Category: Uncategorized (Page 1 of 3)

Pathology of Judgments

It’s Intrusive, overvalued and delusions, if we consider them according to the degree of aggravation. How to distinguish them?

Obsessions arise involuntarily, against the will, and disorganize the logical course of thinking. Important: they are perceived by the patient as painful, and they remain critical, they do NOT determine the direction of the activities of this person, that is, do not subordinate it to themselves, although they disorganize mental activity as a whole.

  • Obsessive thoughts arise in the mind of a person involuntarily and even against his will. While consciousness remains nepomucenum, clear.
  • Obsessive thoughts are not in a visible connection with the content of thinking, they are in the nature of something alien, extraneous to the thinking of the patient.
  • Obsessive thoughts can not be eliminated by the will of the patient. The patient is unable to get rid of them.
  • Obsessive thoughts arise in close connection with the emotional sphere, accompanied by depressive emotions, a sense of anxiety.
  • Remaining alien to thinking in General, they do not affect the intellectual level of the patient, do not lead to violations of the logical course of thinking, but their presence affects the productivity of thinking, mental disability of the patient.
  • The morbid nature of obsessive thoughts is recognized by patients, there is a critical attitude towards them.

Supervaluable idea. The concept of overvalued ideas was put forward by K. Wernicke (1892). They affectively rich take a large (disproportionate) in the mind of the patient, disrupt his mental activities and dominate in large measure his behavior. Occupying an intermediate position between obsessive and delusional ideas, they, unlike the latter, are always based on their real (not fantastic, not fictional) background, although criticism of them is already formal or not at all.

Delusional ideas are painful, absurd, unshakable judgments and conclusions that do not correspond to objective reality, disorganize mental activity and subordinate the behavior of the patient, not amenable to criticism and correction.

Figuratively speaking, the husband, suffering from obsessions of jealousy, tormented by the question — and does not change his wife, but because he can not find real evidence of that, suffers to himself. Husband with overvalued ideas of jealousy, convinced that his wife is wrong, can cause some very real, albeit indirect, of facts and a considerable part of free time devoted to the Amateur detective, aware that, even having found them, to kill no one. A husband with delusional ideas of jealousy doubts nothing. He KNOWS she has the mayor’s lover. Or downstairs neighbor. Or specially called her a witch, the Incubus. The evidence, therefore you don’t even have to look, but if someone still doubts — here: the color of the clothes in which she went to work, the spirits, who certainly likes not only her cigarette butt with her lipstick, thrown on the lower balcony, as well as traces of astral presence. And essential, volatile, ejaculate. And in case of paraphrenic delirium of the spouse and at all the organizer, the ideological inspirer and the only volunteer of an all-galactic brothel.

Now more

Obsessive phenomena can be divided into ideatory, phobic and motor. Ideational, or obsessions, is abstract obsessive thoughts, obsessive doubts (turned off or not turned off the stove-water-light) and memories, haunting score (and there are nine steps, and for me at the bus stop consisted of five people, and the next eight) and thought, often blasphemous or sacrilegious (and dead-it is better all settled, it is not hot; and there is the girl in black — well, so I would…), obsessive sophistication (at least the goal is to guess whether the mood of watching something dead or alive Schrodinger’s cat).

Motor (volitional) disorders are divided into the following categories:

Obsessive drives — the desire to make unnecessary, antisocial, sometimes dangerous actions, which is accompanied by internal discomfort, if not implemented. Most often they are not implemented, especially those that are dangerous:

Homicidalmaniac — obsessive attraction to murder, often of a close person; suicidaire — obsessive desire for suicide; coprolalia — the desire to flip off as it should. By the way, the obsessive desire to step out of the window or from the balcony belongs to the same group, it is almost never realized.

Obsessive actions — implemented obsessive drives, often ritual (made — obsession has passed). Among them, automania — obsessive hand washing when mysophobia, bacillophobia. There are other self-obsessive actions: autoreplace — pulling out own hair (not to be confused with makeup and autoreplace sacral-ischial region, since the objectives are totally different); onychophagia — nibble nails, burrs, obsessive ticks.

Overvalued ideas — allocate the content dismorphophobia (“my nose is a honker, not the chest, and the two blemishes, the legs are as hereditary cavalry, and authorship over the form of the ears are fighting elves Cheburashka”); hypochondria (“Oh, somewhere, something popped, gurgled, tumbled and capricornus — not otherwise kirdyk on approach”); inventions (“not bosonic engine for flying saucers, something more earthy, like a special feature head rivets, but the patent office zadolbali»); reformism (amendments to the law on pensions, the proposals of various parties about the change of the Charter, leadership and the main line); litigation (querulant, prosecutors in their work calculated volumes and tones); erotic (starting from the desire to bring happiness to a marriage Miss My Hometown and ending with a pathological belief in their own irresistibility and sexual omnipotence); sexual inadequacy (“I do not like human beings and, in General, such as me, is that a good wholesale”).

It is necessary to distinguish super-valuable ideas from dominant, dominant — which occur in mentally healthy people and represent devotion to any scientific, cultural or religious ideal, the idea for the sake of the celebration of which a person is ready to neglect everything else (remember the ardent fighters in the name of anything).

If you are paranoid — it does not mean,

that THEY’re not after you.

Every fighter against punitive psychiatry sincerely wish at least once in his life to be woven into the delusional system of one of our patients. An unforgettable experience is guaranteed, level up (raising the level) in the worldview and impatient “when will these wonderful people come in white coats?”as a free bonus.

Pathology of the Associative Process

Depending on what part of the associative process of thinking has suffered, we can conditiaonally divide these violations as follows.

On rates:

Accelerating the pace of thinking, when a person processes information, makes a decision and generates ideas much faster than others. Characteristic of manic States, where this acceleration can be expressed up to the “jump of ideas”. Slowing down the pace of thinking. Reflection and decision-making is delayed, sometimes so much that the attempt to talk turns into mutual torture for its participants, and if the second interlocutor is also still in a manic state (see the previous paragraph), not far from self-harm.

Mentalism is an involuntary influx of thoughts, when these thoughts invade in addition to the will of a person in his measured thought process, thoroughly interfere with his activities, often completely disorganizing it. How would you like, say, if the influx of thoughts about the fate of the Fatherland caught you watching a porn film?

Stop (blockage, sperrung) thinking — involuntary breakage, stopping the flow, the absence of thought. Thought-thought — and all. Deadlock. Cliff. No thoughts. And no dialogue to continue, no thing to do there is no way. Frozen, waiting for everything to move again.

By mobility, liveliness of the process:

Detail — secondary nonessential details are constantly involved in the thinking process. It is as if you are in a casual conversation about the weather made happy by the classification of clouds and the average annual norms of temperature and precipitation.

Thoroughness — a pronounced detailing with a systematic stuck on the details and side associations. The wind rose, the discussion of the spoiled ecology and the coordinates of the most trustworthy forecast Bureau would surely have been added to the previous details.

Viscosity — a pronounced thoroughness in which thinking becomes unproductive, to track the original thought is not possible, as well as the direction in which the conversation was originally – in General, by the fourth hour of the discussion, you are likely to be painfully decide who to beat the face: Greenpeace, meteorologists or interlocutor.

On the grammatical structure of speech:

Speech stereotypes — stamped turns or use of a question to build an answer; this is when the speech uses cliched, formulaic turns (“so, what I said…”, “well, as they say, let’s go back to our rams”, “as one of my friends said — however, you do not know…”), as well as the use of the question to build an answer: “How is my name? And my name is too well known for me to tell you!”Verbigeration is a meaningless repetition of the same words, phrases, endings of words or individual sounds. Incoherent — “verbal hash”, a set of individual words or phrases, devoid of logical and grammatical structure (not to be confused with the poem “Mom, dad, spoon, cat”).

By focus:

Flowery — in this case, to Express even a simple thought, the patient resorts to a mass of comparisons, excerpts from various sources, metaphors and sayings, formulas and scientific terms. All you have to do is say, “go fuck yourself.” Now imagine how such a person would sound an explanation of love.

Slippage — this disorder can be represented as follows. The patient talks, for example, about cats. Thinks quite coherently and sensibly. Suddenly, clinging to the fact that some of them are gray, recalls the Maxim “in the dark all cats sulfur” and then gives a lengthy discussion on the relationship of cats, darkness, demonic beginning in the cat’s soul… and then as if nothing had happened returns to the discussion of what they are, in fact, cute and fluffy creatures. Why the slippage? Because such a course of thought looks like a patient, walking along the path of reasoning, slipped, leaning on a minor Association, and for a while rode on it, and then returned to the previous, well-trodden path.

Logic-chopping — long-winded philosophizing, the transfusion of a sieve, lengthy torrent minor subject — without a goal, without any direction. Who met with a flood (chatter off topic) in the comments replicas that way for twenty or thirty, I understand.

Formalism of thinking — when all the attention and all the power of the intellect is not thrown to the comprehension of the essence of the issue, but to a clear execution of the Protocol and the letter of the Charter.

Diversity — in this case, the patient can consider the subject or phenomenon from several points of view, based on several evaluation criteria, constantly changing the levels of generalization, but is not able to come to a decision what in this particular situation should be preferred. So, asking him to exclude from the pictures with the image of the castle, castle and hut one thing, you will not get an answer from him. He says that in one way or another all the pictures are interconnected, nothing extra on them, and in General, specifically, whether such an unsolvable puzzle planted?.. Amorphous — fuzzy, contradictory use of concepts. In this case, it is built syntactically and grammatically correct, but it is not possible to understand WHAT it says. There is no main idea, no conclusions — only a set of phrases that seem logical to the patient himself. If you ask him “how is life”, the answer may well be: “Well, how to say? That is to say must. Because you know the difference between that and that. You can’t just go one way. Justice will prevail though, but it’s when we second such a leader will find objective conditions are not impossible to satiate. When the top can’t, the bottom doesn’t want to. And when it’s full, it’s too late to talk. That’s it.”

Paralogical thinking is a violation of the logic of thinking, the so-called “logic curve”, when either the prerequisites or the evidence suffer, or the process of establishing a connection between cause and effect (this distinction is conditional). Example? The patient basically does not drink juices. Why? “Juice is health. Health is sport. Sport is a lot of money. A lot of money — a lot of women. A lot of women is AIDS. AIDS is death. Am I so fucking happy?”Symbolic thinking — thinking based on pseudo-concepts, symbols, the meaning of which is clear and accessible only to the patient. So, he can talk about the special meaning of what colors are dressed today his employees, and that it can mean. Or to say that for him all the numbers have, in addition to the main, more and additional, secret meaning, thanks to which each new date is an encrypted message with a guide to action.

Pathological polysemantism — when a patient discovers a new meaning in words, based on how many vowels or consonants they have, for example, whether they rhyme with a particular word — say, with such as “death”, “love”, “treason»…

Autistic thinking — is thinking, little in contact with the surrounding reality of the patient, clear and accessible only to him, reflecting his world, in which outsiders are not allowed. Thinking fantastic and bizarre, but not devoid of its own pretentious logic, “feast behind closed curtains” E. Bleiler. Here is an example given by Blejleru [18]: “the Patient B. S. in the work of Jung’s early dementia is Switzerland, she is also Ivikov the crane; she is the owner of all of the world and a seven-story factory of Bank bills; it is also double the Polytechnic University and the assistant of Socrates. All this seems, at first glance, complete nonsense, and indeed is nonsense from the point of view of logic. But if we look more closely, we will find clear connections: thoughts are essentially subject to affective needs, i.e. desires, and sometimes fears; the patient is a Willow crane because she wants to be free from guilt and depravity; she is Switzerland because she must be free.”

Archaic thinking — in this case, for the Foundation of the building are the judgments “the times of Ochakov and the conquest of the Crimea”, attitudes and stereotypes, for example, the same dissenters-old believers. Or the Neanderthals — there could be as lucky…

Perseveration (from lat. perseveratio — perseverance, perseverance; from persevere — persevere, continue) — most clearly this disorder is characterized by an anecdote: “Doctor, I do everything four times, four times, four times, I am very tired, very tired, very tired, but the wife is happy, the wife is happy, the wife is happy…” This is a steady repetition or continuation of once started activities, phrases, and this repetition continues even when the context appropriate for him is exhausted. For example: “what’s your name? — Lesha. — How old are you? — Lesha. Are you retarded or something? — Lesha. — Where do you go? — Lesha. — Who are your parents? I’m not retarded.…»

Fragmentation — the lack of logical connection between individual conclusions, judgments, concepts with the formal preservation of the grammatical structure of speech. If the rupture of thinking acquires an extreme degree of severity — begins to suffer and speech. Example: “I believe it is necessary to use extreme geographical, constitutional and obscene terms, that every kind and species, sex, and religion you have understood who could not stop performing our great, horrible, but extremely pleasant mission membership in the Federation Council”.

If the above were described violations of the associative process of thinking concerning how a person thinks, now we will talk about WHAT he thinks.

Memory Disorders

If all the angry questioning your half repeats the mantra “I debianchangelog”, do not rush to take up kitchen utensils, posing a diagnostic and educational objectives. Perhaps the man really does not remember anything.

Memory disorders can be divided into quantitative and qualitative.

Quantitative memory disorders are hypermnesia, hypomnesia and amnesia.

Hypermnesia (from Greek. hyper — over and mnesis — memory). This does not mean that the subject suddenly acquires a phenomenal memory that allows him to become a superspy or a successful card player. The ability to remember it often does not change. But dramatically increases the playback of memories, against the will of man, begin to invade the consciousness and does not contribute to clarity of thought and clarity of objectives, rather the opposite — desorientiert, muddle.

Hypomnesia (from Greek. hypo — under and mnesis — memory). In this case, the memorization of current information or the reproduction of past events is weakened.

Amnesia (from Greek. a— as a denial and mnesis — memory) is characterized by the lack of the ability to save, reproduce and (in some cases) record the patient experienced events — at a particular time. I would like to emphasize that this is not a weakening of memory, as in hypomnesia, but its complete disappearance for some period. And depending on what it is for the period, there are the following types.

Congrega amnesia (from lat. prefixes con— together and gradior — go) — loss of memories for the period of the darkened consciousness (in most cases — if it was switched off by itself or due to insurmountable external circumstances). Retrograde amnesia — loss of memory of everything that was BEFORE the painful condition (injury, attack, etc.).

Anterograde amnesia is the loss of memories for the period AFTER an injury, attack or acute stage of the disease that caused a violation of consciousness, that is, the recovery period is forgotten. Interestingly, in this period the patient, as a rule, adequately behaves, talks and answers questions, but in the future all this will be erased from his memory.

Anteretrograde, or total amnesia — there’s you know…

Depending on which of the memory functions suffers more, you can also highlight the following types of amnesia.

Fixation amnesia — a strong weakening or complete lack of ability to capture and hold in memory new information, current events (in such cases say, that “memory as sieve”).

Anaktoria (from the Greek. an— + ekphorio — make) — the failure timely to recall a known fact, the inability of the memories without prompting (not to be confused with the state of the student during the delivery of the session!).

According to the dynamics of amnesia is divided into the following:

Progressive— when there is a disintegration of memory in accordance with the law of RIBO, from the current to an increasingly long past; while a person may not remember where he lives, but perfectly list all the neighbors from the village where he lived in his youth. Especially if one of them once owed.

Stationary — when the existing memory impairment is not aggravated, but does not pass. Regressing — when eventually after a pronounced deterioration in memory is gradually improving and memorizing the teachings, and playback of the past. Retarded — when events fall out of memory not immediately, but after a while after an illness or injury.

By object can be selected:

Affectogenimap, or catalkoy, amnesia — when memory fall only special, meaningful human events, resulted in very strong feelings (usually unpleasant, those which this man can not continue to live in peace).

Hysterical amnesia, which is somewhat similar to the previous one, when selectively erased from memory (Freud would say — replaced) only unacceptable for the individual events (with the experience about them, unlike those in catatymic amnesia, may be weak or not at all — whether to worry about what was not!).

Sodomization, which is similar to the previous form of amnesia, her memories fall out partially, the plots but the personality is not the hysteroid.

Epochal — it usually occurs after shock and covers long periods of life (months, years).

Separately it would be possible to allocate an alcoholic palimpsest (from Greek. рalimpsestos — text, manuscript, written on top of that scraped from the parchment — that nothing material to translate, but some of the previous labels you can guess). This is a condition where some of the details and events that took place during the libations are erased from memory, leaving behind only vague hints and a feeling of vague anxiety in half with a painful awareness of his own wrong, but still would remember what exactly… Alcoholic palimpsest — the first bell warning that not far off alcoholic amnesia and other delights of alcoholic brain damage.

Qualitative memory disorder is to many cases of paramnesia. It’s a distortion, a perversion of memories. To paramnesias include pseudoresistance, confabulation and cryptomnesia.

Pseudoresistance (from the Greek. pseudos- — false-, lat. reminiscentia — memory) — usually occur in a patient suffering from fixation amnesia. He tries to fill the gaps in his memory as best he can, eventually filling them with events that REALLY took place in his life, but not at the time he is trying to remember. So, as “patches” may well fit student or even school years, or those of the more recent events that were able to stay in memory.

Confabulation (from lat. confabulari — to talk, to tell) — in this case, the patient fills in holes in the memory of what never existed, and often does could not exist. So, asking to talk about violent youth, you can get the answer a story about the guerrilla actions in the forests of Belarus with the exact personally killed the Nazis, as well as modest mention of the fact that the flight to Mars has been, just for the purposes of secrecy not publicized, and who do you think flew there? Yes, and the defeat of the third intergalactic occupation case don’t forget. With these two hands sword in zero gravity Mahal. There are substitute confabulations — when the holes are filled with something close to reality, everyday-mundane (went to the bath, drank beer, immediately after fishing — this was a bite!). By the way, General Ivolgin in F. M. Dostoevsky’s novel “the Idiot” demonstrates the replacement confabulations. There are fantastic confabulations — it’s just about Mars, checkers and weightlessness.

Cryptomnesia (from Greek. kryptos — hidden, secret and mneme, memory, remembrance) — when it is better not to give up fantasy. And put the TV away. Otherwise you will be told about the adventures in the spirit of the main character of Sapkowski’s novels, with the beheading of all monsters in the vicinity of the promenade and circuses. And strictly to ask, what makes the kitchen the old hag and just what happened to Maria. The patient, being unable to remember or dream up, draws events from those sources of information that are at hand: books, Newspapers, television – without making a distinction between his own life and all other events. What he saw in the dream, by the way, can also be regarded as taking place to be in fact, so that “return back to the Bahamas and the mulatto with lush Breasts.”

Amnesia — when the patient there is a sense that the event is repeated. Most frequently occurs when substance-induced psychosis.

Symptoms of Attention Disorder

Geopresence (from the Greek. hypo — under, below and rgoah — note), i.e. low attention. It is represented by the following types:

Attrition — reducing the intensity of attention after a certain period of time, while active attention quickly exhausts itself, replacing passive. It’s like making a Sprinter run a marathon. Easier to shoot from considerations of humanity to the end of the first kilometer.

Attention distraction — deterioration of the ability to maintain focus for a long time, the ability to fix it on a given object; this reduces the total amount of attention. It’s like trying to get yourself together after a day of hard work.

Distraction — extreme mobility, rapid change of focus, concentration, intensity of attention with a decrease in its depth. Attention at the same time as if flutters from flower to flower. Or from water Lily to water Lily. Or jump on the supplied volume, the Brownian motion as a crowd of students during recess.

Giperprodukcia (from the Greek. hyper — over, over and prosexis — attention) — pathologically enhanced concentration of attention on individual objects, phenomena, thoughts or sensations, with enhanced predominantly passive, involuntary attention. Often this concentration is one-sided, aimed at what worries the patient most: his ailments, fears, ideas. Often accompanied by such a phenomenon as stiffness – when attention is inert, sticky, fixed, while it is difficult to redirect from one object to another. It resembles an aircraft carrier: a huge tonnage, mind-blowing weapons, but it is better to start dodging the coastal lighthouse with one caretaker and a Canary in advance.

Paraprotex (from the Greek. para — about, past and prosexis — attention) — perversion of attention. Perversion not in the sense that it is fixed on painful experiences, and that there is a discrepancy of expectation to result. How? Man is so intensely and anxiously waiting for some event that when it happens, he is simply not able to notice it. It’s like convincing yourself not to miss the approach of the train and eventually do a fascinating braking distance, evenly distributed over the landscape.

Aprosexia characterized completely turned off by both active and passive, and to attract it is not possible. Usually, this indicates quite a serious illness, unless you guru in Samadhi. However, it all too seriously, but for a different reason.

As a rule, attention disorders do not occur in isolation. They are part of the symptom complex of a wide variety of psychopathology.

Symptoms of Disorders of Perception

According to the levels of complexity of the perception, the symptoms of his disorder can be divided into three groups: a) disorders of sensations; b) disorders of perception itself and C) disorders of representation (or hallucinations). Now on counts.

Disorders of sensations

Hypersensitivity (from the Greek. hyper — excessively and aesthesis — sensation, feeling) — hypersensitivity under the action of ordinary or even weak stimuli, while the sensations are bright, up to discomfort and even soreness. On what senses are involved, allocate hyperesthesia optic, acoustic, gustatory, olfactory and tactile (or cutaneous hypersensitivity of the senses). Accordingly, the first in the eye with a flashlight to Shine on the second not to scream, the third and fourth do not give garlic, fifth not to tickle. And not mistake!

Gipostezii (from the Greek. hypo- — and aesthesis — feeling, feeling) — decrease in susceptibility to external stimuli, when the colors of the surrounding world fade and the sharpness of sensations is dulled. It’s like sex in a wetsuit: the meaning of all these physical exercises is unclear…

Hyperalgesia (from Greek. hyper — excessively and algos — pain) — increasing pain sensitivity. Inquisitor’s dream.

Anesthesia (from Greek. an— negative particle and aesthesis — feeling) — loss of sensitivity. Here it is necessary to allocate separately hysterical neurotic symptoms: mental amblyopia (blindness), mental anosmia (insensitivity to smells; from the point of view of the passenger of public transport in the summer it is already rather good), mental ageisia (loss of sense of taste), mental deafness, mental analgesia (loss of pain and tactile sensitivity, respectively — the nightmare of the Inquisitor). Do not confuse them with neurological symptoms when anesthesia is caused by nerve damage or the corresponding area of the cerebral cortex.

Senestopatii (from lat. sensus — feeling, Greek. pathos — ailment, suffering) — extremely painful and unpleasant, indefinite bodily sensations despite the fact that in reality there is no bodily injury or pathology, that is, the sensations that the patient projects into his own bodily “I”: pain is, suffering is very much there, and there is no organ damage. At the same time, descriptions of suffering are vivid, imaginative and colorful, unusual and pretentious. So, the patient can complain of tightening, tearing, gurgling, clogging, pulsation, drilling, chaining and even biting! Most often, these feelings do not have a clear localization, blurred or migrate through the body. As a rule, with such complaints go anywhere, but not to a psychiatrist, to whom they get already with a plump from the analyzes of an outpatient card and a refrain of mass dance of doctors of other specialties: “NOT OURS, NOT OURS!»

Perception disorders: a) psychosensory disorders; b) illusions.

Psychosensory disorders — when the surrounding objects, your own body or the flow of time are perceived distorted in size, shape, volume, weight or flow rate (for time). At the same time, a person knows for sure that this is the same object (say, a teapot — he is also a teapot in Africa) or that the body is his own, which distinguishes them from illusions. Highlight:

Metamorphosis (from Greek. meta — beyond, after; morphe — form, shape; opsis — vision) distorted in appearance, the perception of magnitude: micro – and macropsia (little people around the small and cockroach in the apartment — just elephant-like); forms: of dysmorphobia (skaloobraznuju uncle with Contrabassoon Auntie); the increase in the number of polyopia (how many moons? and in what number?) and the spatial arrangement of objects.

Derealization is a distorted perception of the world as a whole or its individual objects according to more generalized characteristics. At the same time, the surrounding world can appear dead, lifeless, flat, as if painted, unnatural, unreal. May be extraordinary contrast (Galerija), painting everything around in yellow (xanthopsia) or red (Eritrea, not to be confused with “All red” by I. khmelevskiy [14]). This also includes the phenomenon of “already seen”, or déjà vu, when an unfamiliar place or situation is perceived as having happened before; “never seen”, or jamais vu, when a familiar situation is perceived as completely new and unknown; “already heard”, as well as false recognition of others — a symptom of a positive double (what the hell our brother-in-law does an alcoholic in the state Duma?); symptom of a negative double, when familiar faces are not identified as such (can fill the face, if you have them something borrowed).

Disorders of body scheme (somatopsychic derealization) — when there is an unpleasant, painful sensation changes in the shape, size, quantity, texture, spatial location of body parts: the head is abnormally large, fingers longer than expected, the subject of male pride size and consistency is not satisfied — but you never know!

Deceptions of orientation in space — when the surrounding is seen rotated 90 or 180 degrees in a particular plane. Perhaps even more impressive has got to look the highway, going up into the sky. Or the sea.

Disorders of perception of time — when it begins to flow faster or slower, and loses smoothness and moves in leaps or jerks.

Illusions — perverted sensations and perception realistically (!) of existing objects and phenomena, when the understanding of these objects and phenomena is not true and has distorted the meaning (in contrast to hallucinations, there object, sound, feeling really exist, but are perceived differently). Distinguish the illusion of the physical, physiological, mental.

Mental illusions: auditory — when human voices are heard instead of noise (the same “white noise” of the radio, if you listen to it for a long time) or human speech is distorted (what-what did you call me?); visual and others. There are affective illusions that arise in affective States (fear, anxiety, depression, ecstasy) — then their content is consistent with the current mood; pareidolic illusions in which the play of light and shadow, spots, frosty patterns, cracks, cracks, plexus branches of trees are replaced by fantastic, bizarre images.

Any moron who claimed the Lord God was talking to him actually heard my voice… or his imagination.

K/f “Dogma»
Disorders of representation are, in fact, hallucinations.

Hallucinations are representations that have reached the sensual power and brightness of real objects and phenomena, it is “perception without an object.” That is — entirely the creation of the patient. Not a breakthrough into another reality, like the vents in an alternate Europe, not the machinations of angels and demons (in shifts, according to the approved schedule), not a local materialization of the astral plane (demonstrasi, beta, copyright is missing). Of course, we cannot exclude that at this moment the inhabitants of other realities and plans, coupled with Angelo-demonic community resent or, on the contrary, ugly chuckle — say, wait a minute, let’s see what you say after a century or two… But prevailing in the present opinion of the official science on the nature of the hallucinations I have outlined.

According to the analyzers, hallucinations are divided into auditory, visual, olfactory, tactile, gustatory, visceral (from lat. viscera — insides), kinesthetic.

On complexity — the simplest, ordinary and complex.

The simplest, or elementary, hallucinations are located a little apart. They are United by the incompleteness of what a person sees. Visual — photopsias (from Greek. phōs, phōtos light and opsis — vision) in the form of circles, spots, sparks, balls, etc.; auditory — acousma (footsteps, noises, squeaks) and phoneme (from the Greek. phonema — sound) (inarticulate sounds, calls, syllables, pronouns). That is, separate the fragments, the details of which do not stack in any particular way.

Simple — when hallucinations are born in one analyzer [15]: only auditory, only visual — and not a step aside.

Complex — multiple analyzers connected to the overall plot (see in the courtyard of the assassins, hearing their voices is heard behind the wall that the neighbors are plotting to poison him while smelling poisonous gas).

It is also possible to separate one-sided, or unilateral, hallucinations (visual and auditory), when a person sees or hears them only from one side. They happen when the cerebral cortex is affected in the form of a focus from any of the sides.

Hallucinations with complete objectivity (as opposed to the simplest):

Verbal (verbal) — by belonging: familiar, unfamiliar, male, female, child, belonging to other beings; by volume: quiet, loud, deafening, natural, whispering; by content: threatening, accusing (not to be confused with the voice of conscience), blaspheming (usually with a predominance of profanity), commenting (look — got up; here he went; Opanki — fell; and you — again got up; well, you see — now we swear…), contrast (one voice praise and promise medal, the other a mother and threaten to shoot like a mad dog), stereotypical (every day the same), imperative (those that ordered, the indication for immediate hospitalization, the patient wants that or not); in the form of: monologues, dialogues, conversations in their native and foreign languages; duration: episodic, persistent, SAG; focus — from any direction and distance.

Interesting auditory hallucinations of Allenstyle — when people are tensely waiting for the knock on the door or a phone call and then starts to hear them. Found in healthy people and is regarded as a variant of the “acoustic memory”.

Visual — different colors or without them, moving and motionless, scenic (they are scene-like, where everything that sees the patient, linked to one theme, the scene with a clear plot), landscape, portrait, kaleidoscopic, demonomanic (characters all entirely folklore and mythological orientation); content: threatening (and what is it in a hoodie and with a scythe here is?), apathetic (well worth and worth — maybe waiting for the tram…), accusing (scenes of the court, including Scary); autoscopia (the appearance of hallucinating your DoppelgangeR), negative autoscopia (the disappearance of the reflection in the mirror, may cause the appropriate treatment); largest: normal, midget, giant and other, other, other…

Separately, we can distinguish peduncular hallucinations of lermitt, arising from the defeat of the brain stem (or to be precise, in the area of the legs and the third ventricle): in the evening see moving medium-sized pictures, quickly replacing each other (insects, animals, etc.), while patients are not afraid of what they see, and clearly realize that this is a hallucination; hallucination van Bogart, characteristic of leukoencephalitis [16]: see animals painted in different colors, fish, butterflies, all this is brightly colored with emotions And interspersed with bouts of drowsiness; hallucinations Tibia: on the wall seen the glowing letters written by someone’s invisible hand; hallucinations Peak (if it affects the bottom of the IV ventricle): patients say they can see through the wall: “there is one through it has passed, there he is behind the wall goes, there’s a cat too, through the wall slipped — a nest there, or what?”Tactile: the skin and under the skin; dermatotropnye: the perception of objects, insects, animals, spider webs, ropes; temperature: heat, cold; haptic: the sense of grasping, touching, bumps and shocks from the outside; gigacheck: the feeling of moisture.

Olfactory — often the perception of unpleasant, sharp, stinking odors of decay, decomposition, often as if emanating from the patient (there are two oddities: first, I almost did not meet the description of pleasant olfactory hallucinations-in the form of smells, for example, “Chanel № 5”, and, judging by personal observations, the mass of people have negative olfactory hallucinations on the actual smell coming from them; in any case, with the benefits of civilization in the form of soul and soul deodorant they are in no hurry to get acquainted). Visceral — endoscopic — vision of their internal organs (a dream or nightmare of an endoscopist); hallucinations of transformation — changes in the internal organs, their movement, elongation, shortening (also a dream or a nightmare, depending on the location and character); genital (feeling as if with the genitals do something shameless and obscene).

Kinesthetic — perception, or lack of limbs, or the presence of additional (to the volume of Confucius and the cell phone when you drive), violent movements, including recidivating (feeling the movement of the tongue, uttering words).

Hallucinations often have objective signs, when the occurrence of hallucinations can be determined by the behavior of the patient: when the visual patient looks closely, monitors the hallucinatory way; when hearing listens, closes his ears or talks (you should make sure that the person does not use at this moment a headset for a cell phone or mp3-player); when tactile something shakes off.

One day, walking with his wife in the city, we saw this picture: to meet us, actively gesticulating and enthusiastically talking with an invisible interlocutor, was a lady. As she came up to us, she nodded, pointing at us.:

You know who that is? Doctors, psychiatrists, so behave yourself! she continued her exercise.

Under the conditions under which they occur, hallucinations are divided into:

Functional — often auditory, which occur in the real sound stimulus (in the noise of water — whisper poisoners in the stop of the wheels — the conspiracy of neighbors in the compartment on the theme of “kill-kill”, etc.).

Reflex or reflected — when the action of a real stimulus for the analyzer gives impetus to the beginning of the hallucinations (it is a push, not a constant background, as in functional). Can occur under the action of canalizador: auditory hallucinations, while irritation of the visual, visual hallucinations at acoustic stimulus, etc.

Hypnagogic (from Greek. hypnos — sleep, agogos — causing) — when falling asleep (found normally).

Hypnopompic (from Greek. hypnos — sleep, pompos — accompanying) — upon awakening, as well as in the interval between sleep and wakefulness (can also occur in a healthy person).

Type Charles Bonet — with damage to the peripheral part of the analyzer, for example, “vision” with severe cataracts.

Apperceptive — caused by strong-willed effort (“I said — squirrels! Three lines! On the windowsill!”).

Psychogenic: dominant — saturated with affective experiences, for example, the “voice” of the deceased spouse; the imagination Dupree — when dreams and fantasies, especially easily arise in children and in individuals with painful a keen imagination; induced — inspired hallucinary patients (that is, from one patient to another patient); suggestion (not to be confused with induced) imposed by the physician in the study, for example, in a patient with alcoholic delirium — a symptom of the set, when instigated visual images (“Oh, look, a Goblin!»); a symptom of Aschaffenburg — when a patient in delirium tremens talking on a pre-disconnected phone.

It is characteristic that in childhood there are more visual hallucinations, and if there are auditory, they are often simple or elementary.

Pseudohallucinations differ from the true character of artifice, perceptions, lack of properties of objectivity: if “voices” are sounding inside the head, if the “vision” — something like a movie or cartoon.

Although hallucinations as an isolated symptom can not allow to accurately determine what kind of disease the patient has, nevertheless, their presence (except for hypnagogic, hypnopompic and auditory Alenshtil — these may be normal) is serious and not good. In addition, we can say, for example, that auditory pseudohallucinations are more characteristic of schizophrenia (although can also occur in many other psychotic disorders), and visual hallucinations for the intoxication process, or vascular catastrophes. This sets the direction for further diagnostic search.

Symptoms of disorders of consciousness

Symptoms of impaired consciousness (be patient, such Goodies as, for example, coma or delirium, will be considered in the section syndromes). They are still in 1911, was clearly described by Karl Jaspers:

Violation of orientation in time, situation, space, surrounding persons and self. Let’s try to reveal a little the essence of each of the points of disorientation.

In time. Of course, to forget what today is the day or day of the week, happened to each of us, especially if the work or the situation (vacation, for example) does not imply the need to clearly monitor them. Another thing, if you struggle to understand what in the yard a season or a year. Or why it’s evening, but only that it was morning, although there may also be options…

In a situation. At once the fool to whom participants of a funeral procession hung for a wish “to drag to you — not to drag”is remembered. In other words, it is alarming if a person is not able to assess what kind of situation and relationships (at least in General terms) develop around him: anniversary or Wake.

In space. Of course, no one requires you to know the exact longitude, latitude, altitude and serial number of the galaxy, but the city, the area, and the way home — should.

In the surrounding seats. The General rule of loving people: if you do not remember the name of the partner, call a Bunny, sun or lapulya — you will live longer. Worse, if you are not able to identify people from the surrounding brother, sister, mother, father (the intricacies of the plot lines Express the hero of the Indian cinema), raises many questions.

In self. Unlike Hu em AI, played perfectly by Jackie Chan, a patient who is truly disoriented in his own personality is unlikely to molest you with self-identification problems. And generally hardly understand a word of speech addressed to him — will react as the sound, but no more. Usually this happens with a gross disorder of consciousness.

It should be added that the above paragraphs are given in such a sequence is not accidental. They are a kind of scale of increasing depth and severity of the disorder of consciousness: from disorientation in time, as the easiest (if not a miss in half a century), to disorientation in his own personality, when everything is very, very bad and the patient’s life is in question.

  1. Detachment from the surrounding reality. This is a situation where the reality itself, the patient itself. Events, facts and external stimuli are perceived as fragments of conversations from the street — fragmentary, on the very verge of perception, a person is not able to seriously and permanently attract attention, not to mention a clear and holistic awareness of them. Confusion, indecision prevail — how to behave in a situation when the reality waves the handle? Confusion, surprise: Oh, what is it? Where is it? Oh my gosh!
  2. Violations of understanding. Since consciousness and the process of thinking are inextricably linked with each other, any violations of consciousness will certainly be reflected in the harmony of thinking. This simplification of the associative process (to complex series, when everything is bad!), and problems with abstraction, and violation of sequence — in one way or another least, in dependence from depth disorder.
  3. Memory disorders relating to the period of the disorder of consciousness, amnesia or congrega. Can be full, when memory falls all the painful period, and partial, when some of the memories still remains. For this reason, many alcoholics who have suffered delirium, swear that more — no-no! And we pretend to believe.

Symptoms of disorders of consciousness

  1. Violation of orientation in time, situation, space, surrounding persons and self. Let’s try to reveal a little the essence of each of the points of disorientation.

In time. Of course, to forget what today is the day or day of the week, happened to each of us, especially if the work or the situation (vacation, for example) does not imply the need to clearly monitor them. Another thing, if you struggle to understand what in the yard a season or a year. Or why it’s evening, but only that it was morning, although there may also be options…

In a situation. At once the fool to whom participants of a funeral procession hung for a wish “to drag to you — not to drag”is remembered. In other words, it is alarming if a person is not able to assess what kind of situation and relationships (at least in General terms) develop around him: anniversary or Wake.

In space. Of course, no one requires you to know the exact longitude, latitude, altitude and serial number of the galaxy, but the city, the area, and the way home — should.

In the surrounding seats. The General rule of loving people: if you do not remember the name of the partner, call a Bunny, sun or lapulya — you will live longer. Worse, if you are not able to identify people from the surrounding brother, sister, mother, father (the intricacies of the plot lines Express the hero of the Indian cinema), raises many questions.

In self. Unlike Hu em AI, played perfectly by Jackie Chan, a patient who is truly disoriented in his own personality is unlikely to molest you with self-identification problems. And generally hardly understand a word of speech addressed to him — will react as the sound, but no more. Usually this happens with a gross disorder of consciousness.

It should be added that the above paragraphs are given in such a sequence is not accidental. They are a kind of scale of increasing depth and severity of the disorder of consciousness: from disorientation in time, as the easiest (if not a miss in half a century), to disorientation in his own personality, when everything is very, very bad and the patient’s life is in question.

  1. Detachment from the surrounding reality. This is a situation where the reality itself, the patient itself. Events, facts and external stimuli are perceived as fragments of conversations from the street — fragmentary, on the very verge of perception, a person is not able to seriously and permanently attract attention, not to mention a clear and holistic awareness of them. Confusion, indecision prevail — how to behave in a situation when the reality waves the handle? Confusion, surprise: Oh, what is it? Where is it? Oh my gosh!
  2. Violations of understanding. Since consciousness and the process of thinking are inextricably linked with each other, any violations of consciousness will certainly be reflected in the harmony of thinking. This simplification of the associative process (to complex series, when everything is bad!), and problems with abstraction, and violation of sequence — in one way or another least, in dependence from depth disorder.
  3. Memory disorders relating to the period of the disorder of consciousness, amnesia or congrega. Can be full, when memory falls all the painful period, and partial, when some of the memories still remains. For this reason, many alcoholics who have suffered delirium, swear that more — no-no! And we pretend to believe.

General Psychopathology

In this part, I will try, so to speak, to shove nevpihuemoe, because please be patient, it will be easier and more fun. Come on.

If we consider what is the picture of the disease, it can be divided into three levels of complexity:

  1. The symptoms are as individual manifestations of the disease state.
  2. Syndromes as a set of several symptoms (and not from the ceiling typed, and harmoniously adjacent).
  3. Actually the disease characterized by:

A) necessarily or most often occurring syndromes (what is called” obligate” — from lat. obligatus — a required, indispensable);

B) syndromes occurring from time to time, but not necessarily due here to be (optional), and

C) their change as the disease progresses, or pathokinesis.

The terminology given below is not intended to mislead patients or to plunge into a light trance of frowned girls. The main, if not the only, its task — to lead to a certain common denominator such capacious and imaginative, but too original and picturesque expressions as zakolbasilo, inserts not childishly, a flying trip, the bar collapsed, the roof drove off, the cuckoo flew off, all on nervousness, glitches, nonsense of a gray Mare in a quiet moonlit night, etc., so that specialists of different schools and regions could at least about something, in addition to joint drinking, agree.

To clarify the question of what in the mental activity of a person can go wrong, imagine what it looks like and what conditional fragments this activity is divided into in the norm. So:

  1. Consciousness, where the same without him. The highest form of human reflection of the surrounding reality, characterized by the orientation of man a) in space; b) in time; C) in his own personality.
  2. Perception of the surrounding world: first in the form of sensations as elementary components of the process, and then the perception itself as a more complex and holistic process, not only covering objects and phenomena as a whole, but also laying them out, as they are called, on the shelves (immediately included awareness, understanding and comprehension of the object and phenomenon), as well as representation (when a person mentally reproduces images of objects and phenomena that he perceived earlier).
  3. Attention — not in the sense of universal Achtung, and the ability to focus on any events, objects and activities.
  4. The memory — synthesis, integrative process that encompasses the results of sensation, perception and thinking. It provides memorization (fixation), preservation (retention) and reproduction (reproduction) of past experience. Short-term (while there is a signal source — there are its traces; the source disappeared — traces soon died out) and long-term memory is allocated. You can, of course, take a smart look and note that it is on the terms of retention is divided into iconic (clear, full imprint of 0.25 seconds.), short-term, operational (when the information necessary to achieve a certain goal is selectively stored and reproduced) and long-term (see), but the electorate can fairly rebel.
  5. Thinking is a reflection in the consciousness of the surrounding reality, when a person establishes the relationship of objects and phenomena not only on the basis of the facts lying on the surface (the sun rose — people are hot-hot), but also using the ability to abstraction, analysis and synthesis, as dialectical materialism teaches us. By the way, judging by the huge number of citizens, enriched on the stock exchange, the ability to abstract thinking today is simply frightening scale. In appearance, thinking can be divided into visual-effective (purely concrete), visual-figurative (contemplative-dreamy) and abstract-theoretical (one schrödinger cat what is worth!). You can also on the concrete situation and the abstract and the verbal. Or affective and logical. Or something like that. Forms of thinking are as follows: a) the concept — the allocation of essential properties of a homogeneous group of objects or phenomena; b) judgment — reveals the relationship of the subject — sign, the relationship between objects. Here there is a movement from the particular to the General, from the phenomenon to the essence; C) conclusion — the conclusion of a new judgment from other judgments, obtaining new knowledge from existing knowledge.
  6. It is a process of human communication through language (with words, not anything else). It is divided into internal and external. External speech, respectively, is oral and written. Oral, respectively, — monological and dialogical.
  7. Intelligence (someone would prefer to say — the mind, someone more politically correct – ability) — is the ability of a person to successfully apply existing knowledge and experience in practice. This includes the ability to generate new ideas, as well as criticism and self-criticism.
  8. Emotions: higher and lower, positive and negative. A little digress to make them out more. The scheme of human activity, as an option, can be represented as follows: need — motivation — action — result — emotion. According to the result, positive or negative. Further, the emotions themselves can form new needs (if I liked it, then I need it), sometimes becoming a need per se (Yes, Yes, more!), plus added awareness of Tao and admiring the process of achieving the result — and now a simple scheme is looped and overgrown with fractals. Everything in life, everything as it should be… As for the higher and lower emotions, here is another scheme. According to A. Maslow, the needs can be divided into three levels: a) biological — to breathe, eat, drink, allocate waste products, move, continue the race or have sex (located on the border with the next level); b) social — to create a family, take a place in society, to gain recognition; C) spiritual level — to know yourself and your place in the world, to determine your attitude to religion, to find worldview. The lower emotions are related to the satisfaction of the needs of the biological level, and the higher — respectively, social and spiritual. Reference is also made to the division of emotions on scenicheskoe (mobilizing), and asthenia (disruptive), reactive (as a response to the external process) and vital (due to internal reasons), but also in strength and duration — in the mood (long, smooth), passion is a strong, persistent and profound emotional state and the affect rapid short-term emotion.
  9. Will — is the ability to purposeful organized activities to achieve conscious (and sometimes unconscious) goals. Is completely formed by the age of twenty. The needs and their levels I have just cited, the will sets the direction in the implementation of activities that meet these needs. At all stages, from motivation to result and emotions.
  10. Sleep is a physiological state of the body, alternating with wakefulness and characterized by the absence of conscious mental activity and a significant decrease in reactions to external stimuli.

Now let’s try to consider how each of the components of mental activity can be disturbed.

Little history

They say that the fifties radically changed the face of psychiatry. Why? Yes, because there was aminazine. And then other neuroleptics. And — antidepressants. And off we go. If you believe the teachers, with the beginning of the era of neuroleptics mentally ill people are not left — in its classic version, which existed before many centuries. Now the psychiatrist at hand has an Arsenal of magic pills and injections: from bad mood, from surveillance of intelligence services, from cosmic rays and alien invasion — Yes from anything. Not only potions of intelligence, charisma powder, vaccinations conscience and something else on the little things. And Yes, still no one really knows what’s going on in your head and where schizophrenia comes from. But now there is an opportunity not to keep patients in isolation from society for life.

A natural question: what was the treatment of patients in psychiatric hospitals until the fifties? Let me give you a brief overview of the methods — so you have a General idea about them.

The ancient Greeks to the mentally ill were quite severe — could and stones beat. According to some reports, particularly demoniac they even chained or put on an electric Stingray (as we see, the basics of electroconvulsive therapy date back to the fifth century BC).

The Romans offered their options: to follow, to avoid constipation (it’s in melancholia), bind and keep in the dark (rage and fury), to give the emetic and the time to associate with hallucinations and delusions (if not helps, to prescribe “fasting and healing Lyuli”, recommended that Celsus). And epilepsy was proposed to treat the blood of a Gladiator. No,no, don’t spill it. That is to spill, of course, and then give it to the insane.

Quite varied were approaches to the treatment of mental illness in medieval Europe. Patients were often kept at monasteries and used exorcism. Hot iron and therapeutic auto-dafe were used infrequently. For the treatment of melancholy offered to eat pork heart stuffed with herbs. There were also rods (in order to switch the thoughts of the patient to bodily discomfort), mustard plasters for the whole person (to dilute the blood, stagnated in melancholy), bloodletting and, as an act of condescension, — warm baths. In Switzerland, in a shelter near Zurich, practiced content on the chain and the daily issuance of wine for medicinal purposes. Hellebore water was used quite widely — both from lice on the head, and from “cockroaches” inside (now it, by the way, sometimes pour alcoholics caring wife, in full accordance with the attached instructions).

In Europe, the XVIII century continue to actively use americnas water (it was used in psychiatry for a long time) and practice of the cold water. The British instead of ropes and shackles begin to use a straitjacket — a prototype of a straitjacket. However, in Bedlam still let onlookers (one-penny entrance), and on weekends it’s a full house. The French, through the efforts of Philippe Pinel, too, reject the detention of patients in chains and begin to use a straitjacket to the early nineteenth century. The style of this kind of clothing is relevant to this day.

In the nineteenth century, doctors began to show a greater interest in the mentally ill, combined with irrepressible imagination. Thanks to this, there are a straitjacket chair, a straitjacket bed, a rotational bed and a rotational machine (so that the blood flows to the head and the brain works better), a device for an unexpected immersion in a pool of cold water, as well as an ice shower on the head from a hose (the prototype of the Charcot shower — this method will appear in the same century a little later). Leeches (10-12 pieces per head) are popular in combination with wrapping with cold wet towels and laxative salt (the practice of the ancient Greeks was in use for a long time). Treatment with morphine and cannabis is in Vogue. The first sprouts of psychotherapy begin to break through. Hypnosis is increasingly practiced. There are preparations of bromine and barbituric acid: veronal, medinal. Begin to use paraldehyde and chloral hydrate.

In the XX century (first half) – box methods of treatment of mental illness updated malariotherapy (vaccination of malaria-treated paralysis), and then the injection sulfazine, and electroconvulsive and insulin shock therapy. Except for the lobotomy, of course. And finally, there are the antipsychotics, antidepressants and other psychiatric the contents of the magic briefcase. We look forward to the vaccine against Alzheimer’s disease in this new XXI century, but the creation of vaccinations of conscience and intelligence potions can not even hope.

Sleep Deprivation

Depression is almost always associated with sleep disorders. Depending on the type of disease, these disorders can be of different nature, from difficulties with falling asleep, surface sleep with frequent awakenings to opposite symptoms, expressed in increased drowsiness, heavy waking. It is characteristic that with any orientation of violations sleep does not bring relief to the patient, recovery in sleep does not occur, regardless of the amount of time spent in bed.

There have even been theories that point to sleep disorders not as a symptom, but as a cause of depression, although to date there is no scientific evidence to support this assumption.

The mechanism of the therapeutic effect of deprivation is based on the regulation of disturbed daily cycles of the body, the so-called circadian, 24-hour rhythms, in this case, the cycle “sleep – wakefulness”. In the same rhythm there are changes and other human functions, such as appetite, body temperature, heart rate, blood pressure and others. The speed of metabolic processes, the activity of the endocrine system, the metabolism of neurotransmitters – all this is subject to circadian rhythms.

In a healthy person, all these periodically occurring processes are strictly synchronized with each other, but in a depressed state their normal course becomes disturbed, while there are also characteristic daily fluctuations in the emotional background, in the morning the patients feel worse, in the evening the condition usually improves.

These biochemical studies show that during depression disturbed normal daily rhythm of hormone production, metabolism of other biologically active compounds. All this suggests that somehow such desynchronization is involved in the pathogenesis of depressive States. Sleep deprivation is a kind of reset, an attempt to restore the original synchronicity of the circadian cycles.

The positive effect of sleep deprivation on endogenous depression was first reported in 1966. Since that time, deprivation has become popular as a simple and relatively safe method. There have been many reports from various psychiatrists about the successful application of the method in practice. Subsequently, enough data have been accumulated to judge a certain commonality of mechanisms for the development of disorders and depressive States.

The structure of sleep is cyclical, that is, in its course there is a change of several phases. These encephalograms show that in depressed patients there is a violation of these phases, the process of falling asleep and waking, the overall quality of sleep deteriorates. The distribution of sleep stages changes dominated by superficial sleep and reduced during the phase of deep sleep. There is a sharper than in healthy, the transition from one phase of sleep to another. Accordingly, the improvement of the clinical condition of patients is accompanied by its normalization.

The indication for the use of sleep deprivation as a therapeutic method is not only the presence of depression itself, but also a depressive state in other diseases, including some forms of schizophrenia. The best results are achieved with classical melancholic depression, with a marked decrease in mood, psychomotor inhibition, a feeling of sadness, guilt, combined with low self-esteem, and a sense of lack of prospects in life.

Sleep deprivation is considered to be effective both in recent depressions and in prolonged, drug-resistant therapy. Moreover, in some cases of severe prolonged depression, depression was effective in overcoming such resistance and increasing the patient’s sensitivity to antidepressants.

There are no absolute contraindications to its use, you should take the usual precautions for hypertension, recently suffered a stroke. The natural limitation of its wide application is a violation of the rhythm of life of the patient, the discomfort experienced by him, the difficulty of resisting the desire to fall asleep. The advantage is the availability and possibility of independent practice.

As for the practical application, there are several methods of deprivation, the most common of which is total sleep deprivation. The essence of the method is that the patient misses one night, that is, he does not sleep a day, a night and another day, the total is about 36 hours of continuous wakefulness. A single procedure, as a rule, causes a short-term effect, so it is repeated 8-10 times, twice, and then once a week.

On the day of the beginning of the procedure, you should exclude daytime sleep and make a program of classes at night to successfully combat drowsiness. You can prepare in advance the materials for reading, playing, music, stock up discs with movies. Load yourself with work is not necessary, because it leads to fatigue and increased need for sleep. You can alternate these classes with light exercise, push-UPS, abdominal muscles load.

During the night, you can eat light food, reception of stimulating drinks (tea, coffee) is best avoided. The next morning it is better not to sit at home, take a walk, do something in the fresh air. Having held out thus 36 hours, it is possible to go to bed at usual time for itself.

A more gentle method is a partial deprivation of sleep, in which the patient sleeps at night for about three hours, then wakes up, and then everything happens as in total deprivation. Partial deprivation is easier to tolerate than total, but it should not be used for patients with disturbed sleep, in this case, from attempts to sleep and a short sleep, a person feels only more broken.

There is an even more technically complex version of partial deprivation, in which the patient is woken up at the onset of his REM phase and then allowed to fall asleep again, before the next such phase. This procedure is repeated throughout the night. This so-called REM (rapid eyes movement) deprivation, no special efficiency it does not have, requires technical equipment and therefore is currently rarely used.

In deprivation, there are several stages, during the day the fluctuations of the emotional sphere occur in the usual scenario, in the morning the state of health is worsened, in the evening it is leveled and remains so for the first few hours of the night. Closer to the morning, the state of health improves, usually imperceptibly for the patient, and remains so until the end of the procedure.

The main difficulty is the struggle with sleep, with good preparation, the first night hours usually pass without problems, the probability of falling asleep increases sharply closer to the morning, if it is overcome, then during the next day it will be easier to sleep, periods of drowsiness will be observed at times, but not as pronounced as the morning.

In the first half of the second day, a paradoxical feeling of vivacity, a surge of energy, even talkativeness can be felt. Sometimes they write about the appearance of headaches, weakness for this period, but this phenomenon is individual and occurs not at all.

The maximum improvement occurs at 9-12 o’clock in the morning, at this time, usually in depressed patients there is the most severe period during the day. Subjectively perceived mood elevation, disappears retardation, the person becomes active, communicative, critically ill patients may disappear suicidal thoughts, ideas of self-malacense.

During the rest of the day, the mood gradually decreases, but never falls below the level usual at this time of day. Sleep, after deprivation is very good, deep, comes very quickly and lasts all night, even in patients with obvious disorders. After awakening, the symptoms of depression are again felt, albeit to a lesser extent than before the procedure. Unfortunately, the effect of deprivation is short-term and requires repeated repetition of the process.

As the procedure is repeated (first two, then once a week), there is a gradual improvement in the patient’s condition, the duration of periods of good mood increases, respectively, the periods of bad are reduced, with time, the reduction of symptoms can take large values. There is interest in what is happening, improves appetite, is inhibited. Later, other symptoms are a receding concern. This is a typical pattern, from which, of course, there may be deviations, both in relation to the reaction to the deprivation itself, and the speed and sequence of reducing symptoms.

Some patients during the night procedure may increase symptoms, more often it is observed in patients with anxiety and depressive disorder. But in the morning, almost everyone gets better.

I have repeatedly tried this method, and it really has a short-term effect, but I can not attribute it to physiological. Yet there is a rough intervention in the functioning of the body, and although the literature does not describe the serious side effects of its use, it seems to me that long-term use for the benefit of health it does not go. It should be understood that the state of consciousness in deprivation refers to the changed, it is not normal, although it brings relief. The use of deprivation is poorly combined with social life and work, although in severe depression it is not so significant.

Is it worth trying this method? I think he’s definitely better than electrical stimulation, whose effectiveness it is often compared, side effects are certainly less. Deprivation is a good immediate effect, even a short-term improvement can be a great gift for a serious patient, to open the long-closed door to another world, to give hope and give strength to continue the struggle. But I still have not seen the information about the patients, get rid of depression, just practicing deprivation.

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