Psychiatry. Guide for doctors Boris Dmitrievich Tsygankov

Chapter 14 PATHOLOGY OF EMOTIONS (AFFECTIVENESS)

PATHOLOGY OF EMOTIONS (EFFECTIVENESS)

Under emotion(from lat. emoneo - excite, shock) understand a person’s subjective reaction to the influence of various internal and external stimuli. Accompanying almost any manifestation of the body’s vital activity, emotions reflect in the form of direct experiences the significance of various phenomena and situations and serve as one of the main mechanisms of internal regulation of mental activity and behavior aimed at satisfying needs (motivations). Affect also denotes emotional excitement and reflects emotional condition a person in various conditions and situations, characterizing the features of his experience.

In textbooks on psychiatry, in most cases, we find a fairly clear formulation in the general part: pleasure or displeasure in connection with affects constitutes the concept we are talking about. If we want to differentiate the concepts of “feelings”, “mood”, “emotion”, “affect” so that they become suitable for practical application, then we must first establish that in a mental act only a theoretical, and not an actual division of the mental qualities in question can take place. E. Bleuler emphasizes that with any, even the simplest light sensation, we distinguish between qualities (color, hue), intensity and saturation. Similarly, we talk about the processes of cognition (intelligence), feeling and will, although we know that there is no such mental process that would not be characterized by all three qualities, even if one of them comes to the fore, then the other. Therefore, when we call a process affective, we know that we are abstracting something, just as we consider color regardless of its intensity. We must always be clearly aware that the process that we call affective also has an intellectual and volitional side, which in this case we neglect as an insignificant factor. With the constant strengthening of the intellectual factor and the weakening of the affective factor, a process ultimately arises that we call intellectual. Thus, we cannot divide all mental processes into purely affective and purely volitional, but only into predominantly affective and predominantly volitional, and intermediate processes may occur. A similar analytical approach to describing psychopathological symptoms and syndromes has currently been developed in Russian psychiatry (S. Yu. Tsirkin, 2005).

Like most other psychological terms, the word “feeling” originally meant something sensual. It was equivalent to the modern term "sensation" and still bears the imprint of this origin. A person feels a prick, feels a fly crawling over his face; a person experiences a feeling of cold or a feeling that the ground is shaking under his feet. Thus, E. Bleuler believes, this ambiguous word cannot be suitable for the purposes of psychopathology. Instead, the term “affectivity” is practically accurate, which should serve to express not only affects in the proper sense, but also to designate light feelings of pleasure and displeasure in all kinds of experiences.

In accordance with the predominance of one of these experiences, hypothymia And hyperthymia(from Greek ????? - mood, feeling, desire).

Hypotymia, or depression, characterized by a decrease in general mental tone, loss of a sense of joyful and pleasant perception of the environment, accompanied by the appearance of sadness or sadness. Hypotymia underlies the formation of depressive syndrome.

Depressive syndrome in typical cases, it is characterized by a triad of symptoms of inhibition of mental activity: sad, depressed mood, slow thinking and motor retardation. The severity of these structural elements may vary, reflecting wide range depression from mild sadness with a feeling of decreased mental tone and some general discomfort to deep depression with a feeling of melancholy that “tears the heart” and the conviction of the complete meaninglessness and futility of one’s existence. At the same time, everything is perceived in a gloomy light - the present, past and future. Many patients perceive melancholy not only as heartache, but also as a painful physical sensation in the area of ​​the heart, “a stone on the heart,” “precordial melancholy” (vital depression). Some patients in this state also experience other algic sensations, for example, some of them say that it “pains to think.” V. M. Morozov proposed calling such sensations the term “dyssenesthesia,” meaning by this a violation of general sensitivity. Dyssenesthesia in depression is characterized by the fact that expressions relating to mental pain and depression merge with expressions relating to physical pain, which is reflected in the speech of patients (“emptiness in the head”, “longing in the heart”, etc.). The slowing down of the associative process is manifested in the loss of the former, natural and smooth flow of thoughts that was usual for them, of which there are few, they flow slowly, their former liveliness and lightness are no longer present, the acuity of thinking is lost. Thoughts, as a rule, are fixed on unpleasant events: possible illness, one’s own mistakes, mistakes, inability to overcome difficulties, perform the most ordinary, simple actions; patients begin to blame themselves for various incorrect, “bad” actions that, in their opinion, cause harm to others (ideas of self-blame). No real pleasant events can change such a pessimistic mindset. Such patients answer questions in monosyllables, the answers follow after a long silence. Motor retardation manifests itself in slower movements and speech, which becomes quiet, often slurred, and poorly modulated. The facial expressions of the patients are sad, the corners of the mouth are drooping, the patients cannot smile, the expression of grief predominates on the face, and the same posture is maintained for a long time. At the height of the development of depression, complete immobility (depressive stupor) appears. Motor inhibition does not allow many patients, disgusted with life because of their painful state of health, to commit suicide, although they have suicidal thoughts. Subsequently, they talk about how they dreamed that someone would kill them, saving them from “mental torment.”

Manic syndrome (hyperthymia) characterized by the presence of a triad of symptoms indicating the presence of arousal: an elevated, joyful mood, acceleration of the flow of associations and motor agitation, a desire for indomitable activity. As with depression, the severity of individual components of the affective triad varies.

The mood can fluctuate from pleasant pleasure, in which everything around is painted in joyful, sunny colors, to enthusiastic-ecstatic or angry. The acceleration of associations also has a wide range from a pleasant relief with a quick and easy flow of thoughts to a “jump of ideas”, which at the same time lose their goal orientation, reaching a degree of “confusion” (“confused mania”). The motor sphere shows a general tendency towards revitalization of motor skills, which can reach the level of chaotic, incessant excitement. Manic syndrome is characterized by distractibility of attention, which does not allow patients to complete the speech they have begun or the task they have started. In a conversation, this is manifested in the fact that, despite its fast pace, if there is a desire to communicate, there is no productivity, the doctor cannot obtain the information that is necessary for him (for example, find out the sequence of events in the patient’s life preceding hospitalization, etc.) . In a manic state, patients do not show any health complaints; they feel a rush of physical and psychic powers, they say that they have a “huge charge of energy.” Women become erotic, claim that everyone is in love with them, men discover naked hypersexuality. Patients are convinced of their extraordinary abilities in the most various areas, which can reach the level of delusions of grandeur. This reveals a desire for various types creativity, patients compose poetry, music, paint landscapes, portraits, assuring everyone that they have “extraordinary talents.” They can say that they are “on the threshold of great discoveries”, capable of “turning science around”, creating new laws by which the whole world will live, etc.

Speech agitation is a constant companion of mania; patients speak loudly, incessantly, sometimes, without finishing one sentence, they begin new topic, interrupt the interlocutor, start shouting, gesticulate furiously, start singing loudly, not realizing that they are behaving inappropriately to the situation, indecently. In many cases, the acceleration of the associative process is revealed when writing; patients do not pay attention to literacy and cleanliness; they can write separate, unrelated words, so that it is impossible to understand the essence of what is written.

A very characteristic appearance of manic patients is that they exhibit excessive agitation: the patients are excessively animated, their face is hyperemic, due to constant speech excitation, saliva accumulates in the corners of the mouth, they laugh loudly, and cannot sit in one place. The appetite is increased, gluttony develops. Depending on the shades of hyperthymia, one can distinguish “cheerful mania”, unproductive mania, angry mania, mania with foolishness, in which the mood is elevated, but there is no lightness, true joy, motor excitement predominates with feigned playfulness, or there is a picture mannerism, a tendency to flat and cynical jokes.

Mild variants of manic states are designated as hypomania; they, like subdepression, are observed with cyclothymia (more detailed description various options depressions and manias, see the section “Affective endogenous psychoses”).

Moria- a state characterized by a combination of an uplift in mood with some disinhibition, carelessness, while a disinhibition of drives and sometimes a loss of consciousness may be observed. It is most often observed with lesions frontal lobes brain

Dysphoria- gloomy, gloomy, angry mood with grumpiness, irritability, increased sensitivity to any external irritant, slight onset of brutal bitterness, explosiveness. The condition can be expressed by dull dissatisfaction, pickiness, at times with outbursts of malice and anger, threats, and the ability to launch a sudden attack. One type of dysphoria is moros- a gloomy, grumpy, grouchy mood that occurs immediately after waking up (“gets up on the left foot”).

Euphoria- elevated mood with a feeling of contentment, carelessness, serenity. As noted by A. A. Portnov (2004), citing the observations of I. N. Pyatnitskaya, euphoria during anesthesia is composed of a number of pleasant sensations of both a mental and somatic nature. Moreover, each drug has a special structure of euphoria. For example, when intoxicated with morphine or opium, patients experience a state of somatic pleasure, peace and bliss. Already in the first seconds, the opiate introduced into the body causes a feeling of warmth and pleasant “airy” stroking in the lumbar region and lower abdomen, rising in waves to the chest and neck area. At the same time, the head becomes “light”, the chest bursts with joy, everything inside the patient rejoices, just as everything around him rejoices, which is perceived brightly and clearly, then a state of complacency, languor, lazy peace and contentment sets in. which many patients define by the term “nirvana”. Euphoria caused by caffeine, cocaine, and lysergicide is of a different nature. It is combined not so much with pleasant somatic sensations as with intellectual stimulation. Patients feel that their thoughts have become richer, brighter, their knowledge has become clearer and more fruitful; they experience the joy of mental upliftment. Another type of euphoria is observed with alcohol and barbiturate poisoning. Self-satisfaction, bragging, erotic disinhibition, boastful talkativeness - all these are manifestations of an intoxicating or euphoric effect, which patients with alcoholism and drug addiction strive to reproduce. Euphoria is characterized by inactivity, passivity, and no increase in productivity is observed.

Ecstasy- an experience of delight, extraordinary joy, inspiration, happiness, inspiration, admiration, turning into frenzy.

Fear, panic- a state of internal tension associated with the expectation of something life-threatening, health, well-being. Degrees of expression can be different - from mild anxiety and restlessness with a feeling of tightness in the chest, “fading of the heart” to panic horror with cries for help, running away, throwing. Accompanied by an abundance of vegetative manifestations - dry mouth, body trembling, the appearance of “goosebumps” under the skin, the urge to urinate, defecate, etc.

Emotional lability- sharp fluctuations in mood from its increase to a significant decrease, from sentimentality to tearfulness.

Apathy- complete indifference to what is happening, indifferent attitude towards one’s condition, position, future, absolute thoughtlessness, loss of any emotional response. E. Bleuler (1911) called apathy in schizophrenia “the calm of the grave.”

Emotional dulling affective dullness - weakening, insufficiency or complete loss of affective responsiveness, poverty of emotional manifestations, spiritual coldness, insensitivity, dull indifference. Characteristic of schizophrenia or a special type of psychopathy.

Parathymia(inadequacy of affect) is characterized by the manifestation of affect that is qualitatively inconsistent with the reason that caused it, inadequate to the phenomenon that causes it. Such patients, when reporting a sad event, may laugh inappropriately, joke, show inappropriate merriment for the occasion, and, conversely, fall into sadness and sadness in the presence of information about joyful events. Parathymia, according to E. Bleuler, may be characteristic of autistic thinking as affective thinking that does not obey the laws of strict logic.

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Emotional manifestations can also be pathological. This is facilitated various reasons. The source of pathological emotions can be character traits and emotional relationships associated with them.

For example, timidity as a character trait can significantly influence the emergence of a pathological state of fear and anxiety; in a demanding person, dissatisfaction of desires can cause a reaction of anger, and in an undemanding person – compliance and submission; at the same time, anger can cause a painful state of overexcitation, and following compliance, a painful reaction of the nervous system can occur.

It should be noted that emotional pathology is important among various mental disorders. Here it is necessary to note the importance of emotional excitability, for example, a decrease in emotional excitability to the extent that even strong stimuli do not cause emotions, which is called sensory dullness; the opposite is increased emotional excitability, when even weak stimuli cause violent emotional reactions, which is characteristic of neurasthenia.

Emotional disorders include mood disorders such as depression, dysphoria, euphoria.

Depression is an affective state characterized by a negative emotional background, changes in the motivational sphere, cognitive ideas and general passivity of behavior.

Subjectively, a person in a state of depression experiences difficult, painful emotions and experiences, such as depression, melancholy, and despair. Drives, motives, volitional activity are reduced. Against the background of depression, thoughts of death arise, self-deprecation and suicidal tendencies appear. In addition to a depressed mood, ideational - mental, associative - and motor retardation is characteristic. Depressed patients are inactive. For the most part they sit in a secluded place, with their heads down. Various conversations are painful for them. Self-esteem is reduced. The perception of time has been changed, as it passes for a painfully long time.

Distinguish functional states depression possible healthy people within the framework of normal mental functioning, and pathological, which is one of the psychiatric syndromes. A less pronounced condition is called subdepression.

Subdepression is a decrease in mood that does not reach the level of depression, observed in a number of somatic diseases and neuroses.

Dysphoria is a low mood with irritability, anger, gloominess, increased sensitivity to the actions of others, with a tendency to outbursts of aggression. Occurs in epilepsy. Dysphoria is most typical in organic diseases of the brain, in some forms of psychopathy - explosive, epileptoid.

Euphoria is an increased joyful, cheerful mood, a state of complacency and carelessness that does not correspond to objective circumstances, in which facial and general motor revival and psychomotor agitation are observed. Everything around you is perceived in bright rainbow colors, all people seem charming and kind. Another symptom is ideational excitation: thoughts flow easily and quickly, one association revives several at once, memory produces rich information, but attention is unstable, extremely distractible, as a result of which the ability for productive activity is very limited. The third symptom is motor agitation. Patients are in constant motion, they undertake everything, but do not complete anything, they disturb those around them with their services and help.

The instability of emotions manifests itself as emotional lability. Emotional lability is characterized by a slight change in mood from somewhat sad to elevated without any significant reason. It is often observed in diseases of the heart and blood vessels of the brain or against the background of asthenia after somatic diseases, etc.

Emotional ambivalence is characterized by the simultaneous existence of opposing emotions. In this case, a paradoxical change in mood is observed, for example, misfortune causes a joyful mood, and happy event- sadness. It is observed in neuroses, character accentuations and some somatic diseases.

There is also ambivalence of feelings - inconsistency, contradiction of several simultaneously experienced emotional relationships towards a certain object. Ambivalence of feelings in a typical case is due to the fact that individual features of a complex object have different effects on a person’s needs and values; a special case of ambivalence of feelings is a contradiction between stable feelings towards an object and situational emotions developing from them.

In addition, there may be inadequacy of emotions, which can sometimes be expressed in schizophrenia, when the emotion does not correspond to the stimulus that caused it.

Apathy - painful indifference to events outside world, your condition; total loss interest in any activity, even in one’s appearance. The person becomes sloppy and unkempt. People with apathy treat their family and friends coldly and indifferently. With relatively intact mental activity, they lose the ability to feel.

Formation of human emotions – the most important condition his development as a person. Only by becoming the subject of stable emotional relationships do ideals, responsibilities, and norms of behavior turn into real motives for activity. The extreme variety of human emotions is explained by the complexity of the relationship between the objects of his needs, the specific conditions of their occurrence and the activities aimed at achieving them.

20. Symptoms of emotional pathology

Emotions are mental processes and states in the form of direct experience of phenomena and situations affecting an individual. The emergence of emotions occurs either as a result of the satisfaction or dissatisfaction of any human needs, or in connection with the discrepancy between expected and real events.

Emotional experiences may differ from each other depending on the intensity, modality, duration, consistency or inconsistency of the reasons that caused them.

Along with emotions, i.e. experiences associated with the direct reflection of existing relationships highlight deep and lasting experiences associated with a certain idea of ​​​​a certain object - feelings.

DEPRESSION ( depressive syndrome) - low, gloomy mood (melancholy), combined with motor retardation and slowing of the associative process.

MANIA (manic syndrome) is an elevated, joyful mood (euphoria), combined with motor excitement and acceleration of the associative process.

EUPHORIA - an elevated, carefree, inappropriately cheerful mood.

DYSPHORIA - angry - angry mood.

APATHY is a state of emotional indifference, indifference to oneself or the environment.

Weakness - emotional hyperesthesia.

PARATYMIA - inadequate affect, quantitatively and qualitatively inconsistent with the cause that caused it.

FEAR is a feeling of internal tension associated with the expectation of specific threatening events, actions (fear is projected externally - fear of sharp objects, animals, etc.).

ANXIETY is a feeling of internal tension associated with the expectation of threatening events (anxiety is often not projected externally - anxiety for one’s health, for work, for the correct execution of actions, etc.).

MEANING - a severe feeling of tension, bordering on pain, which patients localize in the heart area (unlike anxiety, it is accompanied by motor retardation).

ANXIETY - a feeling of tense anticipation of impending misfortune (plotless, pointless).

FEELING OF LOSS OF SENSES - a painful feeling of insensibility, the experience of an irretrievable loss of the ability to feel.

AMBIVALENCE is the simultaneous coexistence of opposing feelings.

The symptom of alexithymia, the difficulty or inability to accurately describe one’s own emotional experiences, is considered important for clinical practice.

Anhedonia refers to a person’s loss of feelings of joy and pleasure. As a rule, anhedonia is part of the structure of depressive-depersonalization syndrome. Among the most important for the effective implementation of the treatment process is such an emotional experience as empathy - the ability of a person to accurately recognize the emotional state of the interlocutor and empathize with him. Empathy can be called emotional responsiveness. When trying to describe an even mood, the term syntony is often used; with increased sensitivity, manifested by slight vulnerability, they speak of emotiveness.

Particular attention should be paid to the emotional experiences that arise as a result of a discrepancy between the forecast and reality. Their essence lies in the fact that a person often expects a certain stereotype of behavior from others. It predicts people’s actions and assigns certain consequences characteristics of desirability and undesirability. Expectations (expectations), however, are not always justified. This occurs both due to the mental characteristics of a person (in particular, the use of causal attribution), and because the need to satisfy some activity blocks the process of adequate forecasting.

Among the emotional experiences that arise as a result of a violation of the expectation and anticipation mechanisms, insult, disappointment, affect of bewilderment, surprise and some others stand out. It is believed that the most striking examples the formation of emotional experiences due to multidirectional methods of forecasting are resentment and surprise. Surprise arises in cases when reality exceeds expectations (“I thought that the person would deceive, but he acted nobly”); resentment - with the opposite pattern (“I assumed that the person should be grateful and reciprocate, but he acted ignoblely”).

Most common symptom disorders of the affective sphere in somatic and psychiatric clinic fear is considered. There are several hundred types of fear, while the pathological or physiological nature of fears is spoken of rather conditionally, since fears can be an adequate, mobilizing reaction to a real threat.

21. Pathology of will. Kinds

Volitional sphere within the framework of cognitive processes it is represented by the motivational aspect. In this case, it is essential to assess the influence of motivational processes and personality activity in understanding reality.

For clinical psychology, such features of volitional activity as determination, determination and perseverance are important, which can also act as individual psychological characteristics.

Motivation is the process of purposeful, organized and sustainable activity aimed at satisfying needs. In the motivational sphere, several parameters are distinguished: breadth, flexibility, and hierarchization (R.S. Nemov).

Along with motives and needs, which can be expressed in desires and intentions, interest can also be a stimulator of human cognitive activity. It is this motivational state that plays the most important role in acquiring: new knowledge and reflecting reality.

Violations of volitional activity include a large number of symptoms and abnormalities. One of the most important is a violation of the structure of the hierarchy of motives, which is often found in conditions mental illness. The essence of the violation is the deviation of the formation of a hierarchy of motives from the natural and age-related characteristics of needs.

Another violation is the formation of pathological needs and motives (B.V. Zeigarnik). In the clinic, this disorder is manifested by the following symptoms related to parabulia: anorexia, bulimia, dromomania, pyromania, kleptomania, suicidal behavior, dipsomania.

ANOREXIA - lack of appetite, suppression of the desire to eat.

BULIMIA is a pathological desire to constantly eat a lot and often.

KLEPTOMANIA is a pathological irresistible attraction to steal objects that are unnecessary for a given person.

PYROMANIA is a pathological irresistible attraction to arson.

DIPSOMANIA is a pathological irresistible attraction to binge drinking.

DROMOMANIA - a pathological irresistible attraction to vagrancy.

In addition to those listed in the children's clinic, syndromes of a pathological irresistible desire to pull out hair (trichotillomania), bite and eat nails (onychophagia), count windows in houses, steps on stairs (arithmomania) are described.

Along with parabulia, disorders of the motor-volitional sphere have been described, such as:

HYPERBULLIA is a behavioral disorder in the form of motor disinhibition (excitement).

HYPOBULIA is a behavioral disorder in the form of motor retardation (stupor).

One of the most striking clinical syndromes of the motor-volitional sphere is considered to be catatonic syndrome. It includes several symptoms:

STEREOTYPIES - frequent, rhythmic repetition of the same movements.

IMPULSIVE ACTIONS - sudden, senseless, absurd acts without sufficient critical judgment.

NEGATIVISM is a manifestation of an unreasonable negative attitude towards any external influence in the form of refusal, resistance, counteraction.

ECHOLALIA, ECHOPRAXIA - repetition by the patient of individual words or actions that are spoken or performed in his presence.

CATALEPSY (“symptom of waxy flexibility”) - the patient freezes in one position, the ability to maintain the given position for a long time.

And personalities. Accordingly, disorders of consciousness are disturbances in a person’s perception of the social characteristics of the environment and their own personal characteristics. Depending on the interpretation of consciousness in clinical psychology, there are two approaches to understanding the unconscious. In the case of identifying consciousness and psyche, the unconscious is an insufficient level of neurophysiological arousal, ...

Engaged in diagnosis, correction and restoration of the equilibrium relationship between the individual and his life, based on knowledge about emerging maladaptations. Types of diagnostics. Negative and positive diagnostics: meaning and goals. All diagnostics used in clinical psychology are divided into positive and negative. Negative is a type of research used for various disorders...

Mania is a mental disorder accompanied by feelings of joy, lightness, elevated mood and an affect of anger.

• 1. increased mood with a feeling of joy that patients infect others with, and an affect of anger.
• 2. acceleration of thinking (can reach the “jump of ideas”)
• 3. increased speech motor activity

May be accompanied by overvalued ideas of overestimating one’s own personality or delusional ideas of grandeur.

The state of full-blown mania is unproductive. There is absolutely no criticism of one's condition. Mild cases are called hypomania, and we can talk about a rather productive state.

Clinical example: “A 20-year-old patient, barely noticing a group of students, rushes towards them, instantly gets to know everyone, jokes, laughs, offers to sing, teach dancing, in a joking manner introduces all the patients around him: “This is a giant of thought, he doesn’t know twice two.” how much, and this one is Baron Munchausen, an extraordinary liar,” etc. He quickly gets distracted to give guidelines to the nannies, who, in his opinion, are doing the cleaning of the premises incorrectly. Then, jumping on one leg and dancing, he returns to the group of students, offering to test their knowledge in all sciences. He speaks very quickly in a hoarse voice, often not finishing his thoughts, jumps to another subject, and sometimes rhymes words.”

There are several variants of manic syndrome

• cheerful mania - most characteristic of manic-depressive psychosis (increased optimistic mood with moderate speech motor agitation)
• Angry mania (elevated mood, pickiness, dissatisfaction, irritation)
• · mania with foolishness, in which an elevated mood with motor and speech excitement is accompanied by mannerisms, childishness, and a tendency to make ridiculous jokes
• · Confused mania (elevated mood, incoherent speech and erratic motor agitation).
• · Manic violence - excitement with anger, rage, destructive tendencies, aggression.

• · Delusional manic states - development against the background of a manic state of delirium, hallucinations, signs of mental automatism without clouding of consciousness.
• · Manic states with foolishness - elevated mood, a tendency to make ridiculous and flat jokes, grimaces, a tendency to commit ridiculous acts. Delusional ideas, verbal hallucinations, and mental automatisms are possible.
• · Manic states with the development of acute sensory delirium - pathos, exaltation, verbosity. With the development of acute sensory delirium, a staging occurs with a change in the perception of the environment, with the feeling that a performance is being played out, in which the patient plays the main role.

Moriya - a heightened mood with elements of clowning, foolishness, a tendency to make flat jokes, i.e. motor excitement. Always with elements of reduced criticism and intellectual deficiency (with organic damage to the frontal lobes).

Euphoria is a complacent, carefree, carefree mood, the experience of complete satisfaction with one’s condition, insufficient assessment of current events. Unlike mania, the last 2 components of the triad (states of alcoholic, drug intoxication, organic GM diseases, somatic diseases - tuberculosis) are absent.

Explosiveness is increased emotional excitability, a tendency to violent manifestations of affect, and an inadequate reaction. A reaction of anger with aggression can arise over a minor issue.

Emotional stuckness is a condition in which an emerging affective reaction is fixed on long time and influences thoughts and behavior. The resentment experienced “sticks” for a long time with a vindictive person. A person who has internalized certain dogmas that are emotionally significant for him cannot accept new attitudes, despite the changed situation (epilepsy).

Ambivalence (duality of feelings) is the simultaneous coexistence of two opposing emotions, combined with ambivalence (in schizophrenia, hysterical disorders: neurosis, psychopathy).

Weakness (incontinence of affect) - easy tenderness, sentimentality, incontinence of emotions, tearfulness ( vascular diseases brain).

Dysphoria is an angry-sad mood with the experience of dissatisfaction with oneself and others, often with aggressive tendencies. Often accompanied by pronounced affective reactions of anger, rage with aggression, despair with suicidal tendencies (epilepsy, traumatic brain disease, abstinence in alcoholics, drug addicts).

Anxiety - worry inner restlessness, expectation of trouble, trouble, catastrophe. Feelings of anxiety may be accompanied by motor restlessness and autonomic reactions. Anxiety can develop into panic, in which patients rush around, do not find a place for themselves, or freeze in horror, expecting a catastrophe.

Emotional weakness - lability, instability of mood, its change under the influence of minor events. Patients can easily experience states of tenderness, sentimentality with the appearance of tearfulness (weakness).

Painful mental insensibility (anaesthesia psychica dolorosa) - patients painfully experience the loss of all human feelings - love for loved ones, compassion, grief, melancholy.

Apathy (from the Greek apatia - insensibility; synonyms: anormia, antinormia, painful indifference) is a disorder of the emotional-volitional sphere, manifested by indifference to oneself, surrounding persons and events, lack of desires, motivations and complete inactivity (schizophrenia, organic lesions of the brain - injuries, atrophic processes with phenomena of aspontaneity).

Emotional monotony - the patient has an even, cold attitude towards all events, regardless of their emotional significance. There is no adequate emotional resonance.

Emotional coldness - events that are significant in the normal state are perceived as a fact.

Emotional coarsening - manifests itself in the loss of the most subtle differentiated emotional reactions: delicacy and empathy disappear, disinhibition, importunity, and impudence appear (organic lesions of the brain, schizophrenia).

Clinical example: “A patient suffering from schizophrenia for many years lies in bed all day, not showing any interest in anything. She remains just as indifferent when her parents visit her, and did not react in any way to the message about the death of her older sister. She perks up only when she hears the clink of dishes being set out from the dining room or sees a bag of food in the hands of visitors, and she no longer reacts to what kind of home-cooked food was brought to her, but in what quantity.”

Depression is a mental disorder accompanied by low mood, feelings of melancholy, anxiety and a pronounced affect of fear.

• 1. low mood with a feeling of depression, depression, melancholy and an affect of fear
• 2. slowing down thinking
• 3. slowing down of speech motor activity

Depending on the severity of the components of the triad, at the 1st pole there will be a depressive stupor with the most pronounced motor and ideational inhibition, and at the 2nd pole there will be a depressive/melancholic raptus with melancholy, anxiety, and suicidal attempts. These states can easily transform into each other.

Clinical example: “The patient sits motionless on the bed, head down, arms dangling helplessly. The expression on his face is sad, his gaze is fixed on one point. He answers questions in monosyllables, after a long pause, in a barely audible voice. She complains that she doesn’t have any thoughts in her head for hours.”

By depth:

• · Psychotic level - lack of criticism, presence of delusional ideas of self-accusation, self-deprecation.
• · Neurotic level - criticism remains, delusional ideas of self-accusation and self-deprecation are absent

By origin:

• · Endogenous - occurs spontaneously (autochthonous), characterized by seasonality (spring-autumn), daily mood swings (emphasis on the first half of the day). One of the extreme manifestations of severity is mental anesthesia (painful mental insensibility).
• · Reactive - occurs as a result of a super-strong psychotraumatic factor. The peculiarity is that the structure always contains the situation that led to this disorder.
• · Involutional - occurs during the period of age-related reverse development, more often in women. By clinical picture This is anxiety depression.
• · Somatogenic - occurs as a result of somatic suffering.

Masked (somatized, larved) - somatovegetative masks of depressive disorders come to the fore.

Disorder of will and drives

Will - conscious, purposeful human activity

The following stages are distinguished in the volitional process:

• 1) motivation, awareness of the goal and desire to achieve it;
• 2) awareness of a number of possibilities for achieving the goal;
• 3) struggle of motives and choice;
• 4) making one of the possible decisions;
• 5) implementation of the decision made.

Hyperbulia is increased activity caused by a significant number of impulses to activity, often changing in order to implement them (manic states).

Hypobulia - decreased volitional activity, lack of motivation, inactivity, lethargy, decreased motor activity, lack of desire to communicate (depressive states, schizophrenia).

Abulia - absence of any impulses (schizophrenia, organic brain damage, opium addiction).

Parabulia - perversion, change in volitional activity - catatonic syndrome in the form of catatonic stupor or catatonic excitation - a symptom complex of disorders of motor skills and muscle tone.

Catatonic stupor - immobility.

Triad of increased subordination:

• · Echopraxia - repetition of gestures and poses of others.
• · Echolalia - repetition of words and phrases of others.
• Catalepsy - waxy flexibility

Dyad of reduced subordination:

• · Negativism is the patient’s unmotivated resistance to the actions and requests of others (active and passive).
• · Mutism is a complete lack of contact with others.

All types of sensitivity are impaired. Characterized by mannerisms: pretentious gait, foolishness, frozen surprised mask on the face, rare blinking.

• · Symptom " gear wheel»
• Hood sign
• · Symptom of air cushion.

Catatonic excitement.

• · Impulsivity
• · Stereotypes

When you leave, everything remains in memory.

These conditions occur in schizophrenia, head injury, infectious lesions of the central nervous system, and can be somatogenic (liver pathology, tumors).

For schizophrenia:

Lucid catatonia - catatonic agitation is combined with other psychopathological symptoms: delusions, hallucinations, mental automatisms, but without clouding of consciousness.

Oneiric catatonia - characterized by oneiric stupefaction.

Clinical example: “A patient, sitting in bed with his legs tucked under him, makes the same movements for many hours: he stereotypically rubs his hands and, at regular intervals, bows his head, touching his fingers with his nose - and all this in complete silence.”

Desire disorders

• - violation of instinctive drives.
• 1. Violation of the instinct of self-preservation:
  • A) disturbance of desire for food.
  • · Anorexia - loss of hunger, lack of appetite in the presence of a physiological need for food (depression, catatonic stupor, severe alcohol withdrawal).
  • Bulimia is a pathological, sharply increased feeling of hunger, often accompanied by general weakness and abdominal pain (hyperinsulinism, mental retardation, schizophrenia).
  • · Polydipsia - increased fluid consumption, uncontrollable thirst (endocrine diseases).
  • · Coprophagia - eating inedible things, sometimes one’s own excrement (dementia, schizophrenia). Normally - during pregnancy (eating chalk).
  • B) violation of the desire for life:
    • · Self-torture - cuts, injuries (dysphoria, delusional states).
    • · Self-mutilation - irreversible damage (dysmorphomania, imperative hallucinations)
    • · Suicide:
      • - impulsive: spontaneously, without thinking, like a “short circuit”.
      • - demonstrative: with the goal of “scaring, achieving something, being the center of attention, everything according to the script.
      • - “as an outcome” - against the background of depressive states, carefully planned, hidden.
  • 2. Violation of the instinct to preserve the species:
    • A) sexual desire disorder:
    • · Decreased sexual feeling (libido) - hypolibido (neurosis, depression, epilepsy, therapy psychotropic drugs)
    • · Increased sexual feelings - hyperlibido (mania, dementia, alcoholism).
    • · Perversion - perversions:
    • - in the act:

Sadism - obtaining sexual pleasure by torturing a person of the opposite sex (psychopaths). Can be physical and psychological.

Masochism is receiving pleasure from torture by a person of the opposite sex.

Voyeurism is the desire to look at other people's genitals and sexual acts.

Exhibitionism is an irresistible desire to unexpectedly expose one’s genitals in front of the opposite sex (in men with alcoholism, mentally retarded people).

Transvestism is a pathological persistent desire to wear clothes and hairstyles of the opposite sex and play their role. True - from childhood, false - only to obtain sexual satisfaction.

Fetishism - obtaining sexual satisfaction from collecting objects belonging to people of the opposite sex.

Narcissism is receiving pleasure from contemplating one's naked body in the mirror.

In the object:

Homosexuality - receiving sexual satisfaction from a person of the same sex, indifference to people of the opposite sex.

Pedophilia is a pathological attraction to children (mentally retarded).

Gerontophilia is a pathological attraction to older people.

Incest is sexual relations with close blood relatives.

Bestiality - sexual relations with animals.

Necrophilia is a pathological attraction to corpses.

3. Impulsiveness is not a drive disorder.

Impulsive action - a sudden, rapid, unmotivated action that lasts seconds or minutes; a sign of severe mental disorder.

• · Dromamania - an impulsive desire to change places, an attraction to running away from home, wandering and changing places, is observed in various mental illnesses.
• · Dipsomania is an irresistible attraction to drunkenness, accompanied by severe alcoholic excesses. The attraction to alcohol can be so strong that, despite a critical attitude towards it, at first it is not possible to overcome the attraction. In this state, patients commit all sorts of unseemly acts: deception, theft, aggression in order to get the desired alcohol.
• · Pyromania is an attraction to arson, irresistible, unmotivated, suddenly arising, but not accompanied by a change in consciousness.
• · Kleptomania or impulsive theft - an unmotivated attraction to theft.
• · Coprolalia - impulsive utterance of swear words and obscene language. This symptom can be observed in Gilles de la Tourette's disease.
• · Mythomania is an irresistible attraction to lies and deception. Sometimes this is observed in hysterical individuals to attract attention.

Disorders of consciousness

Consciousness is a complex integrative mental process that determines cognitive synthesis and includes subject (allopsychic) ​​and personal (autopsychic) ​​orientation.

• · Subject orientation - orientation in place, time, is more often impaired in exogenous psychoses: head injury, infectious and intoxication psychoses.
• · Personal orientation - a person’s orientation in his spiritual “I”, in himself, is more often disrupted in endogenous psychoses.

Disorders of consciousness are divided into: quantitative violations consciousness (stupefaction) and qualitative disturbances of consciousness (changes in consciousness).

Quantitative disorders of consciousness

Stunning is depression of consciousness, characterized by a moderate or significant decrease in the level of wakefulness, drowsiness, an increase in the threshold of perception of all external stimuli, and torpidity of mental processes. Occurs due to exogenous or endogenous intoxications, at brain injury, increased intracranial pressure. Verbal contact is possible, sometimes the question needs to be repeated, answers to questions are laconic.

The patient answers questions with pronounced delay, often in monosyllables, perseverations are possible, and performs only basic tasks. The patient opens his eyes spontaneously or immediately when addressed. The motor response to pain is active and purposeful. Exhaustion, lethargy, poor facial expressions, and drowsiness are noted. Control over the functions of the pelvic organs is preserved.

Stupor - deep depression of consciousness with preservation of coordinated protective motor reactions and opening of the eyes in response to pain, pathological drowsiness, aspontaneity. The patient usually lies with his eyes closed, does not follow verbal commands, is motionless, or makes automated stereotypical movements. When painful stimuli are applied, the patient experiences coordinated defensive movements of the limbs aimed at eliminating them, turning in bed, as well as suffering grimaces and groans. It is possible to open the eyes in response to pain or a sharp sound. Pupillary, corneal, swallowing and deep reflexes are preserved. Control over the functions of the pelvic organs is impaired. Vital important functions saved, or one of their parameters is moderately changed.

Coma (from the Greek cat - deep dream) - switching off consciousness with a complete loss of perception of the surrounding world, oneself and other signs of mental activity, while the eyes are closed; by lifting the patient's eyelids, you can see a fixed gaze or friendly floating movements of the eyeballs. There are no signs of mental activity, reactions to external stimuli are almost completely or completely lost. There are no skin, mucous and tendon reflexes. After emerging from a coma, there is complete amnesia.

Coma can occur acutely or subacutely, going through the preceding stages of stupor and stupor. It is customary to distinguish coma caused by destruction of the limbic-rsticular parts of the brain or large areas of the cerebral cortex big brain(organic coma), and coma arising in connection with diffuse metabolic disorders in the brain (metabolic coma), which can be hypoxic, hypoglycemic, diabetic, somatogenic (hepatic, renal, etc.), epileptic, toxic (drug, alcohol, etc.).

Criteria for clouding of consciousness by K. Jaspers:

• · Impaired perception - detachment from the environment as a result of the influx of illusory - hallucinatory images;
• · Disorientation - disturbance of allo- and autopsychic disorientation;
• · Thinking disorder - incoherent thinking or the formation of secondary sensory delusions;
• · Memory impairment - complete amnesia of real events.

Quantitative disorders of consciousness include

1. Delirium (delirious change in consciousness): the leading symptoms are disorientation in time, situation, environment while maintaining orientation in one’s own personality, confusion, detachment from the real situation, an abundance of true visual hallucinations. Mandatory - emotional stress (anxiety, fear), acute sensory delirium, hallucinatory-delusional arousal, partial amnesia of both real events and hallucinatory and delusional experiences is noted. Vegetative-visceral symptoms are common. Of the optional symptoms, the most common are auditory and tactile hallucinations and senestopathies.

Classic delirium develops in three phases (stages).

At the first stage - mood variability, talkativeness, mental hyperesthesia, sleep disorders. Fussiness, anxiety, general excitability increase, mood swings from elated, irritable to anxiety and anticipation of trouble intensify. Influxes of figurative, clear memories and sensually vivid ideas appear. In addition to difficulty falling asleep and shallow sleep, vivid dreams of unpleasant content are characteristic.

At the second stage, illusory disorders, mainly pareidolia, appear. Hyperesthesia and lability of affect sharply increase, disorientation in time and situation increases. Symptoms fluctuate, getting worse at night, and at daytime light spaces (“lucid windows”) appear. Sleep disorders become more pronounced and lasting, and hypnagogic visual hallucinations occur when falling asleep.

In the third stage, the leading place is occupied by visual true hallucinations with allopsychic disorientation (in time and place) and preservation of orientation in one’s own personality. Visual hallucinations are perceived by the patient among real objects and merge with them, but gradually, being replaced by scene-like hallucinations, increasingly displacing and renouncing reality and replacing it. By the morning, patients are forgotten in a pathological sleep, similar to stupor.

• · Mumbling (mumbling) delirium is characterized by total disorientation, chaotic disordered agitation, and indistinct monotonous muttering. At the height of delirium, chaotic excitement is replaced by monotonous hyperkinesis or a symptom of fleecing - senseless fingering of fingers, twitching of clothes, etc. Neuro-vegetative disorders appear - hyperthermia, myoclinic and fibrillar muscle twitching, tremor, tachycardia, riperhidrosis, blood pressure fluctuations, severe sleep disorders, etc. As symptoms worsen, delirium turns into stupor or coma and can lead to the death of the patient.
• · In occupational delirium, the leading symptoms are “vision” of the professional environment and the patient’s activities. Excitation in the form of automatic motor acts predominates over hallucinations. The patient is convinced that he is at work, performing the usual professional actions (a janitor waves a broom, a tailor sews, etc.). Disorientation is more severe than in classic delirium, and often, as symptoms worsen, is replaced by stupor or stupor.

Delirium occurs with drug intoxication (atropine, hormones, antidepressants, stimulants, etc.), industrial (tetraethyl lead, etc.), alcoholism, drug addiction, substance abuse, infectious, somatic diseases, vascular lesions of the brain.

2. Oneiric (dreaming) change in consciousness - characterized by an influx of involuntarily arising fantastic dream-delusional ideas in the form of complete pictures in content, following in a certain sequence and forming a single whole (detachment from the outside world with immersion in delusional experiences). There is a discrepancy between fantastic experiences and the patient’s behavior. The exit is gradual from several hours to months (schizophrenia, tumors, intoxication).

Clinical example: “A 21-year-old patient, shortly after admission to a psychiatric hospital, developed an oneiric state that lasted several days. She was lying in bed with with open eyes, periodically made swimming movements with her hands. Later she said that she saw herself on the Moon among robots and fancy rovers. Pushing off from the surface of the Moon, she flew over it, and when her bare feet stepped on the lunar soil, she felt the eternal cold of the stones, and her feet froze.”

• 3. Amentia is the most profound degree of change in consciousness, characterized by complete disorientation in time, place and one’s own personality, total disintegration of all mental activity, incoherence (incoherence) of thinking, aimless chaotic psychomotor agitation in bed, confusion, bewilderment, fragmentary and unsystematic delusions statements, hallucinations, anxiety, fear, complete amnesia (acute and chronic infectious and somatic diseases, encephalitis, neuroleptic malignant syndrome).
• 4. Twilight stupefaction - an acute stupefaction of consciousness, in which deep disorientation in time, surroundings and one’s own personality occurs (leading symptoms) in combination with hallucinatory and delusional statements, an affect of melancholy, anger and fear, sharp hallucinatory-delusional excitement, incoherent speech, less often with outwardly ordered behavior. Upon exiting this syndrome, there is complete total amnesia.

Clinical example: “Patient, 38 years old, engineer, very gentle and kind person. Not married. I have not abused alcohol in the past. On March 8th, at work, congratulating my employees on the holiday, I drank a glass of wine. Returning home, he began to help his old mother set the table and began cutting bread. He woke up from the cold - he slept in the snow in one suit. Next to him, covered with a fur coat, lay the murdered mother, on whose body there were many stab wounds. There are traces of blood on the patient's hands and clothes. I found a kitchen knife lying around in the room; the food on the table was untouched. The patient felt cold at the thought that he could have done all this himself. He called the police, but could not explain anything, no matter how much he strained his memory. He underwent an inpatient forensic psychiatric examination. He was declared insane (pathological intoxication). Subsequently, he was depressed for a long time in a psychiatric hospital and expressed suicidal thoughts. I just couldn’t forgive myself for what I had done.”

5. Ambulatory automatism - automatic, often quite complex motor acts are noted against the background of an impassive affect with a tinge of some confusion. Amnesia is characteristic.

Clinical example: “Patient, 32 years old, disabled group II, suffered severe TBI and suffering from traumatic epilepsy, during twilight disorder consciousness (according to the type of outpatient automatism) left home, went somewhere out of town. Suddenly coming to his senses somewhere in an unfamiliar place, for some time he could not figure out how he ended up there. But, remembering that such situations happened to him, he quickly checked his location with passers-by and hurried to return home. At home, he found the key to the room in the appointed place, but did not remember how he put it there. Sometimes during such disorders, he came to his family or friends, talked to them quite coherently, agreed on something, promised to call, borrowed money. Subsequently, I did not remember anything about this. Friends, not noticing any deviations in his behavior, reproached him for dishonesty and quarreled with him.”

• 6. Fugues, trances are special automatisms when outwardly complex sequential actions seem correct, orderly, purposeful, but are actually meaningless, unnecessary and not planned by the patient (patients wander aimlessly, walk, run aimlessly, etc.) (epilepsy , injuries, tumors, alcoholism).
• 7. Somnambulism - sleepwalking, sleepwalking. May be of neurotic origin.

Emotions- these are physiological states of the body that have a pronounced subjective coloring and cover all types of human feelings and experiences - from deeply traumatic suffering to high forms of joy and social sense of life.

Highlight:

epicritic, cortical, inherent only to humans, phylogenetically younger (these include aesthetic, ethical, moral).

protopathic emotions, subcortical, thalamic, phylogenetically more ancient, elementary (satisfaction of hunger, thirst, sexual feelings).

positive emotions that arise when needs are met are the experience of joy, inspiration, and satisfaction.

negative emotions in which difficulty in achieving a goal, grief, anxiety, irritation, and anger are experienced.

sthenic emotions aimed at vigorous activity, struggle, promoting the mobilization of forces to achieve a goal.

asthenic, causing decreased activity, uncertainty, doubt, inactivity.

Affect - short-term strong emotional excitement, which is accompanied not only by an emotional reaction, but also by the excitement of all mental activity. In some cases, pathological affect is preceded by a long-term psychotraumatic situation and the pathological affect itself arises as a reaction to some kind of “last straw”.

Highlight:

physiological affect - in response to an adequate stimulus, a violent emotional and motor reaction develops, not accompanied by a disturbance of consciousness and subsequent amnesia.

pathological affect - in response to an inadequate, weak stimulus, a violent emotional and motor reaction develops, accompanied by a disturbance of consciousness with subsequent amnesia. Affect may be followed by general relaxation and often deep sleep, upon awakening from which the deed is perceived as alien.

Clinical example: “A man who had suffered a head injury in the past, in response to a harmless remark from his boss about the fact that he smoked too much, suddenly jumped up, threw chairs with such force that one of them literally fell apart, and then rushed with his face twisted with anger at the person who made the remark and began to choke him. The employees who ran up with great difficulty pulled him away from the boss. After this pathological condition passed, I did not remember anything that happened to him during this period.”

Mood- a more or less prolonged emotional state.

Pathology of emotions.

Mania- a mental disorder accompanied by a feeling of joy, lightness, high mood and an affect of anger.

increased mood with a feeling of joy that patients infect others with, and an affect of anger.

acceleration of thinking (can reach a “jump of ideas”)

increased speech motor activity

May be accompanied by overvalued ideas of overestimating one’s own personality or delusional ideas of grandeur.

The state of full-blown mania is unproductive. There is absolutely no criticism of one's condition. Mild cases are called hypomania, and we can talk about a rather productive state.

Clinical example: “A 20-year-old patient, barely noticing a group of students, rushes towards them, instantly gets to know everyone, jokes, laughs, offers to sing, teach dancing, and jokingly introduces all the patients around him: “This is a giant of thought, twice two doesn’t know how many, but this one is Baron Munchausen, an extraordinary liar,” etc. He quickly gets distracted to give guidelines to the nannies, who, in his opinion, are doing the cleaning of the premises incorrectly. Then, jumping on one leg and dancing, he returns to the group of students, offering to test their knowledge in all sciences. He speaks very quickly in a hoarse voice, often not finishing his thoughts, jumps to another subject, and sometimes rhymes words.”

There are several variants of manic syndrome.

cheerful mania - most characteristic of manic-depressive psychosis (increased optimistic mood with moderate speech motor agitation)

angry mania (elevated mood, pickiness, dissatisfaction, irritation)

mania with foolishness, in which an elevated mood with motor and speech excitement is accompanied by mannerisms, childishness, and a tendency to make ridiculous jokes

Confused mania (elevated mood, incoherent speech, and erratic motor agitation).

Manic rampage - excitement with anger, rage, destructive tendencies, aggression.

Delusional manic states - development against the background of a manic state of delirium, hallucinations, signs of mental automatism without clouding of consciousness.

Manic states with foolishness - elevated mood, a tendency to make ridiculous and flat jokes, grimaces, a tendency to commit ridiculous acts. Delusional ideas, verbal hallucinations, and mental automatisms are possible.

Manic states with the development of acute sensory delirium - pathos, exaltation, verbosity. With the development of acute sensory delirium, a staging occurs with a change in the perception of the environment, with the feeling that a performance is being played out, in which the patient plays the main role.

Moria– elevated mood with elements of clowning, foolishness, a tendency to make flat jokes, i.e. motor excitement. Always with elements of reduced criticism and intellectual deficiency (with organic damage to the frontal lobes).

Euphoria- a complacent, carefree, carefree mood, the experience of complete satisfaction with one’s condition, insufficient assessment of current events. Unlike mania, the last 2 components of the triad (states of alcoholic and drug intoxication, organic diseases of the brain, somatic diseases - tuberculosis) are absent.

Explosiveness- increased emotional excitability, a tendency to violent manifestations of affect, an inadequate reaction in strength. A reaction of anger with aggression can arise over a minor issue.

Emotionally Stuck- a state in which the emerging affective reaction is fixed for a long time and affects thoughts and behavior. The resentment experienced “sticks” for a long time with a vindictive person. A person who has internalized certain dogmas that are emotionally significant for him cannot accept new attitudes, despite the changed situation (epilepsy).

Ambivalence (double feelings)-simultaneous coexistence of two opposing emotions, combined with ambivalence (in schizophrenia, hysterical disorders: neurosis, psychopathy).

Weakness (incontinence of affect)– slight tenderness, sentimentality, incontinence of emotions, tearfulness (vascular diseases of the brain).

Dysphoria- an angry-sad mood with a feeling of dissatisfaction with oneself and others, often with aggressive tendencies. Often accompanied by pronounced affective reactions of anger, rage with aggression, despair with suicidal tendencies (epilepsy, traumatic brain disease, abstinence in alcoholics, drug addicts).

Anxiety- experiencing internal anxiety, expecting trouble, misfortune, catastrophe. Feelings of anxiety may be accompanied by motor restlessness and autonomic reactions. Anxiety can develop into panic, in which patients rush around, do not find a place for themselves, or freeze in horror, expecting a catastrophe.

Emotional weakness- lability, instability of mood, its change under the influence of minor events. Patients can easily experience states of tenderness, sentimentality with the appearance of tearfulness (weakness).

Painful mental insensibility(anaesthesia psychica dolorosa) - patients painfully experience the loss of all human feelings - love for loved ones, compassion, grief, melancholy.

Apathy(from the Greek apatia - insensibility; synonyms: anormia, antinormia, painful indifference) - a disorder of the emotional-volitional sphere, manifested by indifference to oneself, surrounding persons and events, lack of desires, motivations and complete inactivity (schizophrenia, organic lesions of the brain - trauma, atrophic processes with phenomena of aspontaneity).

Emotional monotony- the patient has an even, cold attitude towards all events, regardless of their emotional significance. There is no adequate emotional resonance.

Emotional coldness– events that are significant in the normal state are perceived as a fact.

Emotional callousness- manifests itself in the loss of the most subtle differentiated emotional reactions: delicacy and empathy disappear, disinhibition, importunity, and impudence appear (organic lesions of the brain, schizophrenia).

Clinical example: “A patient suffering from schizophrenia for many years lies in bed all day, not showing any interest in anything. She remains just as indifferent when her parents visit her, and did not react in any way to the message about the death of her older sister. She perks up only when she hears the clink of dishes being set out from the dining room or sees a bag of food in the hands of visitors, and she no longer reacts to what kind of home-cooked food was brought to her, but in what quantity.”

Depression- a mental disorder accompanied by low mood, feelings of melancholy, anxiety and a pronounced affect of fear.

low mood with a feeling of depression, depression, melancholy and an affect of fear

slow thinking

slower speech activity

Depending on the severity of the components of the triad at the 1st pole there will be depressive stupor with the most pronounced motor, ideational inhibition, and on the 2nd - depressive/melancholic raptus with melancholy, anxiety, suicidal attempts. These states can easily transform into each other.

Clinical example: “The patient sits motionless on the bed, head down, arms dangling helplessly. The expression on his face is sad, his gaze is fixed on one point. He answers questions in monosyllables, after a long pause, in a barely audible voice. She complains that she doesn’t have any thoughts in her head for hours.”

By depth:

Psychotic level - lack of criticism, the presence of delusional ideas of self-accusation, self-deprecation.

Neurotic level – criticism remains, delusional ideas of self-accusation and self-deprecation are absent

By origin:

Endogenous – occurs spontaneously (autochthonous), characterized by seasonality (spring-autumn), daily mood fluctuations (emphasis on the first half of the day). One of the extreme manifestations of severity is mental anesthesia (painful mental insensibility).

Reactive – occurs as a result of a super-strong psychotraumatic factor. The peculiarity is that the structure always contains the situation that led to this disorder.

Involutional – occurs during the period of age-related reverse development, more often in women. According to the clinical picture, this is anxious depression.

Somatogenic – occurs as a result of somatic suffering.

Masked(somatized, larved) – somatovegetative masks of depressive disorders come to the fore.