With a clear, sensible and generally accepted definition of negative syndromes in psychiatry was no more lucky than the word “ass” in classical literature: there is an objective reality given to us in all the fullness of sensations and a variety of adventures found — and the word seems to be absent. The phenomenon described by the term used, but it is worth asking what is it and why is not reflected in ICD-10— all endemic dysarthria and Sperlonga.
So what are negative syndromes? Negative syndromes are the loss of the formed psyche of its already existing qualities and properties. They are also called deficient, that is, leading to the formation of a mental defect: here was a whole psyche, here is an element dropped out of it — get a defect. Oh, Yes, it should be added that the reason for the loss, loss of these qualities and properties is a mental illness.
There is a scale of negative syndromes: from the lightest to the most severe, the final state of the psyche: exhaustion of mental activity; subjectively conscious change in the “I”; objectively determined change in personality; disharmony of the individual; decrease (or reduction) of the energy potential; decrease in the level of personality; regression of the individual; amnesic disorders; total dementia; mental insanity.
Now learn more about each of the syndromes.
Depletion of mental activity. In appearance, it is very similar to asthenic syndrome. It is characterized by:
• increased fatigue, and it does not matter what to do: roll bags or make small talk;
• irritability — not the sullen one that darkly smoulders in a dysphoric fecaloid for weeks and months, but more like a balloon on an alley of cacti: darted, flapped and sagged;
• emotional lability, when the mood in one day can change from rosy through misanthropic to self-deprecating more than once;
• hyperesthesia, when any more or less distinct stimulus (phone call, camera flash, a trail of perfume from a passing lady, an unexpected touch) it is so painful to the nerves that there is no way to restrain yourself — however, as already mentioned, this surge will not last long;
• weakening of memory and attention — not due to the fact that there is nothing to remember and concentrate on, but due to the fact that memorization and concentration require strength — and they are not.
So what is the difference?
First of all, in the discrepancy between the degree of depletion and the external causes that could cause it. In other words, where did you work so hard that you were so tired? With a neurotic, everything is more or less clear: constant work or household stress, a lot of unsolved (and often unsolvable in principle) small tasks, General unsettledness and lack of a pofigistic Tao — and here is the result. It is the same with a person after a serious illness: the body has spent all its strength to survive, there is no time for higher matters. But when such symptoms occur out of the blue, out of nothing — that’s when it’s different, as well as the direction of diagnostic search.
In addition, the dynamics of the syndrome is important. With the same neurosis or the consequences of a serious physical illness, surgery or injury, this syndrome will sooner or later come to naught: the body will get stronger, the psyche will gain strength and wisdom (the latter, however, is optional), life will get better — and goodbye, asthenia, until new shocks. Exhaustion within the negative syndrome will not let go so easily. It will not go away even if you put a person in ideal conditions, with a lifetime salary just for not daring to work anywhere, a Villa on the Riviera and every season courtesans with an angelic character in quite earthly forms.
On the contrary (and this is the third difference), it will become the essence of the personality itself, gradually eating up the will, the ability to think and act creatively, empathize and turn their attention and interests outside (up to the transformation of an extrovert into an introvert).
Subjectively Conscious change in the “I”. remember the cat Matroskin? “And I increasingly notice that someone has replaced me. I don’t even dream about the seas, TV has replaced nature for me.” Formally, externally, the intellect, memory, and character of a person are the same, and for others it is the same as it was. But not for myself.
The person himself feels that he is not the same as before. And quite clearly, there is no doubt about it. What has changed? The attitudes of life changed: it was as if someone was pulling out the hooks that marked the path to the goal, and the goal itself-now it is not clear whether it was there at all or whether it was its Ghost? In any case, it’s gone, too. Only inertia remains. Changed the motives of: if before something was done because I wanted and they could, now more because I have to or used to, or because that’s what you expect, and sometimes in spite of expectations. The attitude towards oneself has changed — not exactly for the better and not so definitely for the worse — it has simply become different, matching the changed “I”. Having broken through a new attitude to yourself, the attitude to others, relatives and friends has changed. Continuing to live and act outwardly in the same way (well, almost the same way) as before, a person becomes not so much a participant in events as watching his role in this theater from the outside, but not finding the former strength and desire to live this role, and not play it. Yes, and the roles and masks themselves, which previously people changed according to the situation easily and almost without looking, now seem more and more unnatural, false, and you have to make an effort to prevent some Stanislavsky from shouting: “I Don’t believe it!» Again, you don’t want to make an effort!
To objectively determine the personality change. This is the next step on the ladder of negative syndromes, and if at the previous step a person still noticed that something was wrong with him, now these changes are noticeable to others, and he is no longer able to realize them. Why? These changes have already become an integral part of his personality, and the person no longer has any idea how to feel, live and think differently. He had already lived in the shell, whose walls had recently pressed against his thighs. And self-criticism, still trying to reflect and send distress signals at the previous stage, took a spare spacesuit, emergency NZ and quietly deserted.
At this stage, it becomes noticeable how a person avoids everything new and unknown, how he loses the ability to think and act creatively, adhering to the good old (and such a habitually safe) routine. He himself does not notice anything like this for himself, even takes offense and sincerely wonders why he was suddenly recorded in retrogrades and conservatives?
The patient’s life itself becomes monotonous, passive, he goes with the flow, like a lost landing stage, and any attempt to stir him up, make him make independent decisions, and even more so to be responsible for them, only upsets, scares and irritates him.
The circle of interests is narrowing — after all, to be interested in something, you need to get out of your shell: inside there is a warm blanket, a computer and a can of beer with chips, and outside everything is more uncomfortable and anxious. For the same reason, the circle of acquaintances and communication is narrowing: it is troublesome, restless, you need to spend yourself — and just not interesting.
Character traits that were previously smoothed out are sharpened; those that no one guessed at all appear. And they were present before, just successfully masked by the fullness of feelings, emotions, aspirations and willingness to show interest outside. And now the vulnerability becomes especially visible — to the point of resentment, subordination, pettiness and pedantry, hypocrisy. Another half-step and the personality changes will take shape, become fixed, and then we will talk about disharmony.
Disharmony of personality. In appearance, it quite clearly resembles psychopathy. However, there are two big “buts”. First, psychopathy is a personality disorder that manifests itself early, at the stage of formation of this very personality, and disharmony develops during the disease and changes the already formed personality. Secondly, to put it figuratively, psychopathy could be compared to a rock that causes a lot of problems and unflattering epithets, protruding from a deep lake — if you consider the personality itself, with all its qualities, characteristics and habits, as a lake. In this case, disharmony is more like underwater rocks and wrecks of sunken ships, once hidden under water, but now appearing above the surface of a very shallow and swampy lake.
Depending on which set of personality traits will prevail, disharmony can be similar to any of the psychopathies or a combination of them, like mosaic, with the only difference that in this set there will always be something subtly wrong, with two or three elements taken as if from a completely different picture.
There are also quite characteristic types of personal disharmony that allow us to describe them as separate symptom complexes. This is a symptom Feerasta, acquired chitalishte and autism from the inside out.
The Feofrastus symptom was described in 1982 by V. M. Bleicher and L. I. Zavilyanskaya. Plato had a pupil, Theophrastus of eres, who later became a close friend of The great thinker and wrote the book “Ethical characters”. In this book, among other things, described the phenomenon of optimate, which people say: “Gray hair in the beard — a demon in the rib.” There are people who meet the milestone of 55-60 years with dignity, sedately and without emotional anguish. And there is a group of friends who loom on the horizon of old age and counted kilometers of personal nedotraha seem to spit in the soul, and in fact become a fuse to a barrel of gunpowder hidden in the attic. Here’s a light getting closer — and Hello!
The person suddenly seems to come to life: chronically stooped shoulders unfold, convulsive attempts are made to pull in (or at least pull a wide bandage) a flaccid tummy, a mischievous light lights up in the eyes, suspiciously resembling a light reflex from the back of the skull-everything, vintage ass is ready for new adventures. Desperate attempts are made to become young again: youth clothing, youth music, changing the social circle from those who count heart attacks and measure the size of kidney stones and hemorrhoids, to those who take out and make notches on the railing, young lovers and mistresses appear, youth clubs and tourist gatherings are visited. It is useless to call for self — criticism-she has been on the run for a long time, has received another citizenship and prefers not to take a deep drag on the smoke of the Fatherland.
• Acquired chitalishte. This is the result of the development of continuous or paroxysmal-progressive schizophrenia. It is expressed, first of all, in the appearance and growth of autism. Achtung! We are not talking about childhood autism, but about a defect that developed as a result of the disease. Moreover, a defect that is so characteristic of schizophrenia that without it it is impossible to have a sufficiently deep understanding of this disease. How does it manifest itself? First of all, in the emotional detachment of the patient from everything that does not concern his personal world. This is the very strangeness, coldness, alienness to everything external, not your own. This is the inability to understand the usual logic and the inability to cause at least some adequate response to the manifestation of feelings. The patient, in principle, know (somewhere heard, read, learned from others), that a smile would be nice to respond with a smile, good, to return good, a slap in the face to turn the hip, tilting the shot to the chest and finish with your elbow, and on the death of a loved being — at least to shed a tear. But he does not feel the need and need to do so — in his soul, just not born the appropriate response. This is unsociability — simply because there is no need to let anyone else into your world. This is a lack of interest in the events around you — enough of your own thoughts and experiences. This is a symptom of “wood and glass”, with an impenetrable dullness and callousness, even cruelty to what is outside the circle of its own, personal and carefully guarded, and vulnerability, fragility and readiness to break for any attempt to invade — in relation to everything that is included in this circle, whether it is a collection of unwashed socks or a favorite cactus. This is the subordination of thinking to some special schemes, stereotypes, its rigidity and rigidity, not to mention pretentiousness and completely unthinkable logic. This is a sudden change of Outlook — without any visible prerequisites, when a person suddenly dives into mysticism, occultism, or suddenly becomes a zealous advocate of one of the Orthodox religions (usually being a convinced atheist), or suddenly discovers the charms of invention, becoming a real headache for the household and a hemorrhoid for the patent offices. Autism inside out, or regressive synth. Outwardly, it may seem that this state is the exact opposite of autism: sociability beyond measure, openness, even in what is usually supposed to hide, looseness to the point of unbridled. But if you look closely, you can see that this phenomenon is based on the same lack of understanding and inability to subtly feel the emotional and moral-ethical line between what is allowed and taboo, between what is generally accepted and reprehensible, between what can be announced and demonstrated, and purely intimate. Such a patient does not cost anything to walk naked around the hostel, explaining to all comers that the farm should be ventilated so as not to burn. Or share with your neighbors in the compartment the details of visiting the toilet, sincerely expecting them to be the same frankness. Or run around with plans to create a society of people free from prejudice (with forced nudity and mandatory haphazard peretrahom). Moreover, such a patient will be convinced that he does not violate any norms of behavior — everyone is just some kind of complex.
Reducing the level of personality. What happens to a broken limb if it is not forced to work and recover for a long time? That’s right, the muscles atrophy and the amount of movement that can be done with it decreases. Approximately the same thing happens with the patient’s personality when, due to a decrease in the energy potential, for months and years, he is not interested in anything, does not strive for anything, and shows little of his individuality.
The difference can manifest itself in how the remnants of the personality Express themselves:
• in complete detachment from reality, almost complete absence of interests and motives, in a minimum… not even emotions, but their pale similarity, memory of how they should be shown, and in thinking that slips in its reasonableness, constantly slips from the main topic, is stuck in symbolism and diversity — and in the end does not give birth to anything worthwhile;
• fixated and focused on their simple household interests: where to eat, what to drink, where to stay, so as not to touch. These interests are sacredly and meticulously protected, and God forbid you to get further into this badger hole than you should — you are guaranteed to get it. And given that such a patient thinks slowly and with difficulty, but is inclined to attach importance to any trifles and is practically unable to distract himself from something else, the process may be delayed;
• complacency and carelessness (but without real gaiety and hedonism), frivolity and misunderstanding of the depth and volume of the anatomical part of the universe in which the patient is hopelessly stuck.
Regression of personality. Here you will hardly be able to recognize a person you have known for many years, if the patient was familiar to you. If not, you can hardly guess what it was like before. The disease has erased all the hallmarks of his personality, and he is just one of many residents of a boarding house for psychochronics, a group of homeless people or permanently registered patients in a psychiatric hospital. No interests, no attempts to change anything in life, no ability to think coherently and Express, no bright emotions. Yes, you can see that some patients are simply amoeboid and indifferent, others are grumpy and angry, and still others constantly smile — but this is all in which, apart from their appearance and passport data, they can be distinguished.
Amnesic disorders. In this negative syndrome, memory suffers first of all. And mostly memory. Intelligence suffers less noticeably: Yes, it is difficult or impossible to acquire new knowledge and skills; Yes, it is very difficult to keep the necessary amount of information in your head to fully operate with it, but most of the skills, knowledge and proven patterns of actions obtained before the onset of the disease remain intact for a long time. Skill, as they say, you will not drink (by the way, the thesis is controversial, but I do not advise you to check).
The initial manifestations of progressive amnesia (that is, not the one that immediately follows the fateful meeting of the head and flimsy baseball bat) look nothing like the sudden disappearance of memory, and a lower ability to remember or a long time to hold in memory (the expression “memory like a sieve” is the right stone in the right garden), difficulty remembering (a familiar situation when solving the crossword puzzle, isn’t it?). Gradually, the memory becomes impoverished.
If amnesic disorders progress, the Ribot law comes into force: first, the events of the next few days, months, and years are forgotten, and only then does amnesia absorb more and more early events and facts from life, but from the present to the past, and in no other way.
In many patients, amnesic disorders are limited to fixation amnesia, that is, the loss of memory for current events and the inability to remember and retain anything. This condition can last for years before getting worse or improving (the latter, given the non-dormant evil entropy, is less common, but also not excluded). At the same time, the memory of past years, and the knowledge and skills acquired once do not disappear anywhere. In addition, many patients with fixation amnesia realize that they have a problem with memory, and try to somehow cope with it: they start notebooks and organizers, keep diaries and Chronicles, write and stick notes in the apartment that remind them (turn off the gas, take the keys to the house, tell the district police officer and the emergency service where they are going), ask their relatives and friends to make control calls. If the amnesia is pronounced, the patient may forget that he has just been fed or that he has already performed his marital duty today (however, the latter is not always regarded as a disadvantage).
Total dementia. If a person — with his individual characteristics, intellectual baggage, emotions and strong — willed aspirations-can be compared to an architectural structure, then with total dementia, he remains in ruins. And such that no restorer will assume that there was before the bombing.
Intellect has not gone deep underground, as if synodical, he was captured and Kolesova in the square. I got all its components, from the ability to draw conclusions, generalizations and conclusions, the ability to analyze, abstract, compare and highlight the main thing, to basic skills such as counting and the ability to follow even simple instructions. You can search for knowledge and skills, but it is easier to find the gold of the party.
Memory at this stage, as a rule, resembles not even a sieve, but one large gap in the width of life, on the outskirts of which the lemmings of childhood memories are shyly trampling, wondering whether to follow the General trend or linger a little?
The surviving emotions are on the level of joy from a piece of something delicious or displeasure from an overflowing diaper.
Where the will used to dwell, utter apathy reigns. Or the lower instincts that have been stirred up are mischievous (when they say that the whole person has gone to the root).
Mental insanity (from the Greek. marasmos — exhaustion, extinction). This is the terminal, most pronounced and severe stage of dementia. The collapse of mental activity in mental insanity is complete — up to the disappearance of speech, the inability to achieve any intelligible reaction to an attempt to speak, call out, call by name, ask something or ask to do. The semblance of interest remains only in food, and then not always, and emotions — in the form of traces of pleasure or displeasure. As a rule, physical insanity (exhaustion) is soon joined with weight loss, cachexia, gross focal disorders of the nervous system, dystrophy of internal organs, the appearance of bedsores and, often, congestive pneumonia — and there is already half a step to death.
Memory at this stage, as a rule, resembles not even a sieve, but one large gap in the width of life, on the outskirts of which the lemmings of childhood memories are shyly trampling, wondering whether to follow the General trend or linger a little?
The surviving emotions are on the level of joy from a piece of something delicious or displeasure from an overflowing diaper.
Where the will used to dwell, utter apathy reigns. Or the lower instincts that have been stirred up are mischievous (when they say that the whole person has gone to the root).
Mental insanity (from the Greek. marasmos — exhaustion, extinction). This is the terminal, most pronounced and severe stage of dementia. The collapse of mental activity in mental insanity is complete — up to the disappearance of speech, the inability to achieve any intelligible reaction to an attempt to speak, call out, call by name, ask something or ask to do. The semblance of interest remains only in food, and then not always, and emotions — in the form of traces of pleasure or displeasure. As a rule, physical insanity (exhaustion) is soon joined with weight loss, cachexia, gross focal disorders of the nervous system, dystrophy of internal organs, the appearance of bedsores and, often, congestive pneumonia — and there is already half a step to death.