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Labile

If you can say “mood person” about someone — it’s about them. In the morning, I was in a great mood, I was going to work, I loved the whole world, but as soon as a flying pigeon in the act of aiming defecation slightly missed and hit our hero — and that’s all, a drop of organic matter put an end to the episode of humanity. A knight of the order of militant misanthropes came to work, secretly dreaming of punching someone in the eye. Well, well-well-send it away. Well, if you’re going to be nauseatingly objective, it’s not out loud, but in your head.

But the process of work distracts the newly minted paladin from gloomy thoughts, in which there are colleagues, superiors and scenes of beheadings with him in the role of the performer; the prospects are more pleasant-a cozy apartment, a loving wife, cold beer-and again the mood tends to the mark “cloudless”. Who else would have shot a pigeon…

This type is somewhat similar to the cycloid. The difference is in the speed and ease of changing the mood. With all this, emotions and feelings are bright, expressed, deep, there is no talk of superficiality and frivolity here. They don’t change friends and loved ones right and left, no. They prefer to please those who are there with mood changes. Friends and loved ones, remembering such a sweet zest, also do not get very angry. For they know that it is enough to hug and kiss (if a loved one) or offer to give up on everything and drink quantum satis (if a friend) — and the person will be transformed. In the right direction, the main thing is not to confuse. With parents, too, deep and insoluble conflicts, as a rule, do not arise, especially since the vast majority of people of this type in childhood often suffered from all sorts of colds and other infectious sores and perfectly remember who took care of them, sick and unhappy, took care of them.

They are not prone to delusions in the assessment of themselves, their loved ones. As well as in the assessment of others — they feel them more intuitively than logically, because most often it is true. It is unlikely that you will find among them fans of collecting or stubborn hobbits — not that state of mind. If such a person is subordinate to you, remember: praise and encourage! Then the mountains will be rolled up for you and, as a bonus, the hills will be rolled up.

Conformal

Probably the very first version of Adam, until the Lord got bored. For the most part, such people are accumulators of maxims, conservative ideas, popular opinions, established fashion and stamps, stamps, stamps — a kind of press — forging production in a brain factory. A sort of Vasily Alibabaevich: “Everyone ran — and I ran.” The ideal consumer of a mass product and a feed base for the advertiser. The sacred belief in the power of the printed word is not inferior to the effect of the unprintable word on these types. They firmly believe in the healing power of everything that is printed in the “Healthy lifestyle”, which leads to the exhausted despair of the employees of the more traditional and less inclined to experiment with the precious life of health care. On a popular TV show or, God forbid, a favorite TV series, they react more abruptly than banderlogs to the whisper of a hungry Kaa. And at the same time-good and loyal friends who do not pull you to feats, do not force you to participate in actions in the name of something and protests to anything, do not use friendship as a step in their career ladder. Cozy and plush. They won’t sit around and egg you on. Soft and fluffy. This is the main character from “Irony of Fate”. The cement of the collective, since they perceive friction and conflicts as the height of the harvest in the area of their own genitals, therefore, they try to extinguish them even at the first signs of the sickles being extracted. If you drink something because drinking companions from the team, not to fall out of the General background; if you listen to rap it because of all the classmates listen, and that’s cool; length hair is also correlated with the level of Orthodoxy.

From quite obedient children grow up quite obedient husbands and wives, who are unlikely to ever abandon their half on their own: figs, figs, for whom the intoxicating feeling of freedom, and for them-the chilling vacuum of open space, under the heel, though tight, but cozy, and most importantly — familiar.

Unlikely to be the first to leave their homes in search of a better life; however, it is worth “Into the city!” “To Moscow!”, “Israel!” or “Canada!” to take the mass in their environment, the nature, the mood becomes suitcase, distant relatives of these places suddenly nearer and dearer, and the probable point of destination suddenly enveloped by a haze of sweet dreams.

For all that, they are the bulwark of peace and stability, the buffer for revolutionary-extremist ideas and fiery-psychopathic comandantes, which does not allow progress to grow to amazement and fan a world fire on the mountain of all the bourgeois. Again, the number of human particles in the passion state should be at least partially balanced by stationary ones, otherwise it will just turn out to be weapons-grade plutonium. Someone has to plow the land peacefully.

In terms of work, by the way — he is an ideal performer or a middle-level official. Due diligence, due deference, zealous observance of traditions. The main thing is that the company does not rush to change the production of swords for plowshares, sewing for soap, horseradish for radish and so on.

The Hysteroid Type

Remembering the alleged dialogue, where Stanislavsky exclaims “I don’t believe it!”, and Nemirovich-Danchenko beats his chest and assures “I’ll be a reptile!”, I want to say: we need to recruit hysteroids to the theater. And in the movies. And on the stage. Then the person will be in place, his egocentrism will be completely satisfied, and his demonstrativeness will be directed in the right direction, and no one will suffer.

In fact, from a general-hysteroid, you should expect concern about your appearance — whether the jacket fits well, whether the awards are clearly visible to others from this angle, how much more beautiful it is to fall to the ground if a stray bullet suddenly arrives (oh, how tragic!). The hysteroid cosmonaut will bring the Mission Control Center to a white heat with video reports with his heroic face in the foreground, and from the spacewalk he will arrange such a fashion show that it will go down in the annals of manuals for models. Along with two hundred and fifty-six frames of “Me and my little ship against the background of the old woman-Earth”. A hysterical plumber will make your whole family watch the sacred process of skilfully replacing the toilet. The hysterical shahid … stop, stop, stop. There are no hysteroid shahids in nature. Still, he loves himself more than Allah, and the sight of himself in fragments against the background of the landscape is shocking, but unsightly, and the main viewer will be absent.

The egocentrism of the hysteroid can only compete with its own demonstrativeness and can shake our ideas about the laws of gravity: what a planet, what a Sun, when we have such a supernova here! Therefore, do not wait for completed suicides-well, except for an unfortunate misunderstanding: the audience did not arrive in time, the dose of pills was really big, the rope was too strong, and the stool was too shaky, the cut was too deep, the windowsill, infection, slippery — fate also has a sense of humor. But attempts are likely to be made. Because of the lack of understanding and callousness of others, unrequited love (opera theater, she didn’t even notice me!), because of the lack of attention as such. And suicide notes. Yes, before committing suicide, he will wash himself, shave wherever he needs to, make up and do his hair: what if the doctor of the resuscitation team is of the opposite sex?

Having drunk in the company of the least, the hysteroid will be the most intoxicated and strange. Of all those who have tried the forbidden stuff, he will be the most difficult to insert, and he will certainly inform these others about it. If we are talking about a hobby, then it will be one that will fully reveal the uniqueness of Comrade Sumkin.

Speaking of suggestibility and hypnosis ability, it can be noted that, in contrast to the HYSTERICAL, she is present when a strategically important and could give the right impression. If you need to show yourself a persistent tin soldier, then the passes and formulas of immersion in trance will not work: look how well I did!

The chosen ones of the opposite sex are looked after according to the principle “so that it is not a shame to appear in public”. The ideal bedroom — mirror, mirror… And a cheering “it was just amazing, you’re GREAT!”. For complete happiness — ovations and shouts of admiration from behind the wall and greedily interested looks of OTHER people’s halves for the next day and from now on. Having got used to the idea that his half, all so sudden, like diarrhea, and not reflected in any mirror, like a vampire, will leave at any moment — with his external data and the fibers of the soul, the entire opposite sex is just waiting to pounce and tear at souvenirs — the fact that the half, exhausted by this severe form of narcissism, left him first, can plunge the hysteroid into sincere perplexity: HOW??? ME??? I HAVE SOMETHING FOR THAT??? Then there may be scenes worthy of Shakespeare and Byron, with hand-wringing, attempts to drink poison and kill yourself against the wall, with death lyrics-in order to return and throw yourself.

The most likable character-a hysteroid — is, in my opinion, Carlson.

If, due to some fatal misunderstanding, the hysteroid did not find his way to the stage, but got lost and ended up in the position of your boss, remember: no flattery will be superfluous. To admire, to take photographs and portraits to remember! “You have such feathers, you have such horns, your hooves are very slender and a good soul!” If a subordinate does not get to the stage, do not put him for paper work or work involving loneliness — he will wither, wither and will hang around the corridors in mute reproach. Give him a chance to shine in public, hold a symposium, organize a meeting or get-together, and be sure to emphasize the importance and weight of his contribution to the production process.

Hyperthymic Type

This is noticeable immediately and from afar. Even on Monday morning, when everyone is mentally and physically experiencing the excesses allowed to themselves and moaning with anticipation of a full working week, this infection will have a blooming appearance, disgusting cheerfulness and a murderously good mood. Moreover, he will try to raise it to everyone around him and sincerely wonder why he is sent everywhere. However, sincere and targeted wishes are not able to overshadow his radiant state of mind — at least for a long time. As well as an excellent appetite and a good night’s sleep.

He gets to know others and converges with them from half a point, and the fact that for network marketing workers and “Jehovah’s Witnesses” there is a hemorrhoid and the subject of daily meditations is as natural for him as breathing. Or take a leak after a liter of beer. Speaking of alcohol. Someone drinks to dispel the melancholy. Someone to forget. This one drinks in company so that the others catch up with his euphoric-hedonistic level. Maybe, really, get carried away.

In the companies of friends most often leads — so much energy, enthusiasm and bad initiative can be found only in the lost control and long forgotten in orbit of the Soviet spy satellite on nuclear batteries. For the authorities, respectively, a constant source of anxiety and breathing in the back of the head against the background of a maddening image of a cheerful dolt, which is rushing.

As for interests and hobbies-they are there. There are many of them. The mind-blowing breadth of views, coupled with the lightness of thoughts, lead to the fact that yesterday’s Greenpeace activist today begins to collect guns and stuffed animals, and tomorrow — posters selected in fights with the “greens”. In general, ” drama club, photo club, and I also want to sing.”

He treats laws and by-laws as a misunderstanding that hinders a healthy initiative, and considers them only in a recommendatory aspect, which sometimes leads to mutual misunderstandings, also, however, unable to overshadow his brow for a long time.

Asthenic-neurotic Type

Imagine what Comrade Stalin would once have said to Semyon Mikhailovich Budyonny: “You will be, dear Comrade Budyonny, a psychiatrist. There are not enough good psychiatric personnel in the country. And the cadres, Semyon Mikhailovich batono, decide everything.” And I would have to mentally whisper to the swearing uncle to put on a white coat over the sword belt with a saber (where without it), change the felt pointed helmet for a cap (ugh, I’m sorry, God!) and treat the mournful with your head. And give lectures to students. And if you asked Budyonny what the asthenic-neurotic type of accentuation of character is, he would answer…

“Arab horse, fellow students. The same nervous, delicate soul and timid. Capricious, but beautiful. In the long gallop to put the do not can — no, more Yes trot gait, and if you want to gallop short spurts. And don’t let any of the bastards fire their guns next to you, or else get the rider out of here!” Such a … squiggle.”

So long-term loads for a representative of this type of death are similar-it does not matter whether they are physical or psychoemotional. It’s like an F-16 [60] without refueling in the air: it took off, did a dirty trick in order to maintain democracy — and to the base. Standing in queues, waiting for something, the prospect of monotonous work is immediately added to the list of tortures of special sophistication and try, accordingly, to avoid.

Such people are irritable. Not hot-tempered, like hypertimus (about which later) – they say that you are all exclusive here, and I am d’Artagnan; not angry with boiling, redness and steam from the ears, like an epileptoid, but more like a balloon: cotton-and a limp piece on a thread. Moreover, the ” pop ” can be loud, sudden and insignificant in appearance prick. At the same time, they are otkhodchivy, they can even cry on the shoulder of the newly cursed, but also for a short time. Sometimes they confuse their beloved half with this: he yelled, and in the end he has to be comforted, patted on the head and say that everything is fine.

Concerned about their health. Heart, headaches, short sexual intercourse-yes, you never know what, the main thing is to live for some crap. Therefore, they are very much loved by all kinds of healers — the main thing is that the treatment is short and clear. Long-term schemes and diets lead them to a state of sub-stupor, like Winnie-the-Pooh long words.

They are drawn to friends, but quickly get tired of noisy companies. Looking for peace-and quickly climb the wall of loneliness. Recalling the best years, they are surprised to note that they passed under the banner of chronic fatigue and permanent irritability. Making plans for the future, like the Arabs of Inshallah, repeat “if God gives you health.”

Private psychopathology -Accentuation of character

I would start my study of private psychopathology with characters. more precisely, with their accentuations. I want to immediately note that accentuation of character is not a disease.

This is still the norm, just special, emphatically specific. perhaps, under unfavorable circumstances, accentuation will grow to psychopathy or give a specific color to the course of mental illness — but, again, this is a variant of the norm. Angular, bulging with its unique facets, but normal. Characters are like zodiac signs for an astrologer. This is the foundation. Once the term “temperament”was used. The word “temperament “( from Lat. temperans-moderate) in Latin means “the proper ratio of parts”; the Greek word “krasis” (fusion, mixing) was introduced by the ancient Greek physician Hippocrates. By temperament, he understood both anatomical and physiological, and individual psychological characteristics of a person. Hippocrates explained temperament as a feature of behavior, the predominance in the body of one of the “vital juices” (four elements).

The predominance of yellow bile (from the Greek cholē — bile, poison) makes a person impulsive, “hot” – choleric.

the predominance of lymph (from the greek phlégma — sputum) makes a person calm and slow-phlegmatic.

the predominance of blood (from lat. sanguis-blood) makes a person mobile and cheerful-sanguine.

the predominance of black bile (from the greek melas — black and chole — bile) makes a person sad and fearful — melancholic.

They say-cultivate character. And you try to change in yourself what is given by nature itself. Character is a very stable thing. It’s like facial features. Try to give the face the desired expression and keep it for years, without a break for lunch (true, haughty or mournful folds in the corner of the mouth are formed relatively quickly, but this is the rule of all bad habits). Exactly the same as the shape of the character is laid genetically. And during his life, his features are smoothed or sharpened, but very, very rarely change dramatically (usually a psychiatrist is alarmed). Look at your children. Which of your character traits did they inherit? In what bizarre combination? Are there any grandparents in them?

Neuroleptic Syndrome

Although this syndrome belongs more to neurology than to psychiatry, without it, the description of syndromes and understanding of problems in our branch of medicine would be incomplete.

When aminazine first appeared in psychiatric practice in the early fifties, it was a breakthrough. This was the beginning of a new era in psychiatry — the era of neuroleptics. The tactics of managing patients have changed dramatically: now many people could not be kept in hospitals for years and decades — now you could prescribe treatment and let them go home! Not all of them, of course, but many, many. However, according to some adherents of pure science, with the advent of aminazine, the last real mental patient disappeared from clinics-allegedly, neuroleptics changed the picture of the disease so much. But you know these inveterate humanists with a burdened history — do not feed them bread, just let them perform medical and diagnostic decapitation. Or catch a representative sample of pygmies and chimpanzees, and then make them live together for a long time, passionately and presumably happily — just to see who the children will become.

Following chlorpromazine, a number of antipsychotics, selectively acting for different types of psychosomatica: for example, stelazin (triftazin he) was good for the relief of delirium, haloperidol — to deal with the hallucinations. But, as is usually the case with any medicine, after a short period of trying on the laurels of the panacea, the first taste of tar appeared. Patients liked neuroleptics much less than the doctors who prescribed them. Why? It’s all about one of the side effects-neuroleptic syndrome.

Strictly speaking, neuroleptic syndrome, or neurolepsy, is a special variant of the so-called extrapyramidal disorders (the term is taken from neurology; the extrapyramidal system controls human movements, maintains muscle tone and body posture, without involving the cerebral cortex and its pyramidal cells). These disorders can be caused by both the disease and the side effects of certain medications, especially those that affect the concentration of the intermediary (one of many) transmission of nerve signals — dopamine. It could be some of the medications for the treatment of Parkinson’s disease, and calcium channel blockers used in cardiology, and last but not least antipsychotics. And since these are used very widely, the neuroleptic syndrome can be distinguished and considered separately.

It is this side effect (or rather, a whole bunch of them) that neuroleptics are so disliked by psychiatric patients, it is this syndrome that is regarded as a punishment for any offense, and it is this syndrome that is put on view, Recalling punitive psychiatry. Where does it come from and how does it manifest itself?

The exact mechanism is not yet fully understood. It is believed that neuroleptics, among other things, block the receptors in the subcortical nuclei that are sensitive to dopamine. This, in turn, leads to an increase in the synthesis of dopamine in the body (something like a person, getting used to the smell of his Cologne, uses it more and more, up to washing them), and its excess triggers a painful process.

The process itself can take place:

in the acute form: they gave the medicine-crooked, canceled-passed;

• in the protracted form: they gave the medicine for a long time, then canceled, and the side effects last for another week or even a month or two;

• in chronic form, when neurolepsia does not disappear even after the full withdrawal of neuroleptics;

  • in the malignant form: with lightning-fast development and aggravation of symptoms and frequent death.

Neuroleptic syndrome is expressed in the following manifestations, which can either exist in isolation or be combined with each other, sometimes very fancifully.

Neuroleptic parkinsonism. The patient feels stiffness in all the muscles of the body, his movements become stingy, slowed down, his arms are slightly bent at the elbows and tense, his gait is mincing, shuffling. The hands are shaking more or less constantly; in a sitting position, the knees begin to shake – sometimes barely noticeably, then as if the patient throws them up on purpose. Sometimes the lower jaw shakes, which creates the feeling that the patient chews frequently (rabbit syndrome).

Dystonia. There are acute, caused by the current intake of neuroleptics, and late, which occurs after several years of continuous treatment and persists long after the withdrawal of neuroleptics. How does it manifest? Remember how the leg muscles cramp if you sit them out or if you overwork them while swimming. Now imagine that it twists the back muscles in the same way, causing the torso to bend. Or the neck, which causes the head to go sideways or throw back. Or chewing muscles. There is also a so-called oculohirny crisis, when, in addition to throwing back the head, the eyes roll up, because the oculomotor muscles have contracted.

Neuroleptic akathisia. Patients themselves call it restlessness. I always want to change my position, because the one I just took is already uncomfortable. But the new one does not bring relief. Maybe get up, walk around? A little better, but then I want to sit down. Uncomfortable again. Lie down? Yes, it is impossible! Sitting on a chair, the patient fidgets, sways, shifts one leg to the other and, on the contrary, fastens and unbuttons buttons, fingering – not a second of rest.

Neuroleptic malignant syndrome. Fortunately, it is rare. Develops quickly: sharply raises the temperature up to 38 degrees Celsius and above, poruchaetsya consciousness up to coma, the patient is numb, the muscles of the body tense, sweating heavily, panting, the pulse part, the heart begins to malfunction rhythm. Lethality in malignant neuroleptic syndrome is from 10 to 20 %.

Of course, this syndrome was not ignored. Medications were found that completely remove or at least ease its manifestations. However, even here, without reservations and caution, nothing. For example, the same cyclodol. Everything seems to be fine, I took a pill — and the stiffness passed, and the restlessness disappeared somewhere. There is no an, and it has its disadvantages. First of all, it can be abused — for the sake of a relaxed state, when the whole body moves in the surrounding air, as if in a pool: smoothly, freely, moved the fin — and soared… And after a certain excess of the dosage, you can look at interesting hallucinations at all. So they get hooked on this drug. Fortunately, this proofreader is not the only one.

The next step was to develop new, atypical neuroleptics, which, according to the plan, had no neuroleptic effect. Here, too, everything is not smooth: neuroleptic syndrome when taking some of the new drugs is indeed less pronounced, but not all and not always, and even new side effects… in Short, there is something to work on.

And yet, neuroleptic syndrome is not a reason to refuse treatment, especially if it allows you to get rid of an alien invasion of a particular apartment, to shield yourself from harmful rays and vibrations, or to survive a worldwide conspiracy of militant cryptosionism due to an acute attack of philosophizing quasipofigism. The main thing is for both the patient and the doctor to put aside fanaticism and template and solve the problem of selecting drugs and doses creatively each time.

Negative Syndromes

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.

Munchausen Syndrome

The name of the syndrome — Munchausen syndrome-was proposed in 1951 by Richard Asher, who described several clinical cases where patients invented, or even intentionally caused themselves painful symptoms. No, similar cases have been described before. So, a nomadic patient was described, the “hospital flea” syndrome, the syndrome of a hospital frequenter. But you know, the memory is stored with what is associated with more associations and emotions.

Nevertheless, all these syndromes, along with baronsky, took their place on the shelf of the international classification of diseases. In its 10th revision-under the code F68. 1 That is, it is “intentionally causing or simulating symptoms or disabilities of a physical or psychological nature (fake violation)”. But note that the simulation itself is encrypted as Z76.5 in the same classification. Why is this? And most importantly-what symptoms are invented or demonstrated?

Yes, a lot of different things. Abdominal pain? As many as you want, and whatever you want. Bleeding? Any, up to the real ones (like, for example, a swallowed razor blade on a thread that you can pull, so that somewhere there, in the bowels, it is cut and bled?). And suffocation, heart pain, fainting and seizures, paralysis and headaches, unsteadiness of gait and numbness of the limbs. Someone even, for example, manages to borrow a porphyria patient’s urine to pass it off as their own for analysis. I’m not even talking about the comrades who mow down our psychiatric patients. These, however, are not very many — still not resort conditions in the hospital — but they are also found. Just to get to the hospital, for examination, for treatment, and even for surgery. Well, now a few words about why Munchausen syndrome is considered separately from the banal simulation. And why the Barony is not hung on a whole cohort of hysterics and hypochondriacs.

To begin with, it is different from a simulation with external motivations. What is the difference? Yes, just in the absence of these most external motivations. That is, there is no need for a person to mow down from the army or hide in a hospital from prison, there is no intention to get additional coins or square meters of living space on benefits, there is no need for narcotic analgesics like tramal or something roof-bearing like cyclodol. All exclusively … well, not that out of love for art, but for some internal reasons. So far, there is a lot of speculation and discussion about these internal motives, but no final and unified opinion has been reached. It is assumed that in this way patients are looking for care, psychological support, escape from everyday life and the need to do something independently and decide — the list can be supplemented, but so far it remains tentative.

In addition, Munchausen syndrome should not be confused with distantly similar, but nevertheless related to other operas, experiences and symptoms in hypochondriacs and hysterics. Yes, the very personality of a patient with this syndrome may have a number of hysterical features, and something hypochondriacal may be present in it — but nothing more. The main difference is in the awareness of causing symptoms of the disease. And if a patient with Munchausen syndrome does this just consciously, then the hysteric or hypochondriac is not. For them, all the work is willingly performed (I’m not afraid of this word, it will be appropriate here) by their unconscious.

As you can imagine, recognizing such friends is quite a quest. And as for the treatment… Psychotherapy is often ineffective, because, as one electrocuted but overly corpulent client used to say when the judge asked him angrily why he hadn’t lost weight by the time the court ordered, ” I don’t have the proper motivation, your honor…

Delegated Munchausen syndrome

If, speaking or reading about Munchausen syndrome, an ordinary person, shaking his head, can say-they say, go on, how the people are over themselves izgalyaetsya, and voluntarily! — that description of delegated Munchausen syndrome will probably make many people clench their teeth and fists. And it will cause an irresistible desire to cause irreparable benefit to the delegator. Well, or at least weigh correction pills quantum satis.

Encrypted in the international classification of diseases of the tenth revision, this syndrome is no longer in the psychiatric section-T74. 8. Or as “other cases of ill-treatment”. With whom? Someone who will be delegated the symptoms of a disease that doesn’t actually exist. That is, it would be fine if the person himself portrayed or caused signs of the disease: well, he is not well, well, others are deluded, but at least the radius of the lesion is limited. But when the victim of such a friend becomes a child or a person being taken care of by a sick person (most often-a disabled person)…

And that’s exactly what happens. After all, it is not difficult: add a drop of blood to the urine collected for analysis, give another medicine (or what was prescribed, but based on the average horse), cause diarrhea or vomiting, bleeding or fever, starve. Poison a little. Strangle, in the end — no, not quite to death, but so that you can pump it out: after all, with a baby or with a weakened person (or with someone who trusts you infinitely), it’s so easy! “Oh, my God, why?!” — you will ask.

The benefit (if this is really delegated Munchausen syndrome) is not material, but psychological. This is what the opportunity, slightly polynov utrechka halo, walk and Shine in his eyes and a distant light! What a Martyr’s halo you can carefully wrap yourself in-lo, see what and in what quantities I have to endure (no, I don’t mean a duck, but in a global sense), looking after this unfortunate! This is such a geyser of someone else’s admiration-they say, there are such selfless people! And most importantly-not at your own expense. The victim is the victim. Even if it’s your own. And who appreciated when she was given birth (raised, raised, supported-underline)?

“What kind of monster is this?» — you may ask. Often a pretty cute monster, I must say. Technically not crazy. It has become a part of the mask of a benefactor, a Martyr who patiently bears his heavy cross, his burden of care and responsibility for a seriously ill person. Should I draw a psychological profile? Here, rather, a sketch will turn out. Smears. Abstractedly. Like a Checkered portrait, but there will be recognition. So, check it out.

A person with a stunningly developed self-centeredness. There is he, and there are other means to achieve his own goal-of course, he will never tell you about this. Psychologically immature. In some places. No, it will look and behave outwardly as accomplished and responsible, but if you dig — there will be too little “can’t” and too much “want”, with a completely sluggish, almost agonizing struggle of motives. Emotionally cold — Yes, but only internally. For show, there is just a flood of feelings, but to be warm and loving is only in relation to the precious self. Hysterical features? Yes, perhaps. Not at all and not always, but often. The oppression of certain past and present external circumstances? May be present, though not always: the authoritarian parent “you should/should not dare to” not really existing marriage, when it is necessary to do a good mine at bad game (and not anti-personnel and not on the football field), an underlying but permanent feeling of inferiority or neozelandese and the deficit either desires, or possibilities to turn the tide in their favor something constructive.

What adds dark notes to the situation is that it is extremely rare to detect such a syndrome and press the carrier against a warm wall in a dark corner. This is all within the family, as a rule, happens. A little push, doubt — and then you will not wash away from the counter-accusations. How! This is distrust! This is a vile slander! What kind of doctor/social worker/investigator are you after that? Again, go on to prove it, even if something was discovered: was it really done intentionally or out of thoughtlessness? You know how we are doing with the health literacy of the population, doctor… And even if everything is revealed and proven — how to treat? Psychotherapy that a person is sure to refuse? Or undertake to radically change the foundations of personality? Well, this (and thank God) is generally from the field of science fiction. And if the carrier of such a syndrome is also a doctor himself — then you can safely make a horror movie.

In short, this is a problem-fortunately, not too widespread.

Syndrome of Emotional Burnout

This term (in the original — burnout) was proposed in 1974 by the American psychiatrist Freudenberg. It occurs not only in doctors, although they are the ones who sit quietly and thoughtfully at the very top of the palm tree. In second place — teachers and psychologists. The syndrome also affected social workers, as well as a tribe of managers and a clan of bosses.

There are many reasons for the occurrence of burnout syndrome, but they can be summarized in two words. No, not the one that’s full. This is hopelessness and hopelessness. This work is nonstop in the Stakhanov pace, with a mini-weekend microtoponymy is sarcastic salary is the boss, always ready to cheer anything high-rise, and the team, giving odds to any serpentarium clients and patients, which howled to the staff GUFSIN is the inability to somehow influence the result of the work or at least be aware you’re doing something and someone needs is the need to constantly wear a smile instead of a Kalashnikov machine gun.

How does the burnout syndrome manifest itself? Three groups of symptoms.

1) Extreme exhaustion (of the nervous system, of course). If you remember, I described asthenic syndrome. So here it is almost the same: exhaustion, when the strength to work is not available after an hour or two from the start of the shift, fatigue, especially from monotonous work-and at the same time lack of strength to search for non — standard solutions and learn new ones. This is an emotional explosion (more precisely, a pop when the balloon goes from the “inflated” state to the “burst” state) to any significant push, it is an intolerance to sharp stimuli (light, sound, smell), when the next patient who slams the door has some risk of being subjected to strangulation with a stendoscope. This scattered attention (well, there are no forces to collect it in a heap and keep it in it) and an abundance of what was once fashionable, and now holivarno called vegetative (or neurocirculatory) dystonia. This is a gratuitous anxiety, this mood with a constant, though not as deep as in clinical depression, the “minus” sign.

2) Detachment, distancing from patients (in the case of other professions — clients, students, subordinates). Because every next attempt to penetrate, understand, share burns even deeper, and so I want to leave something for those who stayed at home! As a result, more and more cynical notes slip through, a person becomes callous, and even a warm and cozy (if it is really such) home environment can not soften this crust on the soul.

3) Sense of inefficiency and insufficiency of their achievements. Yes, I have a dozen years of experience, a PhD, a lot of more or less grateful patients (not about the pathologist, be it said) – and a feeling of complete hopelessness, uselessness and hopelessness (especially when mega-responsibility is in stark contrast to the nano-salary). And you realize that you should get out of this well-worn rut, but it’s scary that you don’t have enough strength. And that in the end you can lose more than you can gain. Hence the all-encompassing pessimism, lost ideals, and unwillingness to move further up the professional and career ladder.This term (in the original — burnout) was proposed in 1974 by the American psychiatrist Freudenberg. It occurs not only in doctors, although they are the ones who sit quietly and thoughtfully at the very top of the palm tree. In second place — teachers and psychologists. The syndrome also affected social workers, as well as a tribe of managers and a clan of bosses.

The burnout syndrome can affect anyone, but there are also special personalities for it:

✓ Anxious and suspicious;

✓ Emotional and responsive;

✓ Responsible and demanding to themselves;

✓ People who tend not to show emotions (especially negative ones) in public, monitor how they look, what they say, and how they look from the outside;

✓ Used to strict self-discipline and self-control.

Who can save themselves: an evening Cup, pills (most often — tranquilizers, antidepressants and stimulants, as well as nootropics), going to the virtual space, hunting, fishing; in the summer-a dacha, the sea and healing waters.

Tips to prevention a lot to learn to actively relax, to switch from one activity to another, to leave the work problems at work, do not attach much importance to industrial disputes, to be able to put before a tactical and strategic objectives (achievement first itself, to encourage and indulge, in the process of achieving a second look, but not to force), not to miss opportunities for professional growth, not to try to receive from the universe excellent grades in all disciplines (notice the Trinitarian life easier?) and don’t forget to communicate, so as not to go completely wild. And most importantly-do not forget at least the list of tips.

There is another good, but little and rarely used advice: time to change the sphere of professional activity (worked for ten years as a psychiatrist-re-qualified as a huntsman). Only who would dare to do such a thing!

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