and memories that involuntarily appear in the patient’s mind.
Headaches, sleep disturbances, and vegetative manifestations are often observed.
The patient's condition may change depending on the level of barometric pressure (meteopathic Pirogov syndrome).
Asthenic syndrome is the most nonspecific of all psychopathological syndromes. It can be observed with cyclothymia, symptomatic psychoses, organic brain lesions, neuroses, and intoxication psychoses.
The occurrence of asthenic syndrome is associated with depletion of the functional capabilities of the nervous system when it is overstrained, as well as due to autointoxication or exogenous toxicosis, impaired blood supply to the brain and metabolic processes in brain tissue. This allows us to consider the syndrome in some cases as an adaptive reaction, manifested by a decrease in the intensity of activity of various body systems with the subsequent possibility of restoring their function.
^ HALLUCINOSIS SYNDROMES.
Hallucinosis is manifested by numerous hallucinations (usually simple), which constitute the main and practically the only manifestation of psychosis. There are visual, verbal, tactile, olfactory hallucinosis. Hallucinosis can be acute (lasting several weeks) or chronic (lasting years).
The most typical causes of hallucinosis are exogenous hazards (intoxication, infection, trauma) or somatic diseases (cerebral atherosclerosis). Some intoxications are distinguished by special variants of hallucinosis. Thus, alcoholic hallucinosis is more often manifested by verbal hallucinations of a condemning nature. Tetraethyl lead poisoning causes a sensation of hair in the mouth. Cocaine intoxication results in tactile hallucinosis with the sensation of insects crawling under the skin.
In schizophrenia, this syndrome occurs in the form of pseudohallucinosis.
^ PARANOIAL SYNDROME.
Paranoid syndrome manifests itself as a primary, interpretive monothematic, systematized delusion. The predominant content of delusional ideas is reformism, relationships, jealousy, and the special importance of one’s own personality. There are no hallucinatory disorders. Delusional ideas are formed as a result of a paralogical interpretation of the facts of reality. The manifestation of delusions may be preceded by the long existence of overvalued ideas. Paranoid syndrome tends to be chronic and difficult to treat with psychotropic drugs.
The syndrome occurs in schizophrenia, involutional psychoses, and decompensation of paranoid psychopathy.
^ PARANOID SYNDROME
Paranoid syndrome is characterized by systematized ideas of persecution. Delusions are accompanied by hallucinations, most often auditory pseudohallucinations. The occurrence of hallucinations determines the emergence of new plots of delirium - ideas of influence, poisoning. A sign of an allegedly existing influence, from the point of view of patients, is a feeling of mastery (mental automatism). Thus, in its main manifestations, paranoid syndrome coincides with the concept of mental automatism syndrome. The latter does not include only variants of the paranoid syndrome, accompanied by true taste or olfactory hallucinations and delusions of poisoning. With paranoid syndrome, there is a certain tendency towards the collapse of the delusional system, delirium acquires features of pretentiousness and absurdity. These features become especially pronounced during the transition to paraphrenic syndrome.
SYNDROME OF MENTAL AUTOMATISM (Kandinsky-Clerambault syndrome).
This syndrome consists of delusions of persecution and influence, pseudohallucinations and phenomena of mental automatism. The patient can feel the influence carried out in various ways - from witchcraft and hypnosis, to the action of cosmic rays and computers.
There are 3 types of mental automatism: ideational, sensory, motor.
Ideatorial automatisms are the result of an imaginary influence on thinking processes and other forms of mental activity. Manifestations of this type of automatism are mentism, “sounding” of thoughts, “taking away” or “putting in” thoughts, “madeness” of dreams, a symptom of unwinding memories, “madeness” of mood and feelings.
Sensory automatisms usually include extremely unpleasant sensations that occur in patients also as a result of the influence of an external force.
Motor automatisms include disorders in which patients have the belief that the movements they make are carried out against their will under external influence, as well as speech motor automatisms.
An inverted version of the syndrome is possible, the essence of which is that the patient himself allegedly has the ability to influence others, recognize their thoughts, influence their mood, feelings and actions.
^ PARAPHRENIC SYNDROME.
This condition is a combination of fantastic delusions of grandeur, delusions of persecution and influence, phenomena of mental automatism and affective disorders. Patients call themselves rulers of the Earth, the Universe, heads of state, etc. When presenting the content of delirium, they use figurative and grandiose comparisons. As a rule, patients do not seek to prove the correctness of statements, citing the indisputability of their beliefs.
The phenomena of mental automatism also have a fantastic content, which is expressed in mental communication with outstanding representatives of humanity or with creatures inhabiting other planets. Positive or negative twin syndrome is often observed.
Pseudohallucinations and confabulatory disorders can occupy a significant place in the syndrome. In most cases, the mood of patients is elevated.
^ SYNDROMES OF DISTURBED CONSCIOUSNESS.
Criteria for impaired consciousness have been developed (Karl Jaspers):
Detachment from surrounding reality. The outside world is not perceived or is perceived fragmentarily.
Disorientation in surroundings
Thinking disorder
Amnesia of the period of impaired consciousness, complete or partial
switched off syndromes
clouded consciousness syndromes
Syndromes of clouded consciousness: delirium, amentia, oneiroid, twilight disorder of consciousness.
Delirium may be alcoholic, intoxication, traumatic, vascular, infectious. This is an acute psychosis with impaired consciousness, which is most often based on signs of cerebral edema. The patient is disoriented in time and place, experiencing frightening visual hallucinations. Often these are zoohallucinations: insects, lizards, snakes, scary monsters. The patient's behavior is largely determined by psychopathological experiences. Delirium is accompanied by multiple somatovegetative disorders (increased blood pressure, tachycardia, hyperhidrosis, tremor of the body and limbs). In the evening and at night, all these manifestations intensify, and in the daytime they usually weaken somewhat.
Upon completion of psychosis, partial amnesia is observed.
The course of psychosis is characterized by a number of features. Symptoms increase in a certain sequence. It takes from several days to 2 days for psychosis to fully develop. Early signs of developing psychosis are anxiety, restlessness, hyperesthesia, insomnia, against the background of which hypnogogic hallucinations appear. As psychosis increases, illusory disorders appear, turning into complex hallucinatory disorders. This period is characterized by pronounced fear and psychomotor agitation. Delirium lasts from 3 to 5 days. The cessation of psychosis occurs after prolonged sleep. After recovery from psychosis, residual delusions may persist. Abortive delirium lasts several hours. However, severe forms of delirium are not uncommon, leading to a gross organic defect (Korsakoff syndrome, dementia).
Signs of an unfavorable prognosis are occupational and persistent delirium.
Oneiric(dreamlike) darkening of consciousness. Distinguished by the extreme fantastic nature of psychotic experiences.
Oneiroid is a kind of alloy of real, illusory and hallucinatory perception of the world. A person is transported to another time, to other planets, is present at great battles, the end of the world. The patient feels responsible for what is happening, feels like a participant in the events. However, the behavior of patients does not reflect the richness of experiences. The movement of patients is a manifestation of the catatonic syndrome - stereotypical swaying, mutism, negativism, waxy flexibility, impulsiveness. Patients are disoriented in place, time and self. A symptom of double false orientation is possible, when patients consider themselves patients in a psychiatric hospital and at the same time participants in fantastic events. Feelings of rapid movement, movement in time and space are often observed.
Oneiroid is most often a manifestation of an acute attack of schizophrenia. The formation of psychosis occurs relatively quickly, but can last for several weeks. Psychosis begins with sleep disturbances and the appearance of anxiety; concern quickly reaches the level of confusion. Acute sensory delirium and derealization phenomena appear. Then fear gives way to an affect of bewilderment or ecstasy. Later, catatonic stupor or agitation often develops. The duration of psychosis is up to several weeks. The exit from the oneiric state is gradual. First, hallucinations are leveled out, then catatonic phenomena. Ridiculous statements and actions sometimes persist for quite a long time.
Oneiric experiences that develop against the background of exogenous and somatogenic factors are classified as manifestations fantastic delirium. Among exogenous psychoses, the most consistent with the picture of a typical oneiroid are the phenomena observed with the use of hallucinogens (LSD, hashish, ketamine) and hormonal drugs (corticosteroids).
Amentia – severe clouding of consciousness with incoherent thinking, complete inaccessibility to contact, fragmentary deceptions of perception and signs of severe physical exhaustion. A patient in an amental state usually lies down, despite chaotic agitation. His movements sometimes resemble some actions indicating the presence of hallucinations, but are often completely meaningless and stereotypical. Words are not connected into phrases and are fragments of speech (incoherent thinking). The patient reacts to the doctor’s words, but cannot answer questions and does not follow instructions.
Amentia occurs most often as a manifestation of long-term debilitating somatic diseases. If it is possible to save the lives of patients, the outcome is a pronounced organic defect (dementia, Korsakoff syndrome, affected asthenic conditions). Many psychiatrists consider amentia as one of the options for severe delirium.
^ Twilight darkness of consciousness is a typical epileptiform paroxysm. Psychosis is characterized by a sudden onset, a relatively short duration (from tens of minutes to several hours), an abrupt cessation and complete amnesia of the entire period of upset consciousness.
The perception of the environment at the moment of clouding of consciousness is fragmentary; patients snatch random facts from surrounding stimuli and react to them in an unexpected way. Affect is often characterized by malice and aggressiveness. Antisocial behavior is possible. Symptoms lose all connection with the patient’s personality. Possible productive symptoms in the form of delusions and hallucinations. Once psychosis ends, there are no memories of psychotic experiences. Psychosis usually ends in deep sleep.
There are variants of twilight stupefaction with vivid productive symptoms (delusions and hallucinations) and with automated actions (outpatient automatisms).
^ Outpatient automatisms manifest themselves in short periods of confusion without sudden excitement with the ability to perform simple automated actions. Patients can take off their clothes, get dressed, go outside, and give brief, not always appropriate answers to the questions of others. Upon recovery from psychosis, complete amnesia is noted. Varieties of ambulatory automatisms include fugues, trances, and somnambulism.
Twilight stupefactions are a typical symptom of epilepsy and other organic diseases (tumors, cerebral atherosclerosis, head injuries).
It should be distinguished from epileptic hysterical twilight states that arise immediately after the action of mental trauma. At the time of psychosis, the behavior of patients may be characterized by foolishness, infantilism, and helplessness. Amnesia can cover large periods preceding psychosis or following its cessation. However, fragmentary memories of what happened may remain. Resolving a traumatic situation usually leads to restoration of health.
^ KORSAKOV SYNDROME
This is a condition in which memory disorders for events of the present (fixation amnesia) predominate, while it is preserved for events of the past. All information coming to the patient instantly disappears from his memory; patients are not able to remember what they just saw or heard. Since the syndrome can occur after an acute cerebral accident, along with anterograde amnesia, retrograde amnesia is also noted.
One of the characteristic symptoms is amnestic disorientation. Memory gaps are filled with paramnesias. Confabulatory confusion may develop.
The occurrence of Korsakoff syndrome as a result of acute brain damage in most cases allows us to hope for some positive dynamics. Although complete memory restoration is impossible in most cases, during the first months after treatment the patient can record individual repeated facts, the names of doctors and patients, and navigate the department.
^ PSYCHOORGANIC SYNDROME
A state of general mental helplessness with decreased memory, intelligence, weakened will and affective stability, decreased ability to work and other adaptation capabilities. In mild cases, psychopathic states of organic origin, mild asthenic disorders, affective lability, and weakening of initiative are revealed. Psychoorganic syndrome can be a residual condition that occurs during progressive diseases of organic origin. In these cases, psychopathological symptoms are combined with signs of organic brain damage.
There are asthenic, explosive, euphoric and apathetic variants of the syndrome.
At asthenic variant The clinical picture of the syndrome is dominated by persistent asthenic disorders in the form of increased physical and mental exhaustion, symptoms of irritable weakness, hyperesthesia, affective lability, and disorders of intellectual functions are slightly expressed. There is a slight decrease in intellectual productivity and mild dysmnestic disorders.
For explosive version Characterized by a combination of affective excitability, irritability, aggressiveness with mildly expressed dysmnestic disorders and decreased adaptation. Characterized by a tendency towards overvalued paranoid formations and querulant tendencies. Quite frequent alcohol abuse is possible, leading to the formation of alcohol dependence.
As with the asthenic and explosive variants of the syndrome, decompensation of the condition is expressed in connection with intercurrent diseases, intoxications and mental trauma.
Painting euphoric version The syndrome is determined by an increase in mood with a tinge of euphoria, complacency, confusion, a sharp decrease in criticism of one’s condition, dysmnestic disorders, and increased drives. Anger and aggressiveness are possible, followed by helplessness and tearfulness. Signs of a particularly serious condition are the development in patients of symptoms of forced laughter and forced crying, in which the reason that caused the reaction is amnesic, and the grimace of laughter or crying persists for a long time in the form of a facial reaction devoid of affect content.
^ Apathetic option The syndrome is characterized by aspontaneity, a sharp narrowing of the range of interests, indifference to the environment, including one’s own fate and the fate of one’s loved ones, and significant dysmnestic disorders. Noteworthy is the similarity of this condition with the apathetic pictures observed in schizophrenia, however, the presence of mnestic disorders, asthenia, spontaneously occurring syndromes of forced laughter or crying helps to distinguish these pictures from similar conditions in other nosological units.
The listed variants of the syndrome are often stages of its development, and each of the variants reflects a different depth and different extent of damage to mental activity.
Illustrative material (slides – 4 pcs.)
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Literature
Mental illnesses with a course in narcology / edited by prof. V.D. Mendelevich. M.: Academy 2004.-240 p.
Medelevich D.M. Verbal hallucinosis. - Kazan, 1980. - 246 p.
Guide to Psychiatry / Ed. A. V. Snezhnevsky. T. 1-2- M.: Medicine, 1983.
Jaspers K. General psychopathology: Trans. with him. - M.: Practice,
1997. - 1056 p.
Zharikov N.M., Tyulpin Yu.G. Psychiatry. M.: Medicine, 2000 – 540 p.
Psychiatry. A textbook for students of medical universities, edited by V.P. Samokhvalova – Rostov on Don: Phoenix 2002
Rybalsky M.I. Illusions and hallucinations. - Baku, 1983., 304 p.
Popov Yu. V., Vid V. D. Clinical psychiatry. - St. Petersburg, 1996.
Security questions (feedback)
name the main features of paraphrenic syndrome
What is included in the concept of psychoorganic syndrome
What are the main reasons for the development of Korsakoff's syndrome?
I. HALLUCINATORY AND DELUSIONAL SYNDROMES Hallucinosis is a condition characterized by an abundance of hallucinations within one analyzer and not accompanied by clouding of consciousness. The patient is anxious, restless, or, conversely, inhibited. The severity of the condition is reflected in the patient's behavior and attitude towards hallucinations.
Verbal auditory hallucinosis: voices are heard talking to each other, arguing, condemning the patient, agreeing to destroy him. Auditory hallucinosis defines the clinical picture of alcoholic psychosis of the same name; the syndrome can be isolated in other intoxication psychoses, in neurosyphilis, in patients with vascular lesions of the brain.
It is observed in psychoses of late age, with organic damage to the central nervous system. Patients with tactile hallucinosis feel insects, worms, microbes crawling on and under the skin, touching the genitals; criticism of the experience is usually absent.
Visual hallucinosis is a common form of hallucinosis in the elderly and people who have suddenly lost their vision; it also occurs with somatogenic, vascular, intoxication and infectious psychoses. With hallucinations of Charles Bonnet BLIND (blind during life or from birth), patients suddenly begin to see on the wall, in the room, bright landscapes, sunlit lawns, flower beds, playing children, or simply abstract, bright “images”.
Usually, with hallucinosis, the patient’s orientation in place, time and self is not disturbed, there is no amnesia of painful experiences, i.e., there are no signs of clouding of consciousness. However, in acute hallucinosis with life-threatening content, the level of anxiety sharply increases, and in these cases consciousness can be affectively narrowed.
Paranoid syndrome is a syndrome of delusion, characterized by delirious interpretation of the facts of the surrounding reality, the presence of a system of evidence used to “justify” errors of judgment. The formation of delusions is facilitated by personality traits, manifested by significant strength and rigidity of affective reactions, and in thinking and actions - thoroughness and a tendency to detail. In terms of content, this is litigious delirium, invention, jealousy, persecution.
Paranoid syndrome may be the initial stage in the development of schizophrenic delusions. At this stage there are still no hallucinations and pseudo-hallucinations, no phenomena of mental automatism. Paranoid syndrome exhausts the psychopathological symptoms of paranoid psychopathy, alcoholic paranoid
Hallucinatory-paranoid syndromes, in which hallucinatory and delusional disorders, organically related, are presented in different proportions. When there is a significant predominance of hallucinations, the syndrome is called hallucinatory; when delusional ideas predominate, it is called paranoid.
Paranoid syndrome also refers to the paranoid stage of delusion development. At this stage, the previous system of erroneous conclusions corresponding to paranoid delusions may persist, but signs of its disintegration are revealed: absurdities in behavior and statements, the dependence of delusions on the leading affect and on the content of hallucinations (pseudo-hallucinations), which also appear at the paranoid stage.
Kandinsky-Clerambault mental automatism syndrome is a special case of hallucinatory-paranoid syndrome and includes pseudohallucinations, phenomena of alienation of mental acts - automatisms and delusions of influence. Being in the grip of perceptual disturbances, the patient is confident in their violent origin, in their creation - this is the essence of automatism.
Automatism can be ideational, sensory or motor. The patient believes that they are controlling his thoughts, “making” them parallel, forcing him to mentally utter curses, putting other people’s thoughts into his head, taking them away, reading them. In this case we are talking about ideptor automatism. This type of automatism includes pseudohallucinations.
Sensory automatism concerns more violations of sensory cognition and corresponds to the statements of patients about “doneness”: Feelings - “cause” indifference, lethargy, a feeling of anger, anxiety Sensations - “cause” pain in different parts of the body, a sensation of electric current passing, burning, itching. With the development of motor automatism, the patient becomes convinced that he is losing the ability to control his movements and actions: at the will of someone else, a smile appears on his face, his limbs move, and complex actions are performed, such as suicidal acts.
There are chronic and acute hallucinatory-paranoid syndromes. Chronic hallucinatory-paranoid syndrome gradually becomes more complex, the initial symptoms acquire new ones, and a full-blown syndrome of mental automatism is formed.
Acute hallucinatory-paranoid syndromes can be reduced under the influence of treatment and can quickly transform into other psychopathological syndromes. The structure of acute hallucinatory-paranoid syndrome contains acute sensory delirium, delusional perception of the environment, confusion or significant intensity of affect;
Acute hallucinatory-paranoid syndrome is often a stage in the development of acute paraphrenia and oneiric state. Hallucinatory-paranoid syndromes can be diagnosed in all known psychoses, except manic-depressive.
II. SYNDROMES OF INTELLECTUAL DISORDERS Intelligence is not a separate, independent mental sphere. It is considered as the ability for mental, cognitive and creative activity, for acquiring knowledge, experience and applying them in practice. With intellectual impairments, the ability to analyze material, combine, guess, carry out thought processes of synthesis, abstraction, create concepts and inferences, and draw conclusions is insufficient. education of skills, acquisition of knowledge, improvement of previous experience and the possibility of its application in activities.
Dementia (dementia) is a persistent, difficult-to-recover loss of intellectual abilities caused by a pathological process, in which there are always signs of a general impoverishment of mental activity. There is a decrease in intelligence from the level acquired by a person during life, its reverse development, impoverishment, accompanied by a weakening of cognitive abilities, impoverishment of feelings and changes in behavior.
With acquired dementia, sometimes memory and attention are primarily impaired, and the ability to judge is often reduced; the core of personality, criticism and behavior remain intact for a long time. This type of dementia is called partial or lacunar (partial, focal dysmnestic). In other cases, dementia is immediately manifested by a decrease in the level of judgment, violations of criticism, behavior, and leveling of the patient’s characterological characteristics. This type of dementia is called complete or total dementia (diffuse, global).
Organic dementia can be lacunar and total. Lacunar dementia is observed in patients with cerebral atherosclerosis, cerebral syphilis (vascular form), Total dementia - in progressive paralysis, senile psychoses, in Pick and Alzheimer's diseases.
Epileptic (concentric) dementia is characterized by extreme sharpening of characterological features, rigidity, stiffness of all mental processes, slowness of thinking, its thoroughness, difficulty switching attention, impoverished vocabulary, and a tendency to use the same cliched expressions. In character this is manifested by rancor, vindictiveness, petty punctuality, pedantry and, along with this, hypocrisy and explosiveness.
With the steady progression of the pathological process, the increase in rigidity and thoroughness, a person turns out to be less and less capable of diverse social functioning, gets bogged down in trifles, and the range of his interests and activities becomes increasingly narrowed (hence the name of dementia - “concentric”).
Schizophrenic dementia is characterized by a decrease in energy potential, emotional impoverishment, reaching the level of emotional dullness. An uneven disturbance of intellectual processes is revealed: in the absence of noticeable memory disorders and a sufficient level of formal knowledge, the patient turns out to be completely socially maladapted, helpless in practical matters. There is autism, a violation of the unity of the mental process (signs of mental splitting) in combination with inactivity and unproductivity.
III. AFFECTIVE SYNDROMES Manic syndrome in its classic version includes a triad of psychopathological symptoms: 1) increased mood; 2) acceleration of the flow of ideas; 3) speech motor excitation. These are obligate (basic and constantly present) signs of the syndrome. Increased affect affects all aspects of mental activity, which is manifested by secondary, unstable (optional) signs of manic syndrome.
There is an unusual brightness of perception of the environment, in the memory processes there are phenomena of hypermnesia In thinking - a tendency to overestimate one’s capabilities and one’s own personality, short-term delusional ideas of greatness In emotional reactions - anger In the volitional sphere - increased desires, drives, rapid switching of attention Mimicry, pantomime and all the patient's appearance expresses joy.
Depressive syndrome is manifested by a triad of obligate symptoms: Decreased mood, Slowing down of ideas, Speech retardation. Optional signs of depressive syndrome: In perception - hypoesthesia, illusory, derealization and depersonalization phenomena In the mnestic process - a violation of the sense of familiarity In thinking - overvalued and delusional ideas of hypochondriacal content, self-accusation, self-abasement, self-incrimination In the emotional sphere - reactions of anxiety and fear; motor-volitional disorders include suppression of desires and drives, suicidal tendencies. Sorrowful facial expression and posture, quiet voice.
Anxiety-depressive syndrome (agitated depression syndrome), manic stupor and unproductive mania in their origin are so-called mixed conditions, transitional from depression to mania and vice versa.
The psychopathological triad traditional for classical depression and mania is violated here, the effective syndrome loses some of its properties and acquires signs of a polar opposite affective state. Thus, in the syndrome of agitated depression, instead of motor retardation, there is excitement, which is characteristic of a manic state.
Manic stupor syndrome is characterized by motor retardation with elevated mood; Patients with nonproductive mania experience increased mood, motor disinhibition, combined with a slower pace of thinking.
Depressive-paranoid syndrome is classified as atypical for the affective level. A special feature is the intrusion into the affective syndrome corresponding to manic-depressive psychosis, symptoms from other nosological forms of schizophrenia, exogenous and exogenous-organic psychoses.
Paraphrenic delirium of enormity, described by Cotard, can also be classified as atypical affective states: hypochondriacal experiences, which are based in depression on a feeling of one’s own change, take on a grotesque character with the patient’s confidence in the absence of internal organs, with denial of the outside world, life, death, with ideas of doom to eternal torment. Depression with hallucinations, delusions, and confusion is described as fantastic melancholia. Blackout of consciousness at the height of a manic state gives grounds to speak of confused mania.
Asthenodepressive syndrome. Some authors consider this concept of syndrome to be theoretically untenable, believing that we are talking about a combination of two simultaneously existing syndromes - asthenic and depressive. At the same time, attention is drawn to the clinical fact that asthenia and depression are mutually exclusive conditions: the higher the proportion of asthenic disorders, the less the severity of depression; with increasing asthenia, the suicidal risk decreases, motor and ideational retardation disappears.
In the practice of a doctor, asthenodepressive syndrome is diagnosed as one of the most common within the framework of borderline mental pathology. Manic and depressive syndromes can be a stage in the formation of psychopathological symptoms of any mental illness, but in their most typical manifestations they are presented only in manic-depressive psychosis.
IV. SYNDROMES OF MOTOR AND VOLITIONAL DISORDERS Catatonic syndrome is manifested by catatonic stupor or catatonic agitation. These outwardly different states are actually united in their origin and turn out to be only different phases of the same phenomenon.
In accordance with the research of I.P. Pavlov, the symptoms of catatonia are the result of a painful weakness of nerve cells, for which ordinary stimuli turn out to be super strong. The inhibition that develops in the cerebral cortex is protective and transcendental. If inhibition covers not only the entire cortex, but also the subcortical region, symptoms of catatonic stupor appear. The patient is inhibited, does not care for himself, does not respond to speech addressed to him, does not follow instructions, and mutism is noted.
Some patients lie motionless, turned to the wall, in a uterine position with the chin brought to the chest, with arms bent at the elbows, knees bent and legs pressed to the stomach for days, weeks, months or years.
The uterine position indicates the release of more ancient reactions characteristic of the early age period of development, which in an adult are inhibited by later, higher-order functional formations. Another very characteristic position is also lying on your back with your head raised above the pillow - a symptom of an air cushion.
Disinhibition of the sucking reflex leads to the appearance of the proboscis symptom; when you touch the lips, they fold into a tube and protrude; In some patients, this position of the lips occurs constantly. The grasping reflex (normally characteristic only of newborns) is also disinhibited: the patient grasps and tenaciously holds everything that accidentally touches his palm.
With incomplete stupor, echosymptoms are sometimes observed: echolalia - repetition of the words of someone around, echopraxia - copying the movements of other people. The basis of echosymptoms is the disinhibition of the imitative reflex, which is characteristic of children and contributes to their mental development. The release of stem postural reflexes is expressed by catalepsy (waxy flexibility): the patient maintains the position given to his body and limbs for a long time.
Phenomena of negativism are observed: the patient either does not fulfill what is required at all (passive negativism), or actively resists, acts opposite to what is required of him (active negativism). In response to a request to show his tongue, the patient compresses his lips tightly, turns away from the hand extended to him for a handshake and removes his hand behind his back; turns away from the plate of food placed in front of him, resists the attempt to feed him, but grabs the plate and attacks the food when trying to remove it from the table. I. P. Pavlov considered this an expression of phase states in the central nervous system and associated negativism with the ultraparadoxical phase
In the paradoxical phase, weaker stimuli can produce a stronger response. Thus, patients do not respond to questions asked in a normal, loud voice, but answer questions asked in a whisper. At night, when the flow of impulses into the central nervous system from the outside sharply decreases, some stuporous patients disinhibit, begin to move quietly, answer questions, eat, and wash; with the onset of morning and an increase in the intensity of irritation, the numbness returns. Patients with stupor may not have other symptoms, but more often there are hallucinations and delusional interpretation of the environment. This becomes clear when the patient disinhibits.
Depending on the nature of the leading symptoms, three types of stupor are distinguished: 1) with phenomena of waxy flexibility, 2) negativistic, 3) with muscle numbness. The listed options are not independent disorders, but represent stages of stuporous syndrome, replacing one another in the specified sequence with the worsening of the patient’s condition.
Catatonic excitation is senseless, undirected, sometimes taking on a motor character. The patient’s movements are monotonous and are essentially subcortical hyperkinesis; aggressiveness, impulsive actions, echopraxia, negativism are possible. Facial expressions often do not match poses; sometimes paramimic expression is observed: the facial expressions of the upper part of the face express joy, the eyes laugh, but the mouth is angry, the teeth are clenched, the lips are tightly compressed and vice versa. Facial asymmetries can be observed. In severe cases, there is no speech, the excitement is mute, or the patient growls, hums, shouts out individual words, syllables, or pronounces vowels.
Some patients exhibit an uncontrollable desire to speak. At the same time, the speech is pretentious, stilted, speech stereotypies, perseveration, echolalia, fragmentation, verbigeration are noted - meaningless stringing of one word onto another. Transitions from catatonic excitation to a stuporous state or from stupor to a state of excitation are possible.
Catatonia is divided into lucid and oneiric. Lucid catatonia occurs without clouding of consciousness and is expressed by stupor with negativism or numbness or impulsive excitement. Oneiric catatonia includes oneiric stupor, catatonic agitation with confusion, or stupor with waxy flexibility. Catatonic syndrome is more often diagnosed with schizophrenia, sometimes with epilepsy or exogenous-organic psychoses.
Hebephrenic syndrome is close to catatonic both in origin and in manifestations. Characterized by excitement with mannerisms, pretentiousness of movements and speech, foolishness. Fun, antics and jokes do not infect others. Patients tease, grimace, lisp, distort words and phrases, tumble, dance.
As part of sluggish schizophrenia, adolescents are sometimes diagnosed with heboidism - an incompletely developed hebephrenic state, manifested by a touch of foolishness, swagger in behavior, impaired drives and antisocial tendencies.
V. NEUROTIC SYNDROMES This pathology is distinguished by the partiality of mental disorders, a critical attitude towards them, the presence of consciousness of the disease, an adequate assessment of the environment and abundant somatovegetative symptoms accompanying the weakness of mental functions. Characterized by the absence of gross violations of cognition of the environment. In the structure of neurotic syndromes there are no disorders of objective consciousness, delusional ideas, hallucinations, dementia, manic state, stupor, or agitation.
With true neurotic disorders, the personality remains intact. Moreover, the effect of external harmfulness is mediated by the patient’s personality, its reactions, which characterize the personality itself, its social essence. All of these features make it possible to qualify this type of disorder as borderline mental pathology, a pathology located on the border between normality and pathology, between somatic and mental illnesses.
Neurasthenic (asthenic) syndrome is characterized by irritable weakness. Due to acquired or congenital insufficiency of internal inhibition, excitement is not limited in any way, which is manifested by irritability, impatience, increased exhaustion of attention, and sleep disturbances (superficial sleep, with frequent awakenings).
There are hyper- and hyposthenic variants of asthenia. With hypersthenic asthenia, the preservation of the excitatory process and the weakness of the inhibitory process leads to the advancement of a tendency to explosive, explosive reactions. With hyposthenic asthenia, there are all signs of weakness not only of the inhibitory, but also of the excitatory process: extreme fatigue during mental and physical stress, low performance and productivity, memory impairment.
Obsessive-phobic syndrome manifests itself as psychopathological products in the form of various obsessions and phobias. During this period, anxiety, suspiciousness, and indecision intensify, and signs of asthenia are revealed.
Hypochondriacal syndrome in its content can be: 1) asthenic, 2) depressive, 3) phobic, 4) senestopathic, 5) delusional.
In neurotic conditions we are talking about simple, non-delusional hypochondria, expressed by exaggerated attention to one’s health and doubts about its well-being. Patients are fixated on unpleasant sensations in their body, the source of which can be the neurotic state itself and the somatovegetative changes caused by it, depression with its sympathicotonia and other reasons. Patients often seek help from various specialists and are examined extensively. Favorable research results calm patients for a while, and then anxiety increases again, thoughts about a possible serious illness return. The occurrence of hypochondriacal symptoms may be associated with iatrogenicity.
Hysterical syndrome is a combination of symptoms of any disease, if in origin these symptoms are a consequence of increased suggestibility and self-hypnosis, as well as personality traits such as egocentrism, demonstrativeness, mental immaturity, increased imagination and emotional lability. The condition is characteristic of hysterical neurosis, hysterical personality development, hysterical psychopathy.
Psychopathic syndrome. This is a persistent syndrome of socially maladaptive disharmony in the emotional and volitional spheres of the patient, which is an expression of character pathology. Disorders do not concern the cognitive process. Psychopathic syndrome is formed in certain conditions of the social environment on the basis of congenital (psychopathy) and acquired (post-processual state) changes in higher nervous activity. Pathology is considered borderline in psychiatry.
Variants of the psychopathic syndrome correspond to clinical forms of psychopathy and are manifested by excitable traits or reactions of increased inhibition. The first case is characterized by emotional incontinence, anger, conflict, impatience, quarrelsomeness, instability of will, and a tendency to abuse alcohol and use drugs.
A feature of the other option is weakness, exhaustion of personality reactions, insufficient activity, low self-esteem, and a tendency to doubt.
All the many syndromes in psychopathology increasingly do not occur independently. In most cases, syndromes are combined into complex, difficult-to-diagnose complexes. When caring for “complex” patients, every doctor must take into account that a somatic illness can often be a manifestation of one or another psychopathological syndrome
Syndrome– a stable set of symptoms united by a single pathogenetic mechanism.
“Recognition of any disease, including mental illness, begins with a symptom. However, a symptom is a multi-valued sign, and on its basis it is impossible to diagnose a disease. An individual symptom acquires diagnostic significance only in its totality and in relationship with other symptoms, that is, in a symptom complex - a syndrome” ( A.V. Snezhnevsky, 1983).
The diagnostic significance of the syndrome is due to the fact that the symptoms included in it are in a natural internal connection. Syndrome is the status of the patient at the time of examination.
Modern syndrome classifications 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.
There are 5 levels (registers) of syndromes based on severity.
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 impaired consciousness.
delirious
oneiroid
amentive
twilight stupefaction
Amnestic syndromes.
Psychoorganic
Korsakov's syndrome
dementia
Neurotic and neurosis-like syndromes
Conditions manifested by functional (reversible) non-psychotic disorders. They can be of different nature. A patient suffering from neurosis (psychogenic disorder) experiences constant emotional stress. Its resources, protective forces, are depleted. The same thing happens in a patient suffering from almost any physical disease. Therefore, many of the symptoms observed with neurotic and neurosis-like syndromes similar. This is rapid fatigue with a feeling of psychological and physical discomfort, accompanied by anxiety, restlessness and internal tension. At the slightest reason 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 neurosis or hysteria are observed.
1. ASTHENIC SYNDROME (ASTHENIA) - a state of increased fatigue, irritability and unstable mood, combined with vegetative symptoms and sleep disturbances.
Increased fatigue with asthenia is always combined with a decrease in productivity at work, especially noticeable during intellectual stress. Patients complain of poor intelligence, forgetfulness, and unstable attention. They find it difficult to concentrate on one thing. They try by force of will to force themselves to think about a certain subject, but soon they notice that in their head, involuntarily, completely different thoughts appear that have nothing to do with what they are doing. The number of presentations is reduced. Their verbal expression becomes 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 inadequacy. Some take breaks from work, but a short rest does not improve their well-being. Others strive through 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 scatteredness in their studies. The work begins to seem overwhelming and insurmountable. There is a feeling of tension, anxiety, and conviction of one’s intellectual inadequacy
Along with increased fatigue and unproductive intellectual activity, mental balance is always lost during asthenia. The patient easily loses self-control, becomes irritable, hot-tempered, grumpy, picky, and quarrelsome. Mood fluctuates easily. Both unpleasant and joyful events often lead to the appearance of tears (irritable weakness).
Hyperesthesia is often observed, i.e. intolerance to loud sounds and bright light. Fatigue, mental imbalance, and irritability are combined with asthenia in various proportions.
Asthenia is almost always accompanied by autonomic disorders. Often they can occupy a predominant position in the clinical picture. The most common disorders of the cardiovascular system: fluctuations
blood pressure levels, tachycardia and pulse lability, various
unpleasant or simply painful sensations in the heart area.
Light redness or paleness of the skin, a feeling of heat at normal body temperature or, on the contrary, increased chilliness. Increased sweating is especially often observed - sometimes local (palms, feet, armpits), sometimes generalized.
Dyspeptic disorders are common - loss of appetite, pain along the intestines, spastic constipation. Men often experience a decrease in potency. In many patients, headaches of varying manifestations and localization can be identified. They often complain of a feeling of heaviness in the head, squeezing headaches.
Sleep disorders in the initial period of asthenia are manifested by difficulty falling asleep, shallow sleep with an abundance of disturbing dreams, awakenings in the middle of the night, difficulty falling asleep later, and early awakening. After sleep they do not feel rested. There may be a lack of feeling of sleep at night, although in fact patients sleep at night. With increasing asthenia, and especially during physical or mental stress, a feeling of drowsiness occurs during the daytime, without, however, simultaneously 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 second half of the day, especially in the evening. One of the reliable signs of asthenia is a condition in which relatively satisfactory health is observed in the morning, deterioration occurs at work and reaches a maximum in the evening. In this regard, before performing 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 hot temper, explosiveness, impatience, a feeling of internal tension, inability to restrain, i.e. symptoms of irritation - talk about asthenia with hypersthenia. This is the mildest form of asthenia.
In cases where the picture is dominated by fatigue and a feeling of powerlessness, asthenia is defined as hyposthenic, the most severe asthenia. An increase in the depth of asthenic disorders leads to a sequential change from milder hypersthenic asthenia to more severe stages. As the mental state improves, hyposthenic asthenia is replaced by milder forms of asthenia.
The clinical picture of asthenia is determined not only by the depth of the existing disorders, but also by such two important factors as the constitutional characteristics of the patient and the etiological factor. Very often both of these factors are closely intertwined. Thus, in individuals with epileptoid character traits, asthenia is characterized by pronounced excitability and irritability; Individuals with traits of anxious suspiciousness experience various anxious 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, which is why the term astheno-depressive syndrome is used.
2. OBSESSIVE SYNDROME (obsessive-compulsive syndrome) - a psychopathological condition with a predominance of obsessive phenomena (i.e., involuntarily arising in the mind of painful and unpleasant thoughts, ideas, memories, fears, desires, actions, to which a critical attitude remains and the desire to resist them) .
As a rule, it is observed in anxious and suspicious individuals during the period of asthenia and is perceived critically by patients.
Obsessive syndrome is often accompanied by subdepressive mood, asthenia and autonomic disorders. Obsessions in obsessive syndrome can be limited to one type, for example, obsessive counting, obsessive doubts, phenomena of mental chewing gum, 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 vary. They can develop gradually and exist continuously for a long time: obsessive counting, mental chewing phenomena, etc.; they can appear suddenly, last a short period of time, and in some cases occur in series, thereby resembling paroxysmal disorders.
Obsessive syndrome, in which obsessive phenomena occur in the form of distinct attacks, is often accompanied by pronounced vegetative symptoms: paleness or redness of the skin, cold sweat, tachy- or bradycardia, a feeling of lack of air, increased intestinal motility, polyuria, etc. Dizziness and lightheadedness may occur.
Obsessive syndrome is a common disorder in borderline mental illnesses, mature personality disorders (obsessive-compulsive personality disorder), and depression in anxious and suspicious individuals.
3. HYSTERICAL SYNDROME - a symptom complex of mental, autonomic, motor and sensory disorders, often occurs in immature, infantile, self-centered individuals after mental trauma. Often these are individuals of an artistic bent, prone to posing, deceit, and demonstrativeness.
Such persons always strive to be the center of attention and to be noticed by others. They don’t care what feelings they evoke in others, the main thing is that they don’t leave anyone around indifferent.
Mental disorders are manifested, first of all, by instability of the emotional sphere: stormy, but quickly replacing each other feelings of indignation, protest, joy, hostility, sympathy, etc. Facial expressions and movements are expressive, overly expressive, theatrical.
Characteristic is figurative, often pathetically passionate speech, in which the patient’s “I” is in the foreground and the desire at any cost to convince the interlocutor of the truth of what they believe in and what they want to prove.
Events are always presented in such a way that those listening should get the impression that the facts being reported are the truth. Most often, the information presented is exaggerated, often distorted, and in some cases represents a deliberate lie, in particular in the form of a slander. The untruth may be well understood by the patient, but they often believe in it as an immutable truth. The latter circumstance is associated with increased suggestibility and self-hypnosis of patients.
Hysterical symptoms can be of any kind 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 hysterical syndrome. Autonomic disorders are manifested by tachycardia, changes in blood pressure, shortness of breath, sensations of compression of the throat - the so-called. hysterical coma, vomiting, redness or blanching of the skin, etc.
A grand hysterical attack is very rare, and usually occurs with hysterical syndrome that occurs in individuals with organic lesions of the central nervous system. Usually, movement disorders in hysterical syndrome are limited to tremor of the limbs or the whole body, elements of astasia-abasia - wobbly legs, slow sagging, difficulty walking.
There is hysterical aphonia - complete, but more often partial; hysterical mutism and stuttering. Hysterical mutism can be combined with deafness - surdomutism.
Occasionally, hysterical blindness can be encountered, usually in the form of loss of individual visual fields. Disorders of skin sensitivity (hypoesthesia, anesthesia) reflect the “anatomical” ideas of patients about the zones of innervation. Therefore, disorders involve, for example, entire parts or an entire limb on one and the other half of the body. The most pronounced hysterical syndrome is with 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.
The disease never manifests itself as a separate symptom. When analyzing its clinical picture, symptoms are noticed that are interconnected and form a syndrome. Any disease process has a certain dynamics, and within the syndrome there are always symptoms that have already formed, as well as those that are in their infancy.
A syndrome is a set of interrelated symptoms that have a common pathogenesis.
The syndrome coexists both positive mental disorders (asthenic, affective, neurotic, delusional, hallucinatory, catatonic, convulsive) and negative (destruction, prolapse, defect). Positive symptoms are always variable, negative ones are invariant.
The syndrome is distinguished by symptoms of the first (leading), second (main) and third (minor) ranks. This distribution allows us to consider them in the dynamics of the disease. During the diagnostic process, the doctor discovers in a particular patient symptoms that are specific to a particular disease, for example, not just asthenia, but asthenia reflecting the characteristics of the disease (atherosclerotic, traumatic, paralytic, etc.), not dementia in general, but atherosclerotic, epileptic, paralytic, etc. .
Syndrome is a stage in the course of the disease. The nosological specificity of the syndromes is variable. The same syndrome can develop in different diseases. Yes. Such syndromes as asthenic and catatonic have no specificity at all. comatose. The specificity of dysmnestic syndromes and organic psychosyndrome is quite pronounced. Syndromes for diseases of the same etiology may differ from each other, and conversely, there are many identical syndromes that arise for different reasons.
Below is a brief description of the main syndromes that are most often observed in mental health clinics.
Classification of main psychopathological syndromes
I. neurotic:
Asthenic:
Obsessively:
Senestopathic-hypochondriacal:
Hysterical:
Depersonalization:
Derealization.
II. affective:
Manic:
Depressive;
Dysphoric
III. HALLUCINATORY-delirium:
Hallucinatory;
Paranoid;
Paraphrenic;
Paranoid;
Mental automatism of Kandinsky-Clerambault;
IV. PATHOLOGIES effector-volitional spheres:
Catatonic;
Hebephrenic.
V. PRODUCTIVE disorder of consciousness (stupefaction):
Delirious;
Oneiric;
Amentive;
Delirium acutum (choreatic)
Twilight state of consciousness: ambulatory automatism, trance, somnambulism, fugue.
VI. Non-productive disorders C information (NON-HYSICHOTIC):
Nullification;
Stun;
Somnolence;
VII. ORGANIC BRAIN DAMAGE:
Organic psychosyndrome;
Korsakov (amnestic)
Paralytic (Pseudoparalytic)
VIII. convulsive:
Grand mal seizure;
Adverse convulsive seizure;
Minor seizures:
Absence;
Propulsive attacks;
Salaama (attacks)
Lightning attacks;
Clonic propulsive attacks;
Retropulsive attacks;
Clonic retropulsive attacks;
Vestigial retropulsive attacks;
Pycnolepsy;
impulsive attacks;
Akinetic attack;
Convulsive syndromes
Jackson's attacks (Jacksonian)
Hysterical attack.
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.
The combination of S. p. creates a clinical picture of various mental illnesses. However, each disease is characterized by a certain set and typical sequence (change) of syndromes. The trace is highlighted. S. p., the most common in mental illnesses: apathetic, asthenic, hallucinatory-paranoid, depressive, hypochondriacal, catatonic, Korsakovsky (amnestic), manic, paraphrenic, paranoid, paralytic, pseudoparalytic.
Apathetic syndrome is characterized by lethargy, indifference to the environment, and lack of desire for activity.
With asthenic syndrome, general weakness, increased exhaustion, and irritability are observed; attention is impaired, memory disorders may occur (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 in alcoholic psychoses, schizophrenia and other diseases.
With depressive syndrome, mental activity is inhibited and the affective sphere is disrupted. The extreme expression of inhibition is depressive stupor (complete absence of movement and speech).
Hypochondriacal syndrome is characterized by increased unreasonable fear for one's health. This syndrome is characteristic of neuroses, reactive states, presenile and senile psychoses.
Catatonic syndrome is characterized by the presence of a state of general excitement and subsequent stupor. The patient's state of general excitement manifests itself in the form of sudden motor and speech restlessness, sometimes reaching the point of frenzy. Patients are in constant motion, commit unmotivated, absurd actions, their speech becomes incoherent.
Stupor is a state against, excitement. It is characterized by a decrease in muscle tone (“numbness”), in which a person maintains the same position for a long time. Even the strongest irritants do not affect the patient's behavior. In some cases, the phenomenon of “waxy flexibility” occurs, which is expressed in the fact that certain muscle groups or parts of the body retain the position they are given for a long time (see Rigidity).
Korsakovsky (amnestic) syndrome is characterized by a disorder in remembering current events with relative preservation of memory for distant events. Memory gaps are filled with events that actually happened or could have happened, but not at the time being described. Memory for past events and skills is retained. Korsakov's syndrome is observed with the so-called. Korsakoff (polyneuric, alcoholic) psychosis, brain tumors and other organic lesions c. n. With.
Manic syndrome is a combination of elevated (euphoric) mood with accelerated thinking (to the point of a rush of ideas) and increased activity. Various combinations and combinations of these 3 disorders are possible, different degrees of severity of 1 of them, for example, the predominance of motor excitation or thinking disorders, etc. Violations of purposeful activity are characteristic.
Paraphrenic syndrome - one of the variants of 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 type of delusional syndrome. Characterized by the presence of systematized delusions of invention, persecution, and jealousy. Often combined with detailed rigid thinking. Hallucinations are usually absent.
Paralytic syndrome is characterized by total dementia, a persistent increase in mood (euphoria), a sharp impairment of criticality and behavior, and a profound disintegration of personality.
Pseudoparalytic syndrome is characterized by a euphoric mood, absurd delusions of grandeur in the absence of serological evidence of progressive paralysis. (E. T. Sokolova.)
