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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!

Cultural Syndromes

Most mental illnesses are found everywhere, whether in Europe or America, Honduras or Dublin. Of course, each culture has its own characteristics of symptoms — starting with the language in which the patient hears hallucinations, and ending with the characteristics of the content of delusions. But many cultures have something purely their own, internal, integral and characteristic only for this area and people in no less degree than the Eiffel tower for Paris, the Taj Mahal for India and the spreading cranberry for Russia. Such syndromes, which are not found anywhere except in a single human community, are called cultural. In some sources — cross-cultural or transcultural, as well as culture-dependent. In the ICD-10, most of them are considered under the code F 48.8 — that is, as specific neurotic disorders, but this is not entirely true, since the symptoms of some of these disorders are very psychotic.

Amok syndrome, or simply amok (from Malay. meng-âmok — to fall into a blind rage and kill). It is most common in Malaysia and Indonesia. In the development of the syndrome in three stages: first, depressed, melancholy mood of serious reflection, the appearance of the reticles in the eyes and gradual creep of toggle switch to “all kill — one remains”; and then a sudden flash, which can be provoked by the insult, with a sidelong glance non-fiction whistling or develops without apparent reason: the man is torn, kills and destroys everything that gets in the way; and finally, a way out of the painful state with complete amnesia of what happened and severe physical and mental exhaustion. Death is possible if the aggression was directed at yourself, too. The prevalence of this syndrome in the past forced local police officers to carry sticks with a loop of barbed wire to catch and hold such patients.

Dhat syndrome. This syndrome originates in ancient Indian tracts, according to which the body of each person contains seven vital substances, or dhata. In a very short and very simple way, these are Rasa (plasma, nutrient fluid), rakta (blood, life force), mamsa (muscle), MEDA (adipose tissue), asthi (bones, cartilage and ligaments), maja (bone marrow and nerve tissue), and shukra (sperm) in men and artava (eggs) in women. Here is with shukra something and released have men embarrassment. Not everyone, of course, but those who know what it consists of. And it has a thin and squishy mental organization. He goes, say, in Mumbai, inhales the thick aromas of his native metropolis and gradually Matures to the idea of getting rid of an extra half — liter of Mala in the form of a mutra-the bladder is not rubber! Does its job in one of the public urinals and suddenly-in the urine something muddy white! “Well, that’s it, a far-off Northern mongoose has crept up on me, now a paragraph to a Cobra! This OK from me shukra flows out with terrible force! I’m now five minutes away from Bhut!» It is in such anxieties, fears, and anticipation of the imminent funeral pyre that the next months of the poor man’s life are spent — until a good doctor or guru is found. In addition to India, this syndrome is found in China, Sri Lanka and the state of Taiwan.

Corot syndrome. It is found in India, China, and Southeast Asia, among Malays, Indonesians, Chinese, and Vietnamese. In the vast majority of cases — in men (fine mental organization, you already know). Got its name from the Chinese “Coro”, which means “head of a turtle”. A turtle in danger does what? No, it doesn’t turn on the first space speed and doesn’t go into geostationary orbit. It pulls its head and legs under the protection of its shell. There she has a bottle of rice vodka and a Smoking bamboo — everything a normal turtle needs to cope with stress. So, with Corot syndrome, the patient begins to think that his long-suffering Yeng could not stand the harms of work and the General injustice of the universe and began to shrink and shrivel up and soon spit on everyone and hide inside, like a turtle. And inside — the patient knows this for sure — there is no bottle of rice vodka, no Smoking bamboo. There is nothing to relieve stress with. And if so, Yeng will not only die himself, but the owner will ride to the other world on his own. And then, without panic and low morale well at all in any way.

Lata syndrome, or latah. It is common among women in Malaysia and Indonesia. This is so that men do not think that only they can learn something tricky. Manifests itself if a woman is scared or creates unbearable conditions for her. In response, she falls into a kind of trance, in which she either implicitly does everything that is asked of her (and here the main thing is not to ask for a splash of boiling water or bring coffee to bed), or simply repeats the gestures, actions and words of those around them, as if deprived of their own will. Periodically, psychomotor excitement breaks out — usually in the form of a good portion of selected matyugov: after all, swearing-they are firmly established in the very depths of the subconscious of any people, and even when the brain is almost completely disconnected — the remaining brain tissue is enough to Express a seven — story compliment to the universe.

PA-LEng syndrome. It is found in China and Southeast Asia. Remember, max Frei was a funny character — samanez rulen of Baghdatis, who believed that without a huge cap to go absolutely not — the brain the wind will blow? Now, it’s almost the same here. This syndrome is associated with the belief present in the local culture that the wind and cold are not just an abomination, snot and the potential to catch something cold. Wind and cold can dampen the Yang Yang in a person, resulting in Yin Yin prevailing and all sorts of crap coming out. You will walk all tired, lethargic and with a drooping Yeng. And then you will die completely. Therefore, you need to dress warmer and more layered. And sweat is not an inconvenience, it is an attribute of a real man. You could say chemical weapons. Suddenly opened ten clothes — and take the chosen one, while she is in a swoon!

Taijin kyofu-Shu syndrome (in another transcription — Tajin kyofusho). It is found exclusively in Japan and is associated with the culture of this country, where the role of a restraining, limiting factor in society is played by shame (in contrast to Russia, where the same role should be played by conscience). The syndrome manifests itself in a panic fear of “losing face”, losing a good attitude and favor from other people. Moreover, the patient is not afraid of the consequences of real actions — he begins to fear something is wrong to say, there is no smile, let the winds with so many people, to insult their breath — and anyway, you never know: suddenly the fact of the appearance of the street his face gets mavasi-giri’s sense of beauty? I’d rather stay at home, locked up. Again, there was a tingle in my side, and my heart ached, and sleep was gone…

Couvade syndrome. Previously, it was distributed among the population of Oceania, some peoples of the Caribbean Islands, as well as in Corsica and Burma. The name, according to some sources, comes from the French word couver, meaning “to hatch chickens”. It is closely related to the custom when a man during the pregnancy of his wife behaved as she did: went to bed, refused food, screamed as if from labor, and in every possible way imitated the process of childbirth. According to beliefs, a woman should have been incredibly relieved by this. Perhaps they were relieved. There may have been some inexplicable mechanism for sharing suffering. There is also a simpler explanation: the desire to get up and strangle the scoundrel was so strong that the pain receded into the background. Some of the men were so impressionable and so well was the character that really started to feel tazelenemedi: they had morning sickness, had lost his appetite, began to pull on something salty or sweet, there are a number of scents and dishes, which turned up from the soul and in every way felt sick, had pains in lower back and lower abdomen and all this was accompanied by moods, resentment, irritability and extreme bulging of self. Childbirth never ended, but with the forced evacuation of fecal masses in the process of attempts-no problems. It is interesting that now this syndrome is no longer characteristic of any one culture — it is found almost everywhere.

Syndrome offwire. It’s called SAC syndrome. Typical for women in South Africa. It is difficult to say exactly how strict their upbringing is and what terrible stories and legends they are told about men, but the trigger for this syndrome is most often the sight of an unfamiliar man. Apparently, the strangers must be indelibly impressed by the frenzied screams, sobs, shouting out some completely new words for the local dialect, Brownian movement with the speed of a mad tennis ball, followed by falling into a trance-either with complete inhibition, or with arms and legs falling away, or with convulsions, in the manner of an epileptic fit. And so for days and weeks. After that, a decent stranger is simply obliged to either marry, or get into a long retaliatory fit — they say, your indescribable beauty did not leave me indifferent either.

Susto syndrome (aka susto’s disease, aka espanto). This syndrome can be found in residents of another continent-among the Quechua Indians in Latin America. Why only there? It’s because we don’t have any demons, soul-snatching witches, or evil quechuan spirits roaming the streets so freely. Gopniki-this is please. Taking money and shooting cigarettes are common. Doing all sorts of unnatural things to the brain — as many as you like. But to take away the soul — we do not have such obscenity. But the Indians are suffering. He would go along the road, meet a demon or a witch, and be ready. Fell to the ground, and the soul, such a fool, there is no to go in the heels — it tries to sniff the ground. And they don’t just let you go back from the ground, it’s not a tour for fur coats with drinking “Metaxa” right in the sewing shop. And without a soul a real Indian is hard: he suffers, he doesn’t eat, he doesn’t sleep well, he gets thin and weak. And everything is waiting for death. You have to go to the shaman, so that he filled the pipe, scored the arrow and agreed with the mother earth, how much you can get your soul back.

Things are no easier for the ojibway Indians in Canada. Their misfortune syndrome vitiko (vindigo, vertigo). However, some unconscious researchers believe that this is not a disease, but just a bad temper and an attempt to justify their culinary preferences, but they are evil. The syndrome is manifested when the tribe has nothing to eat: the wild rice has run out or the food truck has forgotten to overturn. Less often-when there is food, but you want something delicious, but there is no or you can not. And I’m hungry. Right to death. Someone else’s. I’m already getting scared myself. And then the fear passes, and in its place is a giant ice-skeletal demon-Vitiko. He wants to eat even more, and any member of the Indian family is a friend, companion, and delicacy to him. To a sharp change in the diet of a relative, the family treats without understanding and sympathy: an Amateur cannibal is either dragged to a shaman (which is less common), or they decide that it will be cheaper and more reliable to kill. And the ish-demon possessed, human wanted!

Syndrome piblokto (aka Pabloites). It is found in Greenlandic fishermen. Begins, as a rule, either with the appearance of weakness, rapid fatigue, or against the background of a depressed, depressive state: cold, wet, fish are fed up, and in General-what kind of bastard called this land green? Then an astral icicle falls on his head, and the patient explodes: rips off his clothes, screams like a Seagull, snorts like a whale, cries like a seal, roars like a deer (Northern, not spotted — don’t confuse it!), dives into a deep snowdrift, and if he doesn’t stumble on a forgotten household appliance or a freshly buried snowmobile, swims and splashes in the snow. Under the influence of the moment, it is quite capable of demolishing a house on a log, or on a stone, or whatever else they make them out of. It can repeat words or gestures thoughtlessly. Then the charge of bad energy runs out, and the person is forgotten in a deep pathological sleep, after which he wakes up healthy, but a little weak and rumpled, looking at others with bewilderment-they say, why are you all so caring and cautious? Yes, I’m fine. Was there any reason to doubt it? It is very similar to the Arctic hysteria that occurs in the canadian Eskimos. Due to severe stress (for example, the deer is gone or geologists came), the patient is thrown in a hole or escapes into the tundra, and if it is trying to catch and not let go — it becomes violent, aggressive, sometimes gives a a seizure.

Syndrome Camarines. This syndrome is also found mainly among the peoples of the Far North, where the nights are not just long — they are polar, and the stories of shamans would have impressed Stephen king himself. Again, the wind that blows the soul out of you. Again, almost cosmic cold, which tries to take it along with the heat. And this heavy sleep in the heat and among the rushing fire glare, and it was time to go to bed not because it was dark — it was dark a month ago — just time to switch off for seven hours. In short, the situation is very conducive to the fact that when you Wake up one day (I almost said — in the morning) from some smell or noise, you suddenly realize that IT happened. There is no soul. Instead, it was either a sucking emptiness, or someone else had already settled in, someone else, uninvited and hostile. And there is something yourself repurchase in the opening of the breeding season and the development of a new body. Scared? You bet! To complete paralysis, to a clear sense of either someone else’s presence, or to the audible slight rustle of your own fleeing soul.

And a couple more imported syndromes before we talk about domestic ones.

The Jerusalem syndrome. It has spread mainly among tourists who came to worship the Holy land and look at the Holy places. If those who live side by side with shrines have already developed immunity — well, a place, well, Holy, well, two steps away, Yes, thank you, I’m happy by default-then new arrivals eating with their eyes everything so mystical and in such large quantities is not always good. Then, you see, Jesus will suddenly Wake up in a person, then Moses, then Abraham. As a result, in complete bewilderment as those who have woken up-they say, I have never spent the night here! — so are those who suddenly feel like them. The latter in particular. At once they begin to reveal and prophesy, or even make a March across the deserts, for about forty years, inducing some people for the company. It is encouraging that this syndrome lasts no more than a week and often passes on its own.

Stendhal Syndrome. It can be described in three words. Veni, vidi, phallomorphi. Stendhal had also, er, experienced a cultural shock when he saw Raphael’s Madonna and Michelangelo’s David. Even now, some impressionable tourists with a fine mental organization experience something similar when they see a particular work of art. And it doesn’t matter how the shock manifests itself: ecstasy, panic, or reverence for a painting, sculpture, or structure, when all other colors and impressions simply fade and become insignificant and vain, it is impossible not to notice it from the outside. As a rule, local residents and Museum employees do not experience anything like this — in fact, it would be strange to go to work every day for such a thrill. Again, desensitization, cultural mithridatism…

Now let’s talk about cultural syndromes that are common in Russia. No, this isn’t about delirium tremens. And not because we don’t suffer it so much as we enjoy it. As practice shows, alcoholic delirium is a phenomenon outside borders and peoples; devils are driven here, in Western Europe, in Israel, India, Africa and Australia, and this phenomenon is not alien to America — well, unless somewhere after a tequila binge, instead of a devil or a UFO crew, a local Chupacabra will appear, this is already a detail. We already have enough local exotics.

Hiccups (also called hiccups). It is more common in the Perm region and the Komi Republic. It is not the same action that occurs as a result of re-expression of the diaphragmatic nerve — everything is more complex, mysterious, and smacks of witchcraft. So we need to be on our guard against wizards and witches. And if suddenly on a hot summer day you are offered kvass from birch bark tuesca-refuse. Like, thank you, like, I’ll get by on vodka somehow. And then you take a SIP — and there is already a Hiccup (or as it will be called) a piece of mold sitting on the food specially grown. He is a hyperactive demon: go to a new place of residence. Some of them have been in prison for thirty years, or even longer. And it’s okay to just sit in your stomach, so no — it must be made known. Not only to the host — who will not miss the appearance of such a guest — but also to everyone around them. So he does not sit silently-he foreshadows. It can, of course, and just howl, growl or bleat, but more often — something says. Mostly offensive, scary, or abusive. And forces the host to do what the imp wants. Usually something obscene: slap of wine (red, white and because vodka is abhorrent to him), to eat something inedible, but honey, garlic, radish, pepper and sage to shy away like incense; to strip naked when people day to sit in the dark — well, the devil, he is the devil, they’re all character pathology and disorders of the instincts. Well, hiccups are also present — most often, everything begins with it.

Hysterics. Currently, it is not so common, but still occurs throughout Russia to the West of the Urals. The overwhelming majority of hysterics were women. It is difficult to say why the demons that cause klikushestvo are so picky about gender-maybe the reason for this is the peculiarities of the female psyche, or maybe the usual physiology. Maybe they don’t have a place to sit at men’s houses, but it’s inconvenient to sit on what they are offered. In many ways, the behavior of demons is similar to the behavior of Hiccups: they sit inside, make them broadcast (click) on their behalf, do something obscene; being overshadowed by the sign of the cross or the aiming application of the censer, they fall together with the bearer Aki thunderstruck. The carrier, as a rule, has a memory for all obscenities that is completely rejected.

Oracene (also maracena, Emiratele). Its name derives from the Yakut word menarik — “make strange”. It is distributed mainly among the peoples inhabiting Eastern Siberia. However, people who came from other places and settled there for a long time are also not immune from this scourge. In many ways similar to the Malaysian Lata syndrome, but not so gender-sensitive. Kind of reminds syndrome piblokto. You can achieve symptoms of the syndrome by frightening a person with words, your appearance, a sharp sound or a flash of light. Less often, it develops independently. The patient seems to be in a trance-he copies the movements and words of others, obediently performs whatever he is ordered. Sometimes meryachenie covers an entire group of people, in this case it turns out an improvised flashmob.

And finally, three syndrome, which occur in the Siberian Tatars and described by H. M. Mukhamejanova in 2000.

State of “KUEK-ut”. Fire, in addition to running water and other people’s work, is included in the list of things that you can look at indefinitely. Just do not do it too closely — from the OTHER side, we can also be admired. The Fire spirit is not only a curious being, but also, unlike the one who plays peek-a-Boo with a fire, an active one. He sensed a weakness and immediately moved into the gaping hole. Imagine the leap of living fire under the skin, which begins to walk busily around the newfound body? In General, the spirit burns as it can, but the person suffers-it burns, it is hot, he feels pain, he sees the dance and the terrible faces of the spirit of fire, he rushes, not finding salvation. And here the choice is not rich — either a shaman, or a psychiatrist.

The “isce” state. This is when a person suddenly understands: everything, the soul in the morning dressed, gathered a bundle with things and left. And with it went the joy and interest in ordinary pleasures and Affairs, the colors of life, and life itself flows away in a thin trickle. But the Spirit of fear has come to an empty place, and it, unlike the soul, does not stand on ceremony with the owner. Hence fear, anxiety, loss of appetite, confusion, and a complete lack of visible prospects.

The state of the “Cam-Bashan”. There is a strong belief among the Siberian Tatars that shamanic items should not be taken. Well, that is, taking someone else’s is generally not good, and shamanic-in addition, it is also deadly. They even have a tambourine on a special anti-theft device. And curiosity and parses. Touched-nothing. Knocked, rattled-the current does not beat, the siren does not howl. But then… Then comes the fear, the depressed state and the understanding that the anti-theft was shamanic. It would have been better to have been killed on the spot. And so the weakness of some, and the potency is gone somewhere. And yet — comes a solid understanding of the inevitability kirdyk, but it is unclear what he would be immediately if all happens like an accident or will first severe illness.

Endocrine Psychosyndrome

Or Bleuler’s endocrine psychosyndrome (described by Him in 1948). With some reservations, it can be said that it occupies an intermediate stage between mental disorders that develop as a result of external factors affecting the brain (or exogenous-organic disorders-due to the same injuries, infections or intoxications, for example), and so — called endogenous disorders (that is, those whose origin is being investigated, but with no external causes-as in the case of the same schizophrenia).

The reason for the development of endocrine psychosyndrome is a long-term violation of the hormonal background. That’s right. Neither the adrenaline rush nor the blood sugar spikes will form it. It is necessary that the change in the hormonal background be long-lasting, like the Exodus of Evenks to America, from month to month, or even from year to year. Diffuse toxic goiter, myxedema, diabetes mellitus, Itsenko — Cushing’s syndrome, adrenal and pituitary tumors are all welcome. A distant similarity in some details with this syndrome has changes in the psyche during pregnancy (still, with it, the concentration of certain hormones changes hundreds or even thousands of times, and not for a day or two, but throughout the entire term). It’s just that during pregnancy, these changes are reversible.

The main violations are observed in the sphere of emotions and in the sphere of drives.

In the sphere of emotions: irritability and tearfulness-literally because of any little thing, and sometimes for no reason at all (she invented herself, she was offended by everything); viciousness and gloom (who can’t wait to get in the eye or on a course of anti — rabies vaccine-we take a turn); or, on the contrary, euphoria. Severe and persistent, reaching a psychotic level, depression or mania are less common, but also quite likely.

In the sphere of the instincts, violations can have any polarity: strengthening, weakening, or perversion. These disorders can affect both sexual desire and food, but the latter still suffers more often and more noticeably. This is bulimia, when the refrigerator begins to shake nervously when a person appears in the kitchen and tries to hide, if not emigrate; anorexia, when an attempt to feed a person turns into a difficult quest, and the patient himself will give a head start to any visual aid on osteology; Pararexia (or perversion of taste), when raw meat or black soil suddenly become unbearably delicious and desirable, and from harmless ice cream or tangerines just turns inside out.

Much less common is a decrease in intelligence-except for sharply expressed endocrine disorders. Here is the acceleration of the pace of thinking (with hyperthyroidism, for example) or its slowdown (with myxedema) is observed much more often.

Psychoorganic Syndrome

This syndrome is also called organic psychosyndrome, as well as Walter-BUEL syndrome. The cause of the syndrome is a lesion of the brain as an organ. It is noteworthy that this syndrome marks the border between real life and fiction. Only a fictional hero can constantly hit the head with something heavy, sharp or explosive, pour megalitres of fire water into it, get meningitis and go into a coma, and then R-once — and everything is as it was, just a couple of scars adorning a manly face, and not a single hint of changes in the psyche. Believe me, in reality, the brain is much more tender and does not forgive such indecent treatment of itself. Well, unless one day genetics will reach unprecedented heights, and there will be woodpecker warriors…

Leading, obligate symptoms are represented by three groups.

Affective disorder. They are quite diverse, but they have one thing in common: the psyche does not have enough strength to keep the will in check, as well as to maintain the same mood for a long time: a person simply breathes out, the fuse passes, and the mood changes, and quite sharply. From here:

Irritability (no strength to endure) – but quickly passing;

Incontinence (after all, the strength to hold the closet of my soul on the lock, takes a lot);

Emotional lability (flared — calm — burst into tears — comforted — laugh — tears — to begin the cycle anew);

The grouchy, grumbling — even to them that in humans is almost always strong enough; euphoria and carelessness-this is when the critical attitude to the situation and to yourself has already hopelessly waved its tail and went ashore; indifference and apathy — when the forces are no longer even for emotions.

Memory and attention disorders. As for memory, first of all, the ability to remember and reproduce the events of the current moment suffers: from a decrease in the volume of stored and reproduced information to fixation amnesia (ate-forgot-reproached his wife for negligence-ate-forgot). At the same time, the memory of earlier events in life, especially those that preceded the development of the syndrome, can remain unchanged for a long time, but over time it also fades.

Attention becomes passive (that is, the person himself is not able to arbitrarily focus on something), distracted, like a first-grader at the end of the lesson, scattered and quickly exhausted.

Disorders of intelligence and comprehension. First of all, it is the loss of the ability to think and act creatively (of course, if there was any such ability at all). People stop looking for new non-standard ways to solve problems, more often use the established stereotypes, gradually becoming their hostage. Such a patient is painfully difficult, sometimes impossible to master anything new, he becomes forced to be conservative. New ideas do not come to mind in a hurry, and then they do not come to visit at all. Thinking itself becomes more and more mundane, concrete-visual, the ability to abstract disappears. Further — more: it becomes more difficult to think, to solve even standard life tasks, to make decisions independently. Thinking loses its flexibility and is no longer able to fly, it becomes rigid, bogged down in unnecessary details and minutiae, being unable to grasp the whole problem and see the prospects.

The group of facultative syndromes is quite diverse and diverse: it can be perception disorders (illusions, hallucinations, senestopathies), thinking disorders (phobias, obsessions, super-valuable and even delusional ideas), symptoms of a violation of the autonomic nervous system (remember such a widespread diagnosis as vegetative dystonia?), neurological symptoms.

The course of the psycho-organic syndrome is more often stationary, but it is also progressive. And regressive. Pretty typical relationship-being of patients with external factors: they are sensitive to weather and atmospheric pressure (meteosensitivity), the temperature (in most cases heat is worse), to riding in vehicles (many swayed); any infectious diseases, intoxication (including alcohol), exacerbation of chronic diseases.

There are four variants of the psycho-organic syndrome. The sequence in which they are set out is not accidental: when the condition becomes heavier, the progress of the disease, the change of options will take place in this order.

Asthenic version. In the foreground — weakness and exhaustion of mental processes. Here and emotional hyperesthesia, when a person violently, but not for long reacts to any remark, criticism, even just a change in intonation, not to mention sharp sounds (the alarm clock is better to have several degrees of protection from physical influences), flashes of light (the photographer also), unexpected touches (so be careful with the desire to Pat the back on the shoulder). It is also a rapid fatigue, when a person, having taken up a task, deflates like a punctured balloon, and the remaining rag is no longer able to do much. This is a rapid change of mood, this is the inability to focus on one thing for a long time, this is a decrease in memory — small, mainly due to difficulties with remembering, but already quite noticeable.

Explosive version. Emotions are brighter and more brutal, their manifestations have the character of an explosion, it is not just irritability-it is malignity, turning into anger, and in the intervals — a sullen and depressed dysphoric mood with a wandering grid of sight. Grumpiness, disgust, intolerance and grumbling gradually replace everything else. Memory is getting worse, it is becoming more difficult to remember and recall, events are leaving like water through a sieve, leaving only a few grains of the most significant events. It becomes more difficult to learn new experiences and think at all. But it is very sensitive to any events, words and actions that can somehow hurt or offend (even if it was not intended at all).

Euphoric version. A person is no longer able to correctly and critically assess himself and the surrounding environment, so the psyche, mercifully clearing a place in the dump of life, places him in the middle of the Potemkin village, in a jacket and with a Bayan. Why go to the trouble when everything is fine? Outbursts of anger sometimes do occur — when trying to return to reality, to poke your nose at the facts, but then again comes the euphoria. It is no longer possible to think creatively or even productively, so the remnants of life experience, stereotypes and reflexes come to the rescue. Decisions are ill-considered (because there is nothing to do), frivolous (in tune with the prevailing mood), superficial and absurd, but this absurdity is not something new, but rather an old and familiar applied to the wrong place. Professional skills that were still somehow preserved in the previous, explosive version, are also gradually lost. The lack of productive activity is more than made up for by an excess of mobility and fussiness. Memory deteriorates to the point of fixation amnesia.

Apathetic version. The forces for emotions are no longer there, instead of them — indifference and apathy. A person can lie in bed for hours and days, getting up only to the table and to the toilet. Or without getting up at all. Interests — almost no, except how to eat. Wash up, take a bath or shower — this is a feat. Going outside is an almost impossible mission. Thinking becomes slow, tight, like a rusty bolt, stuck in the details — far from being clever and quick-witted! Memory does not hold current events and gradually loses earlier ones. Skills that were honed to automatism in the past (making eggs, hanging a shelf on the wall) are also going somewhere.

Violation of Syndromes

What distinguishes them from amnesic disorders is that amnesia may be absent or not so pronounced as to play a leading role. But the distortion of memory, or paramnesia, will be necessary, they simply can not be overlooked in such cases,and the colors of the picture of the disease will be due to them. There are three of these syndromes:

1) Korsakoff’s syndrome;

2) Confabulation;

3) Violent memory syndrome.

Korsakov syndrome was first described by S. S. Korsakov [51] in 1887. It is interesting because it intertwines both productive symptoms (paramnesia) and negative (amnesia). Its leading, mandatory, or obligate symptoms:

  • Fixation amnesia, that is, the events of the current moment and recent (days, months, last year) time pass through this sieve without being delayed. Here are the events of youth, youth and childhood — this is a different conversation, up to the name of the first love and the circumstances of the first drink. Everything, up to the beginning of the disease itself. Next — a blank sheet, on which memory and displays the bizarre patterns of paramnesias. Fixation amnesia can be so pronounced that it is almost impossible to teach the patient something new, and moving to a new place of residence is a disaster (going out alone on the street, he will get lost, most likely, go to the old address and perhaps try to drive out new residents). Such amnesic disorientation can concern both the place and time, as well as basic professional and everyday skills. Therefore, it is better for relatives to take care of washing, cleaning and, especially, cooking dinner — they will be safer.

— To many cases of paramnesia.

In the case of Korsakovsky syndrome, they are as follows.

  • Confabulations (when gaps in memory are filled with events that never occurred in the patient’s life). In the vast majority of cases, these are substitute confabulations (that is, not very far removed from everyday mundane reality): yesterday I sat with friends in a restaurant, Yes, right after work; a week ago I went hunting, shot two boars and one huntsman, but Shh! Less often they are fantastic (I was on a special mission, thwarted the plans of the world’s financial elite for a carefree holiday: I poured tar into honey, poured sugar into beer, clofelin into vodka and ice into a swimming pool, barely left alive).
  • Pseudoreminescence (when a gap in the patient’s memory is replaced by a piece of the mosaic from his own life, only from the time when the disease itself did not exist).
  • Cryptomnesia (when the patient borrows events from books, movies, TV shows — from everywhere-to fill in gaps in memory). Therefore, it is better to leave something harmless out of literature. No, “Hansel and Gretel” and “Baby and Carlson” are also better put out of harm’s way. It is better not to doubt the personal authorship of famous poems, songs, and scientific works — neither you nor the patent office can explain anything to him. And Windows is also all his credit, no matter what bill gates thinks.

— Anosognosia (a-negation, from the Greek onosis-disease, gnosis-cognition, knowledge), that is, a complete lack of understanding and denial of the fact of the disease and related problems. And here it will be rough, Terry. “Who’s sick? Am I ill? Yes, I’m healthy, like this… like his … horse of Macedon…Ah, Imbecile, in! Yes, I’ll get a job tomorrow at least-immediately as a Director! Wait, I already work there…»

Optional, or additional, optional, symptoms can be affective disorders: anxiety or complacency, carelessness or confusion, euphoria, emotional lability, when the mood jumps from one pole to the other several times a day and changes from any trifle. The patient may be either sedentary, hypodynamic, or, on the contrary, fussy and restless — depending on what kind of affect prevails.

According to the dynamics of Korsakov syndrome can be:

  • progressive (when the severity of symptoms increases);
  • regressing (when things are on the mend) and
  • inpatient (when the symptoms in their severity and severity do not change for many years in either direction).

The cause of Korsakoff’s syndrome — brain damage: the toxic effect of alcohol in Korsakov’s psychosis, other intoxications, infections, trauma, tumor, vascular damage (in stroke and atherosclerosis, for example), atrophic processes in the cerebral cortex.

Confabulation. What is remarkable is that there is no amnesia or clouded consciousness in this syndrome. But confabulation — as much as, and no! Incredible, fabulous, fantastic (which, in fact, should be fantastic confabulations). There are dinners with the President, and Affairs with the wives of Ministers, and escapes from their angry spouses, stuck horns in doorways and goading their loyal nookers, and escape from the country in a diplomatic parcel with cannabis (“just sent to the Netherlands”). For those of confabulation, in addition to the fantastic typical variability of the plot: only yesterday savoured the delights of Ministerial wives and zaboristoe diplomatic mail, and today switched to the details of the abduction of American spy satellites directly from geostationary orbit with a view to push the information home intelligence, and valuable scrap — friendly Madagascar. Another distinctive feature of confabulation is the patient’s desire to prove that this is exactly what happened. “Don’t you believe it? Yes, there, you see-a spoon! Yes, Yes, Malagasy friends cast from the same satellite, as a souvenir.”

Confabulation can develop as an independent syndrome or be a stage in the transition of delirium to Korsakovsky psychosis. If this is an independent syndrome, then the way out of the painful state is usually critical, that is, once — and there is an “Epiphany”. It is usually found in mental diseases caused by damage to the blood vessels of the brain or with severe infections, severe somatic diseases and — quite often-with intoxication.

Violent memory syndrome. The memories are real, they really took place in the life of this particular person. It would seem — what is abnormal here? The abnormal thing here is the WAY they come. Not purposefully (I wanted to-I remembered), not accidentally, obeying a chain of free associations (“they Write that a dog … a lapdog… a bitch … damn! My mother-in-law’s birthday!”). Violent memories invade your mind without invitation, like College students in a Dorm who find out that you’ve been brought three bags of food and one case of vodka from home. They fill in everything-up to the point of not being able to assimilate anything else from current events, and later-leaving no chance to remember if anything was happening at that moment: the memories themselves were, but what was I doing then and where was I?

This syndrome occurs when the left parietal-temporal region of the brain is affected.

Syndromes of Impaired Consciousness

The symptoms of impaired consciousness have already been discussed. Now let’s talk about syndromes. Perhaps, and even most likely, different occult schools would offer their own versions of their classification, but who are we to deviate from dialectical materialism?

So, all the syndromes of impaired consciousness can be divided into quantitative (they are not psychotic) is off consciousness: it was — did not, or considerably diminished; and the quality (or psychotic) is an aberration: it was clear and untroubled, and then mingled such that Mama do not cry!

In addition, both quantitative and qualitative syndromes can develop or suddenly and immediately reach their peak, and then it will be paroxysmal (from Greek. paroxysmos-irritation, excitement) violations, or gradually and consistently, and then they can be attributed to non-paroxysmal violations. As a result, four groups of syndromes are formed:

1) Non-paroxysmal shutdowns of consciousness: stun, SOPOR, coma;

2) Non-paroxysmal obscurations of consciousness: delirium, oneiroid, amentia;

3) Paroxysmal shutdowns of consciousness: large and small convulsive seizures (they are now studied by neurologists, not psychiatrists);

4) Paroxysmal obscurations of consciousness: twilight obscurations of consciousness, special States of consciousness and the aura of consciousness.

Stun. It is the most easy and relatively quickly reversible, compared with SOPOR and coma, but it also does not promise anything good for the psyche, and it is better to study it in theory than in practice. Three of its degrees — light, medium and deep — are allocated conditionally, because, unlike computer characters, the real patient will not light up a colored strip of his current state over his head. All by themselves. So.

A slight degree of stun, aka obnubilation (from lat. obnubilatio-cover with clouds, obscure). The patient can be confused with a person who is a little drunk: not to the extent that it is very stormy, but enough to upset the wife. Disorientation concerns mainly time, space, and one’s own personality. And if the month and year are correct, you may get confused about the date and approximate time. In addition, it is unlikely that the patient will be able to correctly remember what and in what order he did today and when the trouble happened to him. After a little conversation, you may find that he has already forgotten what you just said — the memory of such a patient does not record current events, they simply do not stay in it. It is not possible to attract the attention of the stunned person immediately, so you have to make some effort to make him listen and respond. All his movements are slowed down, the answers follow after a pause, absent-mindedness would please any novice pickpocket. Eloquence is hardly to be expected — for it, as for any subtle action, you need a coordinated work of the entire psyche: not to aerobatics, when the plane is shot down. In emotions, indifference prevails — after all, they take a lot of effort and attention to detail. The state itself can flicker, from time to time slightly brightening, giving the so-called lucid Windows (from lat. lux-light).

With an average degree of deafness, disorientation concerns not only time, but also space. It is useless to ask the patient who is in it where he is, what day it is, and what time it is. It is good if he gives you his last name, first name and patronymic. Year of birth-excellent. The address … it’s unlikely. There is no interest in the surrounding environment and people in this state-it doesn’t matter whether special forces are chasing terrorists around or naked beauties are dancing the cancan. Even a Letka-Yankee performed by special forces will not surprise you. Even in the arms of terrorists. On the face-an expression of confusion and perplexity. It is extremely difficult to attract the attention of such a patient, for this you either need to shout in the ear, or shake something large-caliber in front of his nose. If you leave such a patient alone, he lies down and seems to doze, indifferent to everything, often with his eyes open.

A deep degree of deafness, aka somnolence (from lat. somnus-dream). With it, disorientation is already complete — in time, space, your own personality (that is, even what your name is-will not tell). What is happening around the patient is not able to understand. What they try to tell him, explain, shout in his ear, or show him with gestures-too. The only way to attract a faint semblance of attention is to inflict pain — physical, of course: a slap on the face, a prick, or a good pinch — not out of personal antipathy, but to understand how much the situation is running. Even in this case, the reaction will be sluggish-well, he will open his eyes, well, look without meaning — and that’s it. Most of the time, the patient is motionless, lying down and once again does not remind you of yourself.

As it should be when switching off consciousness, after coming out of this state, the memory will erase some of the memories for the painful period itself (congradnaya amnesia), if the stun was light, or will not leave them at all (meaning, for the period of the stun itself), if the stun was medium or deep.

If the condition improves, the stun passes (regresses), if it worsens, it deepens (progresses) and goes into SOPOR.

SOPOR, or status soporosus (from lat. sopor — numbness, lethargy). This condition is almost a step away from a coma (sometimes called a precoma). Disorientation at SOPOR is complete, that is, to ask what time-day-month-year and try to get acquainted with the same success, you can go to the monument. Only the reaction of others will be slightly different in the latter case. Even on a prick or a pinch, the patient will react, but sluggishly and purposefully-twitch, shudder, but the offender will not look for. Reflexes of the mucous membranes (sneezing in response to an attempt to tickle a feather in the nose — and do not look so disapproving, this is a diagnostic procedure, not a mockery!) and no skin. Tendon reflexes (hammer — knee — kick from the toe) are weakened. Protective reflexes are preserved: corneal, when the eyelids close on an attempt to touch the cornea with cotton wool, coughing, vomiting, swallowing. The reaction of the pupils to light is sluggish. The patient lies motionless and can only occasionally toss around in the bed.

If the condition improves, then first the consciousness passes through the stun to normal, while the memory for the SOPOR period is completely lost. If the condition deepens, a coma occurs.

Coma. The name comes from the Greek word koma, which means “deep sleep”. The psyche in a coma completely resigns all its powers. Most reflexes, including defensive ones, are suppressed. Only those unconditioned ones that allow life to warm in the body are preserved-those that support breathing, heartbeat, thermoregulation, and vascular tone. Deepening the coma leads to death. If the situation is favorable, there is a gradual exit from the coma in the reverse sequence: coma-SOPOR — three degrees of stun-return to clear consciousness. Memory for events that occurred in a coma, as well as for the period of recovery, up to the state of light stun, is lost.

We have already touched briefly on the concepts of delirium and oneiroid, now let’s look at them in more detail, adding to them amentia. Delirium and its stages of development have already been discussed in the section “Intoxicating psychoses”. It should be said that intoxication (most often it is, and it is alcohol) is not the only reason for the development of events in such an interesting scenario. Severe infection (a chronic alcoholic is quite common pneumonia), severe damage of cerebral vessels (hence the delirium in octogenarian grannies who forgot the smell of alcohol, excluding the part of valokordin), severe somatic (bodily, in other words) disease — here is a partial but basic list of possible causes, the rest is out of the realm of casuistry, and stories among colleagues for a saucer of brandy.

Oneiroid, aka oneiroid syndrome (from Greek. oneiros-a dream). It got its name from a dream-like state, similar to the brightest dream, absolutely incredible and fantastic in the content of the nature of the experiences and visions that patients experience. Does it remind you of Alice? However, all in order. The main symptoms of oneiroid are:

Disorientation. Not a loss of orientation in time, space, in what is happening around and in your own personality, as in the case of disconnections of consciousness, and not a desperate attempt to find it again, as in the case of Amenti, but a change. “Time? I’m going to ask that fairy over there, fluttering among the sparkling pollen. You know, the position of the two local moons makes it difficult for me to answer offhand. What of the city? Oh, I was told by the guards at the gate, it completely slipped my mind — a beautiful name… What’s going on? They’re in the middle of a festival, and there’s going to be champagne spouting from all the fountains in the square, so let’s get this over with as soon as possible. Who am I? Elf. Level thirty-one. Well, everyone who goes where, and I-to go to the festival.” Tellingly, the” I ” of the patient in oneiroid does not hesitate to change, to become multiple, fragmented, to envelop entire cities with fog, to become the atmosphere for planets, to inhabit animals, birds, trees and stones, or even to transform into an abstract concept — like universal love or no less universal law of meanness.

Complete detachment from real events — it is still necessary to find out which ones are more real for whom — and the deepest immersion in vivid scene — like (not in fragments, not in snatches, and not single characters, but with a full set of actors and scenery) pseudo-hallucinations: visual, auditory, olfactory, tactile, and gustatory-a complete set in order for the new reality to be more palpable than the one from which the patient fell. And since the consciousness must somehow come to terms with new sensations and situations, these pseudo-hallucinations are accompanied by a fantastic dream-like sensory (that is, not the one that took on itself, but stems from what was seen and felt in hallucinations) delirium. “Coven of witches? Well, that’s right, I was always infernal at heart and looked with interest at all sorts of brooms and mops. The Apocalypse? Oh, my God, I’m the one who screwed him up, and now I’m getting paid for it! I fly in a pack of pterodactyls? Well, I fly myself and fly, I’ve always been very good at snapping my beak, and flapping my wings-it’s so natural, as long as my fingers are spread wide!”Less specific disorders of the autonomic nervous system: greasy skin and hair, sweating (hyperhidrosis), fever, nausea, constipation, fluctuations in blood pressure — both in one direction and in the other; but they also often occur. And, of course, insomnia (dreams and so show, and in reality) and lack of appetite (popcorn in this auditorium is either local, or not provided at all). Oneiroid syndrome most often has one of three types: a pure, classic type — a type of oniric syndrome (aka onirism, aka oniric delirium), which in most cases occurs with severe infectious diseases and is characterized by lethargy with constant drowsiness. The patient, falling asleep, sees such vivid dreams that when he wakes up, he continues to consider them part of his real experiences. He may well be outraged about why the bikini-clad beauties were chased away and his pirate chest was hidden somewhere. And anyway, you can’t see the masts of his personal frigate outside the window, who dared to drive him to a distant roadstead? However, such a patient may not make claims, but the sediment in the soul will remain…

Another type of oneiroid syndrome is one of the stages in the development of an oneiroid-catatonic attack (in the vast majority of cases — in schizophrenia). Unlike pure oneiroid, there will also be elements of catatonic syndrome, most often in the form of catatonic stupor.

The classic, expanded oneiroid is divided into seven stages, which were described by T. F. Popadopoulos in 1975. According to S. T. Stoyanov, there are only five of them, but this is for an Amateur.

Phase one. Or the stage of General somatic disorders and fluctuations of affect. There are no delusions or visions yet, but the body is already sending distress signals: the normal work of the autonomic nervous system is disrupted, the mood begins to change quite sharply, in leaps and bounds — and the further, the more noticeable and more often in the direction of the pole that will color the entire attack — either depressive, with anxiety and fears, or manic, with a sense of uplifting, ecstasy.

The second stage, or stage of delusional affect. At this stage, the mind seems to be looking for a logical justification for the changed mood — and finds it. Bad — it means that something is going to happen. Or someone who is planning something bad is about to appear. Good means, again, something has to happen. The gingerbread truck will tip over under the Windows, or the wizard will fly there. Yes, in a blue helicopter. Yes, and show a movie for free. Or the Nobel prize for personal charm is about to arrive.

The third stage, or the stage of affective-delusional derealization and depersonalization. The environment seems more and more mysterious and suspicious. There’s something here for a reason. More precisely, everything. Everything has a double meaning. Yes, and the thinking itself begins to throw up surprises: then some thoughts will float in spite of themselves (mentalism, remember?on the contrary, the process of thinking will stop, as if someone has plugged the neck (sperrung). Gradually, the delirium begins to gain a clearer content, a plot, and gradually the plot begins to emerge: “Aha! That’s what I thought. This is because I loved the temples more than I loved God!”( ©) According to the content of the delusion, the patient’s” I ” is becoming more and more familiar with the new, dual environment: it seems to be still here, IN this reality, but it is already gradually becoming familiar with it THERE. The surrounding people and objects seem only conditionally belonging to this world — in fact, they are like icebergs, here only the tip, and if you look into the depths-and you will discover their true essence: that person seems to be a relative, but in fact … Oh, did not recognize you, Croesus, you will be rich (a symptom of Fregoli)!

The fourth stage, or the stage of fantastic affective-delusional derealization and depersonalization. The delirium that appeared at the previous stage acquires fantastic, paraphrenic features. He is no longer restrained by the framework of boring everyday reality, he needs space-fabulous, cosmic, apocalyptic or divine, and then Peter got bored at the gate, the devils in hell work somehow sluggishly, completely abandoned the service, and on Olympus, the corporate office needs to be revived — a new round of drunkenness or bruising, that’s how it will turn out. After delusions and changes in the ” I ” begin to appear and the first pseudo-hallucinations — you can not deceive expectations, the new reality must match the plan!

The fifth stage, or the stage of illusory-fantastic derealization and depersonalization. Delirium spurred the imagination, and it galloped madly, sweeping away barriers and unleashing an avalanche of pseudo-hallucinations. Auditory, visual, kinesthetic, tactile, olfactory and taste — all set to dive into the world of dreams was as complete as possible, to the new world found paints and began to live his own life — life stage set for a single audience. The patient’s ” I ” is already almost completely transferred to this new world and holds on to the reality from which it came, only with the little finger. Yes, it still remembers the passport details, and perhaps, with a huge effort of will, it will be able to give an answer on what day and from what geographical point it dived here, but what the hell does it matter! “Now we will conduct an orbital bombardment of the planet of the saber-toothed wetheads, and then there will be a landing, and no one will not think enough!”Or, alternatively,” there opens a portal to Olympus, we are also waiting there, the nectar is warming and expiring! And the mammoth license will expire soon, so let’s hurry!»

The sixth stage, or the stage of true oneiroid confusion of consciousness. Another gust of the mental storm, and the last anchor that held consciousness to these shores was lost. Now the patient is completely THERE; the reality that you and I are in no longer exists for him — he is traveling, fighting, or just contemplating Grand colorful pictures. At the same time, you can observe how the patient’s gaze wanders, stopping at anything but the surrounding environment, how the patient experiences or enjoys. It is useless to call him, to stop him, to try to attract attention — he is too far away! He rides among the horsemen of the Apocalypse, it is repeatedly burnt at the stake, he contemplates the garden of Eden, he steals fire from the gods and apples from the garden of the Hesperides… Yes there! It is he who is the universe, and it is he who watches with detachment everything that happens in it! Everything would be fine, but only the suffering brain gives birth to visions and experiences, and its resources are not unlimited. If the condition worsens, the next stage occurs.

The seventh stage, or stage of the Amen-like (from lat. amentia-insanity) obscuration of consciousness with fragmentation of oneiroid experiences. Consciousness is no longer able to maintain the whole picture in its entirety, and it falls apart into fragments of dreams, individual pseudo-hallucinations. The patient is confused, he tries to make sense of what is happening, where he is, who he is and when he is, but in vain. Thinking is incoherent, speech is slurred. Sometimes at this stage, the General physical well-being worsens, the body temperature increases, and the patient may fall into a coma. More often, after the sixth stage (and sometimes not reaching it), the patient leaves the oneiroid-smoothly or critically. The memories of the experience are most often preserved, with the exception of the seventh stage.

Oneiroid can most often occur in schizophrenia, infections (especially neuroinfections) and in the postpartum period (as part of postpartum psychosis).

The Amentia

The term originated from the Latin word amentia, which means “madness”. Of all the obscurations of consciousness, this is the most profound and serious. It cannot occur on its own, and a powerful artillery preparation is needed — for example, severe infectious or somatic diseases, encephalitis, or neuroleptic malignant syndrome.

Mandatory, or obligate, symptoms of amentia:

Deep disorder of consciousness with complete disorientation in time, place, and self. Therefore, if you suddenly decided to find out what date, day of the week, time of year, how to get to the library, or at least what the patient’s first name is, then you have chosen an inappropriate person to talk to. He would have liked to find out now, but the agonizing attempts to remember and collect himself in a heap do not bear fruit, and tips and even a simple statement of his own passport data do not give anything but even more confusion and weak attempts to somehow digest the information that has fallen on him;

  • Incoherent or incoherent thinking. Attempts to operate with the available information are no more successful than in a patient with cerebellar disorders to juggle ten working chainsaws. If, for example, for most people, the combination of a full white beard, a staff, a red hat and a bag of gifts adds up to a famous character, then for a patient with amentia it is an unsolvable puzzle. For him, putting together a complete image of the characteristic features is like a first-grade student who does not know German, reading and comprehending “Faust” in the original: there are familiar letters of the alphabet, but that’s all. Speech, like thinking, is also confused and incoherent in amentia. This confusion is asthenic: the brain simply does not have the strength for more complex integrating processes. This asthenic confusion of thinking and speech is the main sign by which amentia is determined;

Congrega amnesia. This is when the entire period during which the patient was in a state of amentia, memory mercifully erases. Yes, and not before it the brain — to stay with her!.. Additional, or optional, symptoms: perception disorders-fragments of illusions, hallucinations, senestopathies that do not make up any single picture, but appear in separate strokes: something was heard there, something was seen here, something inside cracked, gurgled, or felt hot…

  • Disorders of thinking — again in fragments, without a clear coherent system and logical completion: fragments of delusional thoughts, paranoid inclusions;

Affective disorder. They are present more often and can be very different: the affect of anxiety, fear, confusion, and much less often — euphoria.

When the General condition becomes heavier, amentia can change to a coma and end in death. Exit from amentia occurs with a sharp weakening, asthenization of the psyche, up to the formation of a psycho-organic syndrome (we are still talking about it).

Now about the paroxysmal obscurations of consciousness.

As the name implies (from Greek. paroxysmos-irritation, arousal), they develop quickly, acutely and immediately reach the peak of symptoms. The memory of events occurring during the blackout is lost completely or, as in the case of hysterical twilight, fugiform reactions or pseudo — dementia, partially.

Now in order. There are the following types of paroxysmal confusion of consciousness:

  • Twilight clouding of consciousness (organic and hysterical);
  • Ambulatory automatisms (actually ambulatory automatisms, fugues and trances, as well as — in the case of hysterical origin — fugiform reactions);
  • Aura of consciousness;

• Exceptional state of pathological affect, pathological intoxication, proselochnoy condition and the reaction of the short circuit.

A twilight blurring of consciousness, organic. Its main prerequisite is the defeat and weakening of the brain as an organ — not by Psychotrauma, but by a more tangible and tangible factor (trauma, infection, intoxication, vascular damage). It starts and ends abruptly, as if it was turned on and then turned off.

Leading, obligate symptoms — deep disorientation (except in some cases, more often with a dysphoric, with a predominance of dark and evil mood, variant) in time, the environment and your own personality, which does not prevent, however, to operate in a very dangerous autopilot mode. The second obligate symptom is total amnesia during the entire twilight period. Sometimes this amnesia is delayed, retarded, that is, the patient in the first hours and days may remember some of these events of the painful period, but then the memory will erase them completely. Moreover, this amnesia is so complete that it is useless to convince a person, to provide him with eyewitness accounts and recordings from surveillance cameras — for him, this period of time DID not EXIST AT all. No, it’s not he uprooted three of the ATM. And the chase with a chainsaw for cash collectors, too, is not stored in the memory. And the police Department simply could not have been harmed by his hands, feet, and tools. What kind of witnesses? What kind of video? No, it just couldn’t be! For this reason, twilight States of consciousness in forensic psychiatric practice are included in the list of exceptional States (more on them later), that is, those that exclude sanity at the time when such a state took place. The third is a deep, restless sleep that occurs when you come out of the twilight state.

Depending on which of the additional, optional symptoms prevail, it is customary to distinguish between delusional, hallucinatory and dysphoric (aka oriented) versions of “twilight”.

• If delusional variant behavior of the patient will largely determine the content of acute-onset (and lasting exactly as long as twilight lasts themselves) delusions: no — to hide, to escape or wait for his pursuers into his own ambush, if the end of the world will either be saved, or to save others, or to off last.

• In the hallucinatory version, everything will depend on what the patient sees or hears, what the devils tell them, who will be looming among ordinary passers-by, what will be the orders of the inner voice.

  • In the dysphoric (oriented) version, the patient may recognize some of the people around him, remember where he is and what time it is, but anger, longing, rage and aggression will gradually boil inside, Shrouding everything in a bloody fog — and an explosion will follow, in the best traditions of true Berserkers. Then, of course, everything will be forgotten. What are the shields? Who’s been eating? Where are the axes from? Yes, there was nothing!

• In the case of hysterical twilight obscuration of consciousness, the crucial prerequisite for its occurrence is the personality warehouse, of course, hysteroid. The state itself is not so much a blurring as a narrowing of consciousness, with the exception of what the patient does not want to see, hear, or be aware of. Moreover, from the current situation, where all the thorns, generously unavozhennaya territory and only points after the letter “e”, the consciousness is quite capable of mercifully transferring the patient to pink childhood (puerilism) or to portray pseudo — dementia-they say, why should the intellect overwork, dear master? Nevertheless, selective contact with such a patient is quite possible, especially on neutral or pleasant topics for him. And amnesia after leaving the twilight is often not complete, but partial.

Outpatient automatics (from lat. ambulo-take a walk). They are more common in epilepsy or organic brain damage. Memory for a painful period of time is also completely absent.

In fact, outpatient automatics usually do not differ in any kind of purposefulness: the patient can spin like a dervish, Crouch or jump, dress or undress many times, suddenly brew tea on beer instead of water, or disassemble a computer — and then wonder: why is it that they look at him so strangely today and collectively frown?

Trances. In contrast to previous States, in a trance, a person behaves quite orderly and seemingly purposeful, so from the outside, in addition to a certain detachment, drowsiness and confusion (not very noticeable, however), it will be difficult to detect any oddities-until the very moment when the person suddenly wakes up and sincerely wonders: what am I doing in this city (in this bed, this country, among recruits)? Even to cope with the official duties of the person during the trance sometimes quite capable (as long as it’s not running the country, by ship, by plane or bus), that’s just coming out of the trance, he completely loses all period of time (days, weeks, and even months) and will be a long time to figure out where a piece of my life.

The Fugue flows more rapidly and briefly. The patient suddenly picks up and runs somewhere, leaves the house, tries to get out of the car, train (well, if not on the move) or plane (what causes a chain reaction among other passengers on Board) — and so for a few seconds or minutes, and then suddenly comes to himself and wonders: why am I in the middle of the highway? Or at a distant station, grass up to your waist, a stopcock in your hand? Or with a parachute at the emergency exit?

In the case of hysterical trances and fugiform reactions, despite their similarity to organic ones, three distinctive features of these States are noticeable: theatricality and emotional saturation, the possible (though not always reasonable) benefit of such behavior for the patient, and partial, rather than complete, amnesia of events. As well as initially hysteroid character traits and personality warehouse.

The aura of consciousness. More often observed in epilepsy, before an approaching seizure; less common in organic brain damage. An interesting and characteristic feature is that the memory of the sensations experienced in the aura is not erased. This allowed F. M. Dostoevsky to describe it in detail in the novel “Idiot”. Why, the prophet Mohammad himself probably experienced this state more than once!

Which symptoms do not occur during aura: this is a dazzling, beautiful, colorful hallucinations, it feels as if the body transformered into something so… so… It’s deja vu and jamais vu, this is an unusual body sensations and change in the course of time, until it stops. And then comes the epileptic attack.

Exceptional condition. The causes of these conditions are different, but there are, nevertheless, criteria that unite them:

  • Sudden development;
  • Conditionality by an external cause;
  • Short duration (minutes, hours, less often days);
  • Accompanied by a clouded consciousness;
  • On exit-full or partial amnesia.

The presence of such a condition can serve as a basis for declaring a person insane if, while in this state, he has committed an offense. Now briefly about what these States are.

  • Pathological affect. There are three phases of it. First, or preparatory: in connection with a Psychotrauma (offense, insult), emotional tension increases, the ability to critically assess the environment and their condition is lost, attention and consciousness itself is narrowed and fixed on the Psychotrauma, from which everything else loses importance and only the offense, experiences are aggravated and inflated to the limit. The second phase, or explosion phase, follows the first, which is called, without warning, sharply, explosively, can be accompanied by illusions and hallucinations. This person is unresponsive and not distracted, he completely dominated outbursts of passion: he excited up to the rampage, senselessly aggressive and destructive, shows no mercy and acts like a machine. The third and final phase-just as suddenly the strength leaves the person, he falls into prostration or falls into a deep sleep.
  • Pathological intoxication. It can occur from both small and large doses of alcohol. At a certain stage of intoxication, consciousness changes sharply, hallucinatory and delusional experiences occur, as well as a pronounced affect: fear, anger, which leads to the corresponding aggressive behavior, with a complete separation from reality, although the behavior may resemble an ordered one: a person can drive a car, perform complex purposeful actions. This state also ends abruptly, often passing into a deep sleep.

Pathological prooecia state. Previously, they were described as” sleep intoxication”: a person does not fully Wake up from a deep sleep: he continues to dream while awake. And if the dream is frightening, heavy, and carries a threat, then the person begins to defend himself and shows aggression, sometimes very dangerous for others. So, the household he may well take for burglars who broke into the house, neighbors in the tent – for bears-perverts — Yes, you never know! And the body, unlike the mind, is already awake and ready for action! After a period of arousal, the patient usually wakes up completely, but either does not remember his dream, or can only partially remember it.

“Short circuit” reaction. Occurs when the stressful situation lasts long, day after day — whether old-timers picking on poor rookie, itchy if my wife to quit drinking, pass the bottle and buy her a mink coat. At the same time, nothing foreshadows a denouement, and the patient certainly does not prepare or plan for such a development of events, everything happens suddenly, vividly, with a powerful outburst of emotions, aggression (which is called “jumped”), after which sleep or exhaustion with detachment occurs.

As a rule, this is followed by a forensic psychiatric examination, recognition of the patient as insane, and compulsory psychiatric treatment, thoughtful and serious.

Since exceptional States occur suddenly and are not often repeated and characteristic of a particular person, it is extremely difficult to predict their occurrence, almost impossible. Have to deal with a fait accompli when only uncontrollable, senseless and destructive aggression, coupled with a glass eye and changed complexion (crimson or, on the contrary, livid), as well as dedication homing missiles — “I see the goal, I do not see obstacles” — suggest that the situation is extremely dangerous, and should save himself or save others.

Syndromes of Motor Disorders

A group of syndromes in which a violation of mental activity is reflected in disorders of actions, movements — that is, what should be controlled by the psyche and what should be subordinated to. It’s like with an aircraft carrier: you can have a nuclear power plant with herds of power horses, a complex control system for propellers and rudders, thousands of tons of displacement, a TUEV Hooch team and all sorts of deadly toys on Board — but if the captain foolishly decided not to give way to an island lighthouse with two caretakers and a Canary, then the lighthouse team will win. And a Canary.

This group of syndromes includes:

  • arousal syndromes; stuporous syndromes; hyperkinetic syndromes; lucid catatonic syndromes.

Now in order about each of them.

With all their diversity, one thing will be common: expressed psychomotor agitation, that is, both strengthening and accelerating the motor (mainly) and mental activity of the sick person, which even with all his desire, he is not able not to demonstrate.

  • Depressive agitation (melancholic raptus) is a sudden wave of acute melancholy, with clear feelings of how painful and unbearable it is, with despair that this agony will not end, and a desire to end it all as soon as possible-even at the cost of life. Sobs, groans, throwing from side to side, trying to kill yourself with something — all this can be found here.
  • Manic arousal occurs with the opposite degree of mood, and the awl in the ass this time is not present for the purpose of execution, but as a stimulating factor: such an excess of mental and physical strength just needs to be applied somewhere, otherwise it will tear the owner to shreds, like a drop of nicotine explodes a hamster. The activity, though violent, is not very productive, it is more fuss than good. Speech is also more like a logorea than a normal narrative, and is also often uninformative.

Hallucinatory-delusional excitement is caused, respectively, either by what is seen or heard, or by what is thrown into the furnace of the imagination by delusional symptoms. Or that and another together. And depending on the subject of the experience, the patient will either escape, or save, or defend, or attack, or… Yes, there is little reason to run and worry! Another thing is that all actions that a sick person will seem logical to the limit, for others may look like impulsive and unpredictable. Recall, for example, Bulgakov’s Ivan Homeless.

In addition, psychomotor agitation can accompany all States of darkened consciousness (delirium, oneiroid, amentia, twilight of consciousness) and is not strictly specific to one thing, but can occur in any mental illness.

Stupor Syndromes

All these syndromes, regardless of the reason for which they arose, have one thing in common: inhibition. And strong. It is so strong that compared to the hand brake that can be activated when looking at the issued salary, meeting with an empty bag around the corner or a neighbor in a mini-bikini on the landing, THIS brake is stronger than a stop crane and more like a Parking anchor for an aircraft carrier of medium tonnage.

In this case, inhibition applies to all areas of the patient’s activity: motor-up to complete immobility, when he rather goes under himself than to the toilet; mental and speech-up to the inability to get an answer to the most elementary question; volitional-up to the complete refusal to eat and drink, and not for some political, delusional or any other reasons, but simply because During this period, even the sensitivity to pain is dulled. The mimicry freezes, the gaze freezes, and the person himself freezes, if not like a statue, then as if he had fallen into a jelly. All the events around you seem to pass by without touching the patient and without disturbing his detachment.

Here you can select the following main (except for catatonic, we will consider it separately) options for stupor.

Depressive stupor. Melancholy, pain, grief and suffering are so strong that it is reflected in the facial expressions (a mask of grief, a pained expression of the face), and in the pose-when the patient sits motionless or sways slightly, clasping his hands, or holding his chest. What kind of food can be when it’s not just bad — everything just had way, life is over, damnation, sin, serious, her ass full and permanent!

A manic stupor is diametrically different in the sign of mood, and although the patient who is in it also does not differ in mobility and speed, this happens for a completely different reason: he is the BEST of ALL! So great that there are no words — and in the literal sense: it is almost impossible to get an answer to questions, the patient is not up to it. The universe loves him, angels tremble before him and representatives of the opposite sex fall in stacks, the oligarchs of the world fight in hysterics, envying his untold wealth. And the frozen expression of happiness on his face is only a faint reflection of the personal sun that shines specifically for him.

Hallucinatory stupor. The cause of inhibition in it is hallucinations, often auditory and often imperative. In fact, how can you not freeze when a voice yells: “STOP!!! To be AFRAID of!!!»

Delusional stupor. In General, there are some ideas that overshadow the mournful brow, such a property-if it arrived, then as a victorious knockout. Or suddenly there will be a clear understanding that everything around is stuffed with motion sensors, and any movement of everything that is larger than a mouse, from orbit, Psion beams are pummeled! The old woman from the other entrance was so smart-she was so stuck on her head, now she smiles blissfully and never takes off Faraday’s knitted chain mail cap…

Asthenic (he’s apathetic, he’s dinamicheskii) stupor. Usually occurs when the brain is so exhausted and weakened (severe illness, trauma, infection, Narzan, port or rehearsals and cocaine) that the only possible mode of existence and work for it at the moment is a saving protective inhibition. The patient is prostrated, listless, apathetic, and relaxed. Answers questions after a pause and, as a rule, in monosyllables; at the same time, he quickly gets tired, runs out of breath, and has to wait a long time for him to gather his strength and thoughts again (they also need effort!) for future responses.

Post-shock stupor occurs as a manifestation of an affective shock reaction: if an empty bag around the corner turned out to be too large and dusty, or the situation is more extreme and dangerous than anywhere else, with a real threat to life and health. Looks like him.

Hysterical (aka emotional) stupor — it occurs when the patient hysteroid traits in the background of the trauma, which is specifically for him is very important and painful, although not deadly: for example, forms neighbor has surpassed all imaginable expectations, or suddenly it turned out that wild-growing hemp can give the time as for first-class Indian, either spouse is angry at loved Terrier, too, and he was bitten… in these types of stupor, the patient usually lies in bed, often in a fetal position; the facial expression is helpless, frightened.

Epileptic stupor occurs immediately after a seizure and lasts for several minutes, after which it passes. The period of stupor the patient usually forgets (and he’s having a seizure, of course, he amaziree ALWAYS).

Lucid Catatonic Syndromes

Before the reader himself gives a slight psychogenic stupor, trying to understand what it is, I will explain. Lucid is derived from the Latin word lux, meaning “light”, and means in this case a syndrome free of other painful symptoms. In other words, flowing without hallucinations, delusions and (formally) obscuration of consciousness. Catatonic-from the Greek word katateino, which means “to stretch, strain, depress, disrupt the tone” – because the leading disorders visible in these syndromes to an outside observer will be motor ones, and so specific that they are difficult to confuse with anything else. Here, for example, if such motor disorders occurred against the background of an oneiroid — we would be talking about oneiroid catatonia, but these subtleties will happen next time. An important difference: in lucid catatonic syndromes, the patient remembers events that occurred at the height of the disease, but in oneiroid ones-most often not.

Actually lucid catatonic syndromes can be observed in two opposite hypostases: catatonic stupor or catatonic excitement — and no compromise.

Catatonic Stupor

Wash the body. Wipe the coffin. I’m going out on an evening horse.

This stupor has several variants that differ in details, but, nevertheless, the entire group, like the Communist party factions, is United by several fundamental features.

First of all, it is hypokinesia (from Greek. hypo – – little and kynesis-movement) – and in a wide range, from sluggish and sparse movements, like a boa constrictor, escaped from the terrarium on the snowy expanses, to complete immobility in the manner of a Caryatid, propping up a detail of the facade. Mimicry, by the way, is also not striking in diversity and would do credit to the actors who play Indian leaders in films with the participation of Goiko Mitich. With regard to the patient’s eloquence, one could set an example for monks who took a vow of silence if mutism (remember the mute button on the TV remote?) was a conscious and voluntary affair.

Parakinesia (here the Greek prefix para-means “distortion, perversion, wrongness”) is just the feature of motor disorders that will not confuse catatonic stupor with any other. This passive negativism (the song “the district being a tourist, vigilant and excessive initiative and trying to take the Manneken Pis in the nearest branch or at least the corner”), and the negativity of the active (the same district ogrebaet from Manneken Pis for trying to clamp on a causal place), this is an unusual, art and intricate postures in which the patient freezes (that is, less exalted than the sitters of the Kama Sutra, but still impressive), it’s symptoms, accompanied by increased muscle tone: “airbag”, when, removing the pillow from under the patient’s head, you spend an hour agonizing over what he is so comfortably settled on — the head still does not touch the mattress… This is “waxy flexibility”, or catalepsy (from Greek. katalēpsis-grasping), when the hand or leg remains for hours in the position that it was given. This is a symptom of the hood, when the patient tries to cover his head with something-no matter, a shirt, sheet, blanket-just to hide it; this is the fetal position, when a person lies on his side, with his arms, legs and head to his stomach-just to shield himself from the hostile world; this is a symptom of the proboscis (not to be confused with the proboscis reflex!), when the lips stretched out in a tube as if frozen in anticipation of a return kiss from the universe — and it is already a couple of hours late for a date…

Failure in the work of the autonomic nervous system is also necessarily present, and it is noticeably more serious and heavier than some kind of vegetative dystonia. It’s all grown-up: it’s greasy skin, and acne, and acrocyanosis (cyanosis) of the tip of the nose and ears, and low blood pressure, and a rapid heartbeat. Sensitivity to pain is reduced until it disappears, the reflexes of the mucous membranes (for example, blinking in response to touching the eye) are hardly more lively than those of a zombie, but in response to an attempt to test the knee reflex, like other tendons, it is quite possible to get an industrial injury. Appetite in this state is reduced or turned off completely, but it is unlikely that this method of losing weight can be adopted.

Now about the details. There are three variants of catatonic stupor.

“Sluggish” stupor. With it, hypokinesia is not so severe as to cause complete immobility, and manifests itself in a General amoebic lethargy, a kind of unhurried state that will cause the envy of any respectable snail. Attempts to stir up and give acceleration are met with either passive negativism (“Though I will not give you an eye, but I will not add speed”), or passive subordination (“Okay, lead, basurmans!”), but if you stop making efforts, snails can again gnaw their shell out of frustration — they will not succeed so impressively.

Stupor with waxy flexibility. Hypokinesia is stronger with it, up to full identity with the exhibits of the Madame Tussauds Museum, and the poses taken, combined with the patient’s ability to stay in them for hours, will give a head start to any sitter who looks pale against this background, swims shallow and is generally similar to a child with attention deficit hyperactivity disorder. Passive negativism in response to an attempt to get a more active civil position from the sculpture is expressed quite strongly, up to the complete impossibility of changing something without resorting to improvised tools and dynamite, and with more insistence from others, it can suddenly change to active, and then risk getting both critics and well-wishers, as well as citizens from immoderately sympathetic.

Stupor with numbness. This is the moment of transition from a wax sculpture to a mummy-like state, just as motionless and indifferent, with the same wooden muscles, with a complete lack of appetite, thirst and interest in the environment, and with the only difference that archaeologists are less likely to catch in the eye when trying to remove bandages. The negativity here is very active. In addition, mummies do not go under themselves, any Museum caretaker will confirm this to you. And they don’t try to adopt the hood or embryo pose. But both of them clearly demonstrate the airbag syndrome.

Catatonic Arousal

Here you can observe the complete opposite of catatonic stupor — as if someone turned the toggle switch from the “freeze” position to the “die” position, but managed to overdo it. Tellingly, the transition from stupor to arousal and Vice versa can occur just like this-suddenly and without any external reasons.

The main, or obligate, symptoms of catatonic arousal are hyperkinesia (or over-mobility) and parakinesia (or, as already mentioned, perversion, distortion of motor activity).

Hyperkinesia is an understatement, here they are represented by a powerful, chaotic (without any purpose, but working on areas no worse than the Grad installation), destructive, sometimes impulsive (when the patient explodes with a motor storm from within, as if a detonator spontaneously triggered) psychomotor excitation.

Paragenesia are quite rich. This:

Echolalia (from the name of the Greek nymph Echo and the Greek word laleo — “I say”), when the patient arbitrarily does not say a word, but repeats a word or phrase from a speech addressed to him or said in passing, and good, if it is something censored;

Echopraxia (the same nymph and praxis-action), when the patient involuntarily copies the actions and gestures of others (not to be confused with dance karaoke!);

Motor Stereotypies, when the same action is repeated senselessly, unconsciously, involuntarily and repeatedly-slapping hands, swinging, shifting objects. It is better not to involve in washing dishes in this state — it will be of little use, plus there is a high risk of switching from uncontrolled washing to uncontrolled beating, and the latter will be more successful;

Speech Stereotypies (standing turns, a symptom of a gramophone record) – when a single word or phrase is repeated in the same senseless way and repeatedly, and the persistence of repetition can cause a nervous TIC even in a battered parrot-they say, is it mocking?!

This also includes pretentiousness and mannerism of poses, but here, in contrast to stupor, not wax figures will nervously smoke, but the pantomime theater with a full complement, even non-smokers and watchmen.

Active and passive negativism, as well as in stupor, will take place here.

This is also impulsivity, or the ability to suddenly, as if obeying an internal push, move to the position of “Android fighting, gone off the rails”.

From optional, or additional, optional symptoms:

• Homicidalmaniac (“kill All, one will remain»);

• Suicidaire (“will kill itself about a wall, nobody gets them»);

• Self-mutilation (not necessarily in the literal sense);

Coprophagia (I believe you can not translate).

There are three types of catatonic arousal.

Pathetic catatonic arousal. It usually increases gradually and does not reach the destructiveness and power of the impulsive. The patient constantly walks, periodically assuming poses that would do honor to any public leader; speech competes with poses in its pathos, and often is not burdened with a semantic load-except that echolalia are now and then included in him, and not in the audience. Exaltation is enough to charge a small sect of worshippers with sacred fervor, if catatonia could be professed. At times, the performance is interrupted by bursts of laughter-for no reason, which is generally natural and pathognomonic.

Impulsive catatonic arousal. As the name implies, this is an excitement with a sharp, explosive beginning. This is a tornado, this is a hurricane of destructive, senseless and cruel actions, this is a Berserker with a completely shot down sight, a disabled “friend-foe” system, turned into a weapon of mass destruction. Speech is jerky — individual shouts, phrases, with echolalia (as a rule, this is a repetition of offensive epithets heard from others, or fragments of their frightened exclamations). Motor stereotypes, especially if they are from the series “hands are used to the axe”, only add color to the picture of destruction. Most often, impulsive arousal replaces the catatonic stupor, does not last long, and is replaced by a stupor.

Silent catatonic arousal is so named because the patient performs all the destructive actions in complete silence (mutism). Often these actions are directed not only at others, but also at yourself, and all attempts to stop them are met with fierce resistance. This type of arousal is more chaotic and purposeless than impulsive, but it is also quite dangerous.

A little apart from the catatonic is gebefrenica excitation (from the Greek. hebe-youth, phren-mind, mind). The fact is that it can be one of the stages of development of catatonic arousal, or rather — pathetic, and then it can be called gebefreno-catatonic arousal, and may occur in itself, in the framework of exacerbation of the same name (ie, gebefrenicheskoy) form of schizophrenia. The name comes, apparently, from the manner in which certain young men have been observed to make faces, APE and flaunt in every possible way all the bad things that are in them, in the hope that girls who find themselves in the radius of defeat will take this as a sign of exclusivity and consider it worthy of attention.

This excitement is manifested by pretentiousness, grimaces and antics, mannerisms of behavior, grotesque gestures and facial expressions-only they do not occur at the request of the patient and not from a flaw in education, but in spite of his will and due to illness: he would be happy to behave differently, but can not. Speech, too, is full of neologisms, periodically turning into something like childish babble and syusyukanyu (puerilizm), flat jokes and memorized once phrases, with periodic jamming and repetition of one of them (verbigeratsii). This is what concerns obligate symptoms.

As for electives, they can be represented by episodes of hallucinations, usually auditory, as well as fragments of delusions.

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