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;
Korsakova (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.
Syndrome is a typical set of pathogenetically related symptoms.
Syndromes, depending on the predominant damage to one or another sphere of mental activity, are divided into neurosis-like syndromes, syndromes of disordered consciousness, delusional syndromes, syndromes of affective and motor-volitional disorders, etc.
*WITH. amentive - (“incoherent” clouding of consciousness) syndrome of stupefaction, characterized by deep disorientation, incoherent thinking, affect of bewilderment, motor stereotypies (like yactation) and subsequent complete amnesia.
*WITH. amnestic (Korsakov's syndrome) is a disorder manifested by a variety of mnestic disorders (fixation, retrograde and anterograde amnesia, confabulation) against a background of euphoria.
*WITH. asthenic– neurotic syndrome, manifested by increased mental and physical exhaustion, various viscero-vegetative disorders and sleep disorders.
*WITH. hallucinosis– a pathological condition, the clinical picture of which is almost completely exhausted by the presence of true hallucinations.
-acute hallucinosis- a type of hallucinosis, characterized by an affect of confusion, anxiety, with sensually vivid hallucinatory experiences and motor agitation.
- chronic hallucinosis– a type of hallucinosis, characterized by monotony of affect and monotony of hallucinations.
*WITH. hallucinatory-paranoid- a disorder characterized by the predominance of pseudohallucinations against the background of delusional ideas (persecution, influence) and other mental automatisms.
*WITH. Ganzer– a variant of psychogenic twilight stupefaction, characterized by the phenomena of “passing responses” and “passing actions”.
*WITH. hebephrenic- characterized by mannered and foolish forms of behavior, motiveless actions and unproductive euphoria (O.V. Kerbikov’s triad).
*WITH. delirious- (“hallucinatory” stupefaction) is a form of stupefaction characterized by disorders of allopsychic orientation and an abundance of fragmentary true hallucinations (illusions).
*WITH. depressive– a variant of the affective syndrome, characterized by decreased mood, motor retardation and slower thinking (“depressive” triad).
*WITH. hypochondriacal – a disorder characterized by the patient's unreasonable concern about his or her health.
*WITH. hysterical– a neurotic syndrome characterized by the presence of conversion and (or) dissociative disorders against the background of specific personality characteristics.
*WITH. Capgras- a disorder characterized by impaired recognition and identification of people.
*WITH. catatonic– a disorder characterized by a combination of severe motor disorders (in the form of hypo-, hyper-, parakinesia) with a variety of psychopathological manifestations.
*-lucid catatonia– catatonic syndrome without oneiric stupefaction.
*-oneiric catatonia– catatonic syndrome combined with oneiric stupefaction.
*S. Kotara- paraphrenic hypochondriacal delirium.
*WITH. frontal– a disorder characterized by the predominance of affective disorders against the background of intellectual-mnestic decline, aspontaneity or disinhibition.
*WITH. manic– an affective syndrome characterized by elevated mood, motor disinhibition and accelerated thinking (“manic triad”).
*WITH. obsessive – a neurotic syndrome manifested by a variety of obsessions (often in combination with rituals) against the background of psychasthenic personality characteristics.
*WITH. oneiric (“dreamlike” stupefaction) - a form of clouding of consciousness, characterized by auto- and allopsychic disorientation, an influx of pseudo-hallucinations of fantastic content.
*WITH. paranoid– a disorder characterized by the predominance of primary delusions of persecution and (or) influence against the background of pseudohallucinations of fantastic content.
*WITH. paranoid – a disorder, the clinical picture of which is almost completely exhausted by primary (interpretive) delusion.
-spicy option - a type of paranoid syndrome in which delusions arise as an “insight” and are formed against the background of pronounced affective tension (anxiety).
- chronic variant– a type of paranoid syndrome, with progressive development of delirium.
*WITH. paraphrenic- a disorder manifested by absurd delusions (persecution, influence, grandeur), various phenomena of mental automatism, fantastic confabulations and euphoria.
*WITH. mental automatism (Kandinsky-Clerambault) – a disorder characterized by various mental automatisms in combination with delusional ideas (persecution, influence) and pseudohallucinations.
*WITH. psychoorganic – a disorder characterized by severe intellectual decline, incontinence of affect and mnestic disturbances (“Walter-Bühel triad”).
- apathetic option - a type of syndrome with a predominance of the phenomena of aspontaneity, narrowing of the range of interests, and indifference.
-asthenic variant- a type of syndrome with a predominance of mental and physical exhaustion.
- local (diffuse) option- varieties of the syndrome, differing in the severity of the disorders and the degree of preservation of the “core of personality.”
- acute (chronic) variant– varieties of the syndrome, differing in the severity of development and duration of the course.
- euphoric version - a type of syndrome with a predominance of the phenomena of complacency, disinhibition of drives and a sharp decrease in criticism.
- explosive option – a type of syndrome with a predominance of psychopathic-like disorders (extreme irritability, brutality).
*WITH. twilight (“concentric”) clouding of consciousness – a form of clouding of consciousness, characterized by paroxysmal occurrence, automaticity of actions, deep disorientation and complete subsequent amnesia.
*WITH. puerilism– a type of psychogenic (hysterical) twilight stupefaction with “childish” behavior, speech, and facial expressions.
*WITH. epileptiform - paroxysmal (convulsive and non-convulsive) disorders that develop with exogenous or endogenous organic damage to the brain.
Literature:
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- Vygotsky L.S. Dynamics and structure of a teenager’s personality. Pedology of a teenager. M., L.; 1931.
- Kaplan G., Sadok B. “Clinical psychiatry” - translation from English, M. Geotar Medicine, 1999. P. 223-231, 269-288.
- Lee S.P. “Forensic Psychiatry” UMK, Minsk, MIU Publishing House, 2006. P. 17-25.
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- Morozov G.V. "Forensic Psychiatry". "Legal Literature", Moscow, 1978, p. 143-150.
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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.
An individual symptom acquires diagnostic significance only in combination and in relationship with other symptoms, that is, in a symptom complex syndrome. The syndrome is a set of symptoms united by a single pathogenesis. The clinical picture of the disease and its development are formed from the syndromes and their sequential changes.
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PSYCHOPATHOLOGICAL SYNDROMES
Recognition of any disease, including mental illness, begins with a symptom (a sign that reflects certain disorders of one or another function). However, the symptom-sign has many meanings and it is impossible to diagnose the disease on its basis. An individual symptom acquires diagnostic significance only in its aggregate and in relation to other symptoms, that is, in a syndrome (symptom complex). A syndrome is a set of symptoms united by a single pathogenesis. The clinical picture of the disease and its development are formed from the syndromes and their sequential changes.
Neurotic (neurosis-like) syndromes
Neurotic syndromes are observed with neurasthenia, hysterical neurosis, obsessive-compulsive neurosis; neurosis-like - for diseases of an organic and endogenous nature and correspond to the mildest level of mental disorders. Common to all neurotic syndromes is the presence of criticism of one’s condition, the absence of pronounced phenomena of disadaptation to ordinary living conditions, and the concentration of pathology in the emotional-volitional sphere.
Asthenic syndrome- characterized by a noticeable decrease in mental activity, increased sensitivity to ordinary irritations (mental hyperesthesia), rapid fatigue, difficulty in mental processes, incontinence of affect with quickly onset fatigue (irritating weakness). A number of somatic functional disorders with autonomic disorders are observed.
Obsessive Obsessive Syndrome(anankast syndrome) - manifested by obsessive doubts, ideas, memories, various phobias, obsessive actions, rituals.
Hysterical syndrome- a combination of egocentrism, excessive self-suggestion with increased affectivity and instability of the emotional sphere. An active desire for recognition from others by demonstrating one's own advantage or the desire to arouse sympathy or self-pity. The experiences of patients and behavioral reactions are characterized by exaggeration, hyperbolization (of the merits or severity of their condition), increased fixation on painful sensations, demonstrativeness, mannerisms, and exaggeration. This symptomatology is accompanied by elementary functional somatoneurological reactions, which are easily recorded in psychogenic situations; functional disorders of the motor system (paresis, astasia-abasia), sensitivity, activity of internal organs, analyzers (deaf-mute, aphonia).
Affective disorder syndromes
Dysphoria - grouchy-irritable, angry and gloomy mood with increased sensitivity to any external stimulus, aggressiveness and explosiveness. Accompanied by unfounded accusations of others, scandalousness, and cruelty. There are no disturbances of consciousness. Equivalents of dysphoria can be binge drinking (dipsomania) or aimless wandering (dromomania).
Depression melancholia, depressive syndrome - a suicidal condition, which is characterized by depressed, depressed mood, deep sadness, despondency, melancholy, ideational and motor retardation, agitation (agitated depression). The structure of depression includes possible depressive delusional or overvalued ideas (of low value, worthlessness, self-blame, self-destruction), decreased desire, vital depression of self-feelings. Subdepression is a mild depressive affect.
Cotard's syndrome nihilistic-hypochondriacal delirium combined with ideas of enormity. It is most common in involutional melancholia, much less common in recurrent depression. There are two variants of the syndrome: hypochondriacal is characterized by a combination of anxious-melancholic affect with nihilistic-hypochondriacal delirium; Depressive is characterized by anxious melancholy with predominantly depressive delusions and ideas of denial of the outside world of a megalomaniac nature.
Masked (larvated) depression- characterized by a feeling of general vague diffuse somatic discomfort, vital senestopathic, algic, vegetodystonic, agrypnic disorders, concern, indecision, pessimism without clear depressive changes in affect. Often found in somatic practice.
Mania (manic syndrome) - a painfully elevated joyful mood with increased drives and tireless activity, accelerated thinking and speech, inadequate joy, cheerfulness and optimism. A manic state is characterized by distractibility of attention, verbosity, superficiality of judgment, incompleteness of thoughts, hypermnesia, overvalued ideas of overestimation of one’s own personality, and lack of fatigue. Hypomania is a mildly expressed manic state.
Affective syndromes (depression and mania) are the most common mental disorders and are noted in the onset of mental illnesses; they may remain the predominant disorders throughout the course of the disease.
When diagnosing depression, it is necessary to focus not only on the complaints of patients: sometimes complaints of decreased mood may be absent, and only targeted questioning reveals depression, loss of interest in life (“satiety with life” - taedium vitae), decreased overall vital activity, boredom, sadness, anxiety, etc. In addition to targeted questioning about actual mood changes, it is important to actively identify somatic complaints that can mask depressive symptoms, signs of sympathicotonia (dry mucous membranes, skin, tendency to constipation, tachycardia - the so-called “Protopopov’s sympathicotonic symptom complex”), characteristic of endogenous depression. A large number of diagnostically significant signs can be detected when studying the appearance and behavior of patients by observation: motor retardation or, conversely, fussiness, agitation, neglected appearance, characteristic physical phenomena - a frozen expression of melancholy, a depressive “omega” (fold between eyebrows in the shape of the Greek letter “omega”), Veragut fold (oblique fold on the upper eyelid). Physical and neurological examination reveals objective signs of sympathicotonia. Biological tests such as therapy with tricyclic antidepressants and the dexamethasone test allow paraclinical clarification of the nature of depression. Clinical and psychopathological studies using standardized scales (Zung and Spielberger scales) make it possible to quantify the severity of depression and anxiety.
Hallucinatory and delusional syndromes
Hallucinosis syndrome- influxes of verbal hallucinations such as different “voices” (conversations) against the background of relative preservation of consciousness.
Paranoid syndrome- primary systematized delirium (jealousy, reformism, “struggle for justice”, etc.), is distinguished by the plausibility of the plot, the system of evidence of the “correctness” of one’s statements, and the fundamental impossibility of their correction. The behavior of patients when implementing these ideas is characterized by sthenicity and persistence (delusional behavior). There are no perceptual disturbances.
Paranoid syndrome- characterized by secondary sensory delusions (persecution, relationships, influences), occurs acutely, against the background of emotional disorders (fear, anxiety) and disturbances of perception (illusions, hallucinations). Delirium is unsystematized, inconsistent, and may be accompanied by impulsive, unmotivated actions.
Kandinsky-Clerambault mental automatism syndromeconsists of pseudohallucinations, delusional ideas of influence and various mental automatisms, conviction of impartiality, involuntary occurrence, subjective coercion, violence of mental processes (thinking, speech, etc.)
Paraphrenic syndrome- a combination of senseless delusional ideas of greatness of fantastic content with phenomena of mental automatism, hallucinations, and euphoria.
To identify hallucinatory-delusional disorders, it is important not only to take into account spontaneous complaints of patients, but also to be able to conduct targeted questioning, which allows you to clarify the nature of painful experiences. Objective signs of hallucinations and delusional behavior, which were revealed during observation, significantly complement the clinical impression.
Syndromes of impaired consciousness
All syndromes of impaired consciousness have a number of common features, first described by K. Jaspers:
1. Alienation from the environment, unclear, fragmentary perception of it.
2. Disorientation in time, place, situation, and in the most difficult cases, in one’s own personality.
3. More or less pronounced incoherence of thinking with weakness or impossibility of judgment and speech disorders.
4. Complete or partial amnesia during the period of disorder of consciousness.
Coma - complete shutdown of consciousness with loss of conditioned and unconditioned reflexes, lack of chop activity.
Sopor confusion of consciousness with preservation of defensive and other unconditional reactions.
Stun - a relatively mild form of confusion. It is characterized by unclear orientation in the environment, a sharp increase in the threshold for all external stimuli, slowdown and difficulty in mental activity.
Nullification - slight clouding of consciousness while maintaining all types of orientation and the ability to carry out normal actions, while difficulties arise in understanding the complexity of the situation, the content of what is happening, the content of someone else’s speech.
Delirious syndrome- a form of confused consciousness, which is characterized by disorientation in place, time and situation, an influx of vivid true visual hallucinations, visual illusions and pareidolia, a feeling of fear, imaginative delusions and motor disturbances. Delirium is accompanied by autonomic disorders.
Amentive syndrome- a form of confused consciousness with a sharp depression of mental activity, complete disorientation, fragmented perception, inability to comprehend the situation, disordered motor activity, followed by complete amnesia of the experience.
Oneiric (dream-like) syndrome- a form of confused consciousness with an influx of involuntarily arising fantastic dream-like delusional ideas; accompanied by partial or complete alienation from the environment, a disorder of self-awareness, depressive or manic affect, signs of catatonia, retention in consciousness of the content of experiences with amnesia of the environment.
Twilight Syndrome- characterized by a sharp narrowing of the volume of consciousness and complete disorientation. The unproductive twilight state manifests itself in the implementation of a number of ordinary automated and externally ordered actions in an inappropriate situation for this in a state of wakefulness (ambulatory automatism) and during sleep (somnambulism). Productive twilight is characterized by an influx of true, extremely frightening hallucinations, an affect of fear and anger, destructive actions and aggression.
Syndromes caused by gross organic pathology of the brain
Convulsive syndrome- manifests itself in a variety of generalized and focal seizures (suddenly onset, rapidly passing states with impaired consciousness up to its loss and convulsive involuntary movements). More or less pronounced changes (decreases) in personality and intelligence are often woven into the structure of the convulsive syndrome.
Korsakovsky amnestic syndrome - characterized by a complete loss of the ability to remember current events, amnestic disorientation, memory distortions with relative preservation of memory for the past and a diffuse decrease in all components of mental functioning.
Psychoorganic syndrome- a more or less pronounced state of general mental helplessness with decreased memory, weakened understanding, incontinence of affect (Walter-Bühel triad).
Intellectual disability syndromes
Mental retardation- congenital total mental underdevelopment with a predominant lack of intelligence. Degrees: mild, moderate, severe, profound mental retardation.
Dementia syndrome- acquired persistent defect of intelligence, which is characterized by the inability to acquire new knowledge and skills and the loss of previously acquired ones. Lacunar (dysmnestic) dementia is a cellular intellectual defect with partial preservation of criticism, professional skills and the “core of personality.” Total dementia is a violation of all components of the intellect with a lack of criticism and the disintegration of the “core of personality” (moral and ethical properties).
Mental insanity- extreme degree of mental disintegration with extinction of all types of mental activity, loss of language, helplessness.
Syndromes with predominantly motor-volitional disorders
Apathetic-abulic syndrome- a combination of indifference (apathy) and a significant weakening of the motivation for activity (abulia).
Catatonic syndrome- manifests itself in the form of a catatonic stupor or in the form of stereotypical impulsive excitement. During stupor, patients freeze in a motionless state, muscle tone increases (rigidity, catalepsy), negativism appears, speech and emotional reactions are absent. During arousal, senseless, absurdly foolish behavior with impulsive actions, speech disturbances with the phenomena of fragmentation, grimacing, and stereotypy are noted.
Other syndromes
Depersonalization syndrome- a disorder of self-awareness with a feeling of alienation from some or all mental processes (thoughts, ideas, memories, relationships to the outside world), which is realized and painfully experienced by the patient himself.
Derealization syndrome- a disorder of mental activity, which is expressed in a painful feeling of unreality, the illusory nature of the surrounding world.
Irritable weakness syndrome- characterized by a combination of affective lability and irritability with decreased ability to work, weakened concentration and increased fatigue.
Hebephrenic syndrome- motor and speech disorders with senseless, mannered and foolish behavior, unmotivated gaiety, emotional devastation, impoverishment of motives, fragmented thinking with progressive disintegration of the personality.
Heboid syndrome- a combination of affective-volitional disorders with relative preservation of intellectual functions, which is manifested by rudeness, negativism, weakening of self-control, distorted nature of emotional reactions and drives and leads to pronounced social maladjustment and antisocial behavior.
Withdrawal syndrome- a condition that occurs as a result of a sudden cessation of taking (introducing) substances that caused substance abuse or after the introduction of their antagonists; characterized by mental, vegetative-somatic and neurological disorders; The clinical picture depends on the type of substance, dose and duration of its use.
Hypochondriacal syndrome- consists of an erroneous (overvalued or delusional) belief of the patient that he has a serious somatic illness, in an overestimation (dramatization) of the severity of his painful condition. The syndrome consists of senestopathies and emotional disorders in the form of depressive mood, fear, and anxiety. Hypochondriacal fixation is an excessive focus on the state of one’s health, one or another of its slightest deviations, complications that threaten one’s own health.
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Psychopathology- a branch of psychology that studies the causes of mental disorders and anomalies, carries out their diagnosis, psychotherapy and psychocorrection.
The main stages of the development of psychopathology.
First stage. Psychopathology arose as a result of the study of individual diseases and the generalization of the data from this study. It originated at the end of the 18th century in the doctrine of mental illness of the Italian psychiatrist Chiaruggi. For the first time, a definition of dementia was given, the division of hallucinations and, the doctrine of. The founder of the general doctrine of mental illness was the outstanding psychiatrist Griesinger.
Second phase in the development of general psychopathology is associated with the activities of the English psychiatrist Model, who applied Darwin’s evolutionary method to the study of mental illness. An important point of his research was the assertion that the clinical picture of psychosis depends not only on the characteristics of external harms, but that external harms cause psychosis through the internal conditions of brain activity.
Third stage the development of general psychopathology is associated with activity - experimentally proved the reflex nature of mental activity, showed that mental activity arises as a result of the relationship of a person, an individual, with the outside world. In the 19th century, the German psychiatrist Emingaus was the first to express the idea that general psychopathology is a general doctrine of mental illness and is part of the general pathology of a person. The further development of the general doctrine of psychosis is associated with Meinert, Wernicke, and also Jackson. They begin to understand mental activity differently: as a result of intracerebral relationships. The second half and end of the 19th century is characterized by a decrease in the general theoretical level in the consideration of mental illness; on the other hand, the end of the 19th century is characterized by the fact that enormous work was done by psychiatrists in all countries. The end of the 19th century included classic studies in the field of pseudohallucinations and apparitions and memory research. At the beginning of the 20th century, in the development of general psychopathology there was a shift towards psychology, and psychopathologists ceased to be interested in brain research.
Fourth stage in the development of general psychopathology is associated with teaching. In his research, he shows that the basis of mental activity is reflex activity, which is at the same time physiological and at the same time mental.
Differences between psychopathology and other disciplines.
If private psychiatry studies individual diseases, then general psychopathology studies the general patterns of mental disorder. Psychopathological typical conditions can occur in different diseases, therefore, they have a general meaning. General psychiatry is based on the generalization of all those changes that occur during individual mental illnesses.
