It is accepted to allocate actually neurotic syndromes and neurotic level of mental disorders. What is the similarity and where is the difference? Neurotic syndromes are characteristic, as their name implies, for the clinic of neuroses. In addition, they fit into the neurotic level of disorders, that is, they do not reach the strength, severity and qualitative characteristics of psychosis.

Neurotic syndromes include:

obsessive-compulsive syndromes; depersonalization-derealization syndromes; senestopathic and hypochondriac syndromes; hysterical syndromes; syndromes of super-valuable ideas.

The neurotic level of disorders, in addition to these syndromes, also includes asthenic syndrome (if it is positive, do not forget) and affective syndromes that do not reach the psychotic level (that is, subdepressive and hypomanic). Let us now consider each of the syndromes in order.

Obsessive compulsive disorder

This

Obsessive syndrome, or obsessions; phobic syndrome, or phobias; obsessive compulsions, movements and actions, or compulsions;

and their combinations.

Obsessive syndrome (from lat. obsessio-siege, blockade)
The main, leading symptoms of this syndrome are obsessive, obsessive:

  • Doubts (“Can I? Do I want to? Am I right? And at all — and what this I…»);

• Remembering (“Abraham begat Isaac; and Isaac begat Jacob; and Jacob begat… who? And most importantly-what…?»);

  • Performances (“Did I turn off the stove? Right, off. And suddenly not switched off? So what? Like what? The cutlets will burn and ignite, the fire spreads to the shelves, a bottle of oil falls from there, the torch of fire soars to the ceiling, bottles of vodka, cognac and whiskey in the bar begin to burst, and now the whole floor is covered with fire. Arrived firefighters die from the detonated bottle of moonshine, arrived to the aid of the calculation dies under a hail of bullets from the red-hot gun safe, begin to collapse the concrete floors … Oh, mom, we urgently need to see the news — I will not pay, I will be imprisoned!»);

Feeling of antipathy (“all That seems to be a good conversationalist, but what I could kick him in the eye? And that angelic creature over there, to fuck off. And that girl over there… Bli-in, hurry to Church! Oh, no, you can’t, I’m going to go completely crazy there!»);

  • Obsessive reflections, then presents mental gum (“and suddenly (there is no-there is no, such a not can be, but suddenly?) I’ll kill the eldest in the house, when she comes to agitate for the clean-up, – where should I put the corpse? Dismembered or lye in the bath? And than to wash floors? Or here is, as option: if God absolute, then he and most bright good, and most dark evil bears in itself — so what same he awaits from us?»);

Obsessive expense (numbers machines (for example, sum up), numbers homes (and thesea-subtract), numbers phones (this already goes higher mathematics, these simply remember);

Additional, optional symptoms are usually:

  • Mental discomfort – because obsessive phenomena are always felt as alien, unpleasant, violent towards a person;
  • Emotional stress – as a person makes efforts to resist these phenomena;
  • Feelings of powerlessness and helplessness – as obsessions, despite efforts, occur again and again;

• Subdepressivee background mood — so how could he be rainbow!

Phobic syndrome (from the Greek. phobos-fear)

All fear!

Signal from the station ” Phobos-grunt»
The main symptom is obsessive fear. We have already touched upon the subject of phobias when it came to the symptoms of a thinking disorder. Most often, phobias are represented by some one topic, although they can be complex — both systematic (fear of meeting a dead man carrying empty buckets on Friday evening of the thirteenth) and chaotic-unsystematic (everyone is afraid of everything!).

Additional symptom:

  • SOMATO-vegetative: tachycardia, hyperhidrosis, or sweating, increased blood pressure, diarrhea (previously, such a reaction to a strong fright was called “bear disease”), vomiting;
  • Behavior, directed on avoidance situations, in which can arise fear (well, when phobia one, poorly, if even with it one account for suffer constantly, – suffering claustrophobic, rents out a pantry and a half on twenty-fifth floor, not describe words);
  • All the same mental discomfort, emotional tension, a sense of powerlessness before fear, subdepressive mood background.

Compulsive syndrome (from lat. compello-compel)

“Judith, honey, what do you mean, ‘the hand twitched’?”

The Head Of Holofernes
The main symptom is an obsessive desire, action and movement. If they are isolated and are not rituals that relieve the patient’s condition, then they are actually compulsions, but in this form they are not so common. It may be the desire to jump from the balcony, to kill someone of your favorite, in General, people-if we are talking about instincts. It can be scratching, winking, stepping over cracks on the pavement, licking his lips-if it is about actions and movements.

Most often you can see a combination of them with obsessions or phobias, and then it will be obsessive-compulsive syndrome, in which obsessive thoughts (obsessions) or fears (phobias) will be combined with obsessive actions or rituals: “I wash my hands so as not to get infected. What if they bleed from the washcloth and brush and began to fester-you need to wash more often. And God forbid to shake hands with someone!»

The ritual can be more complex, covering, with a certain degree of pedantry, the entire daily routine – from waking up with clearly measured centimeters of toothpaste and the algorithm of brushing your teeth (plus the obligatory coffee with two and a half spoons of sugar for Breakfast) to the evening going to bed and planned (safe, of course) sex with a clear sequence of changing poses and a strictly dosed limit of frictions. Curiously, rituals are not always secondary to obsessions or phobias. Not so long ago it became clear that there is often an irresistible desire to wash your hands at first, and only then the brain finds a justification for this action in the form of fear of infection — because the void, even if it is a void in the explanation of behavior, you need something to fill.

Such syndromes are found in a number of mental diseases, as the psychotic spectrum (for example, schizophrenia), and neuroses or depression. One thing unites these syndromes: at depersonalization the feeling of change or loss of own “I” is leading, and at derealization-violation of perception of reality of the surrounding world. Both syndromes can occur both together, and then it will be a question of depersonalization-derealization syndrome, and separately.

Some authors, for example, Y. L. Nuller [33], suggest not to single out derealization but to consider it as a special variant of depersonalization (the so-called “allopsychic derealization”). This does not change the essence of the issue, being one of the points of view.

Syndrome of depersonalization

Mandatory, or obligate, symptom here is actually derealization. What is it?

First and most often — it is the loss or change of emotional color, which previously accompanied everything that a person did, how he perceived the world around him and the result of his activities: now he seems to continue to love his wife and children — but not as before: not specifically, but in principle, and conscience clicks the whip and sentences: “ay, what a bastard, ay, what a bad boy!”He looks at a beautiful girl walking by, admiring the forms — but somehow everything is not bright: “Well, beautiful, well, forms, well, everything” – neither you rise in the soul and other localizations, nor you fantasies with yourself in the lead role. The wife, however, says that it is wisdom… And other colors, smells, sensations and tastes come as if through a veil. Or a condom to just love ourselves. Insipid, dull, and without the spice that gave life a taste. And from all this it is bad and painful-this feeling is called painful mental anesthesia, or anaesthesia psychica dolorosa.

Emotions themselves also change. More precisely, there is a feeling that their brightness was reduced or completely turned off. And not only joy: anger, sadness, anxiety and melancholy this also applies: it seems that they are in the General outlines, it seems that formally a person understands that here in this place you need to slam the service on the floor, and here for five minutes as to beat the muzzle, but the right mood does not appear — and it is oppressive. But again same — on average level, even not howl.

In more serious cases, the ” I ” itself can change, this seemingly unshakable firmament, which does not care about oil prices, government changes and global warming. Man no longer feels the same: one disappears lightness and spontaneity on the verge of surprise, and he himself resembles a machine on the numerical program control, sharpened by some industrial and household crap, the other suddenly discovers with horror that somewhere the soul has disappeared. No, when she was positioned he could not — neither in the stomach nor in the ajna chakra or the source of inspiration for Faberge, and it is not particularly shown: not impressed by the breadth, not moved by kindness, but drat — once gone, so you immediately feel its acute shortage. The third suddenly realizes that he is watching himself as if from the outside, as in a computer game with good graphics and an excellent engine — that’s just with the plot and the choice of the main character at the seams. You may suddenly feel the absence of thoughts — not the taking away, as if someone took and took away, as it happens in the Kandinsky-clerambault syndrome (we will consider it more closely later), but simply the absence: they will not be born, and that’s it.

Sometimes with depersonalization suffer the feeling of sleep seems to be asleep, and the feeling that slept, — no; hunger: well, this is a classic example-in-law who will not understand after the thirtieth Teschin pancake — whether he ate or did not eat; the feeling of cold and heat: they are, but are heard as if from afar. Can change and sense of time: past if and not was, and present stretches, as if syrup, jobs managing freeze until full immobility.

A set of facultative, or secondary, symptoms will depend on the disease in which the syndrome was manifested: reduced mood may prevail, coupled with a slowdown in the pace of thinking and inhibition of movements-if depersonalization is depressive; anxiety and strong internal tension may prevail, if depersonalization was a response of the psyche to a strong, expressed anxiety; it may be accompanied by an emotional and volitional decline (this is from the class of negative syndromes, we will touch on them later) and features of thinking characteristic of schizophrenia — with a number of its forms, depersonalization is quite common.

Derealization syndrome

Not always the presence of this syndrome suggests that the patient likes special mushrooms or no less special grass (although they also cause similar symptoms, not without that). This syndrome is quite possible with epilepsy, with the consequences of brain damage and a number of other mental disorders.

The main symptom is a violation of the sense of reality of the external world. The surrounding reality may pretend to be completely unfamiliar with you. You will look for the old colors — they will be either too bright or dull. You will be looking for volume and perspective — and your eyes will appear lousy diorama a La hack-product. The city will cease to be recognizable: instead of the former, someone has put decorations, and in some places even messed up with the order of their location. The sun, too, on something replaced, with clearly saved on watts. And most importantly-no one to ask the way back to the present.

Memory, too, in this case, can play a cruel joke, slipping either deja vu (“Hell, it’s already happened to me, and I can even remember when, and even what I did then, – just about, now, – Oh, escapes, but still-it was, it was!”) or jamevu (“why the fuck do they all pretend to know me, and not from the best side? We did not have a relationship with you, girl, and have nothing to show to your stomach that you have Gaza!”). Optional symptoms may be confusion, fear, anxiety, mood decline.

Both syndromes, despite the intricacy and originality, are still treatable, which allows the patient to eventually return not only himself, but also a familiar reality into the bargain.

Hypochondriac syndrome. Its name comes from the Greek word hypochondrion, that is, “hypochondrium”, where, according to the beliefs of ancient Greek physicians, the soul hides. From there, she has a habit of whining and hurting there. Not to be confused: the soul is left, and who hurts in the right upper quadrant — liver, it is from the permitted excesses.

With all the variety of manifestations, the obligate (leading) symptom is one: painful, to the point of trembling, care for your precious health, in symbiosis with an unshakable confidence that something is wrong with this health. The behavior of such a patient can be compared to a person who worships the eternally dissatisfied, quarrelsome, always hungover deity, irritating him with his prayer whining and wondering why he is so disliked-there again the ritual helmet melted… And the deity just needed that silence and a glass of vodka. On the altar, not yourself, you idiot!

In search of sores, these people are ready to bypass all the doctors, not to climb under the tomographs – under ultramicrotomas-well, it can not be that the body is healthy! Why is it so disgusting then in the soul and in the body? No, you’re obviously hiding something — not for nothing your handwriting is illegible and half in Latin! Doctor, my dear, let’s do a mA-scarlet control autopsy! Only the anesthesia is softer, and then he, they say, is harmful to health…

What is most interesting is the unpleasant sensations and the conviction that everything is bad with the body, are extremely persistent and very reluctant to be treated, which convinces the patient: in fact, the sickest person in the world is not Carlson at all. Thoughts about health acquire the character of super-valuable, and in some cases reach the strength of hypochondriac delirium.

Senestopathic syndrome. Its basis is senestopatii (from the Greek. koinos-General, anesthesia-sense of, a sense of and pathos-suffering, disease). The term was proposed by French psychiatrists E. Dupree and P. Camus in 1907. What does it mean? Imagine hammering a nail into a wall and hitting your finger with a hammer. If you omit not directly related to the case, but from this no less emotionally rich speech turns, then there is the following: a specific finger, which was hit with a specific hammer, and this finger is quite specifically sore. There is an etiology, pathogenesis and a clear localization of the painful process, with clear sensations. So senestopatii NOT LIKE, except, perhaps, one: they are too painful and agonizing.

In all other things — nothing to do: localization, or “somewhere here”, “here, just been here, and now seem to have migrated”; brightness — as if perceived through the prism of consciousness, a little matted; the feeling — without a definition inherent in the fact that there are real and painful reasons that can be traced quite revealing in how the patient describes them: then he twitches, gurgles, here and shimmers like with the bites. In some cases, the sensations, on the contrary, are quite local and clear, but at the same time so pretentious that against their background a lump in the throat, a stone on the heart and an awl in the ass look pale and float finely. For completeness, only the side of the bow is missing. And be sure: even disassembling the unfortunate organism cell by cell, you will not find the cause of these feelings. The autopsy, as they say, will show that the patient died from the autopsy, and so — was quite physically healthy!

Well, how, tell me, here to do without the accompanying hypochondriac syndrome? How not to take care of your health, which is threatened by an amorphous anonymous something?

Optional symptoms for both syndromes can be:

• Subdepressivee mood (why would it be good when the most patient person in the world so long and unsuccessfully seeking the root of their troubles, and there is only hell?);

  • Anxiety, fears, which can wear character obsessive and be accompanied by rituals (in including ritualistic examination and ritualistic droppers-purely on anyone case);
  • Insomnia (fall asleep here, when there gurgles, then crunches, and even whistles when the squeak ends!);
  • Autonomic disorders-tachycardia, sweating, jumps in blood pressure (not that the crisis, but quite unpleasant to the senses) and so on.

— And you ask me how I feel, and I’ll tell you: I’m the sickest man in the world, and I don’t want anything else!”


The name hysterical syndrome originates from the Greek word hystera, which means “uterus”. The ancient Greeks believed that this disease is subject exclusively to women, and solely because of the disorder of their reproductive organ, with its special opinion and alternative view of reality, with the rest of the body. Men, according to the Greeks, this was not supposed to hurt: Hoplite-tantrums — a godsend for Persian and mastday. The term dissociative, as well as conversion disorder, appeared much later. Already in the era of advanced feminism and bashful political correctness.

For hysterical syndrome, the leading symptom is difficult to distinguish. The fact is that its manifestations are extremely diverse and can resemble a lot of absolutely unlike each other, but outwardly bright and menacing-looking sores. No wonder hysteria is called “the great malingerer”. Here are the areas that hysterical symptoms tend to affect:

• psyche,

• motor skills,

• speech,

• sense organs,

  • somatics and vegetative system.

As you can see, the spheres are completely different. What features are related symptoms?

First of all, it is the cause of symptoms. It is always psychogenic, that is, it is caused by the activity (or rather, disorder) of the psyche and has no real bodily cause, though searched. But stressful the reason to find very possible. And the more it touches the patient’s personality, the brighter the symptoms will be.

Characteristically increased (and indeed appearance) of symptoms in the presence of the audience, their deliberateness (“you’re trying!”). Right, what’s the point of an actor playing for a mirror? All symptoms are bright, experiences are full of drama and passion. Stanislavsky sobs and chants the creed.

As a rule, there is a subdepressive background everywhere: suffering is suffering, even if it is more fulfilled than there is.

Suggestibility and autosuggestion are present and sometimes developed very strongly, but, characteristically, – there and then, where and when there is an underlying (though not conscious) profit for the patient himself.

In General, expediency and benefit are the two constant companions of hysterical syndrome. Let pretentious and incomprehensible, even unacceptable for a healthy person and more befitting a child of three or four years — but they are. You have to get sick not to go to kindergarten and get candy? Yes please! It is necessary that is not abused? “A-a-a, here is die and chase cry!”Moreover, even if all these reasons for others at a glance, the patient himself will not see them point-blank. What did Freud write about repression?.. So, let’s touch on each of the spheres in more detail.

Psyche

This asthenia (usually, weakness comes before the need to do something unpleasant), this subdepressivnaya symptoms, this amnesia (especially in is, that not want recall), this hypochondria-but with all the above additional conditions; this pathological falsehood, often combined with unabashed fantaserstvom (syndrome Munchausen, as a private option). It and hysterical fugues (collected things, disappeared, was found out in other city — and remembers nothing though all this time externally acted very purposefully, young ladies will confirm); hysterical trances with States of mastery (not to be confused with those of epilepsy, intoxication and Kandinsky-clerambault syndrome!) — suffice it to recall the hysterics and terrible demon Ikuku (there’s an old magical equipment in Siberia and the Urals. The essence is grown on the remains of food or a certain kind of food, it is a special kind of mold. It is believed that before getting into the vehicle, “devil” is in the basket with the beer, made by the sorcerer. Then this essence is sent to the victim) – one of the national syndromes is even named after him. This and the constant preparations for hanging, opening veins, drinking poison and other farewell-suicidal activities-would be a sympathetic observer. Here also include The Hanser syndrome (we sit down by the chair, carry a spoon past the mouth, answer deliberately at random and generally create the impression of a deep intellectual disability), puerilism (behavior is almost like a child, except that the skills to light and open a bottle of beer have not gone away), pseudo-dementia (the patient is stupid, deliberately stupid, deliberately incorrectly answers elementary questions, although he can immediately give the correct solution to a complex problem on the machine).

Motor skills

This is a classic hysterical arc (the body is tense, arched, rests only on the heels and back of the head), this is a hysterical seizure, which is unknowingly easy to take for epileptic (unlike the latter, the reaction to cotton wool with ammonia will be here). This all sorts of paralysis and paresis, which can be miraculously cured, saying povnushitelney, nourished German, get up and walk… and walk, and walk, and the now imposing hands will make! This and violations swallowing, and astasia-abasia: stand not can, walk not can, but in bed hands and its feet very even decently move. Torticollis, strabismus, lopsided, which can still be miraculously cured-this is also from here.

Speech

Stuttering, mutism (when not talking at all), aphonia (when only in a whisper), dysarthria (suddenly begins to distort speech, do not pronounce individual consonants, syllables, lost articulation). Again — all of the above may not be hysterical, so it is important to consider all the symptoms.

Sense organs

This blindness (in focus not see), deafness (the same the reason), loss of sense of smell (expression of “losing nose” not quite hence, but a common situation reflects), gustatory sensitivity, loss of skin sensitivity — on type “gloves”, “stockings”, “cowards”, “pince-nez, tie and condom.” however, the last hardly, forget.

Somatics and vegetative system

But these manifestations ARE very many. Here and spasms, simulating asthma, and obstruction of the esophagus, and hiccups. Here everything that can soak the gastrointestinal tract, from heartburn with belching and ending with flatulence and diarrhea (constipation, too, as an option). On the part of the cardiovascular system-fluctuations in blood pressure, pre-fainting and pre-infarction States (not on the cardiogram, everything is in order there), tachycardia and arrhythmia, pallor or redness of the skin. Vicar bleeding [35]. As an option, which is now rare — bleeding from the feet and palms, as well as from the skin of the forehead and of the intercostal space where the spear struck the Christ the Roman soldiers. Appearing and disappearing without a trace impotence and frigidity, false pregnancy-this is also from here.

Supervaluable idea

Ceterum censeo Carthaginem esse delendam!

The super-valuable idea of Cato the Elder
With some assumptions, it can be said that super-valuable ideas occupy an intermediate position between obsessive and delusional: unlike obsessive, they are no longer perceived as something alien and interfering with eating life with a big spoon, but, unlike delusional, are not so absurd and fantastic. They are a little short of the revolutionary moment when the worldview is completely captured by them. Along with the post and Telegraph.

The main, obligate symptom is actually super-valuable ideas. The most often among these meet:

  • Super-valuable ideas of jealousy, when, for their own safety, even Telegraph poles are better off lying than standing;
  • Super-valuable ideas of reformism; carriers of such ideas are a real headache for public organizations (“We do not work like that, we are not governed by those, and in General-why am I not in the Presidium?”), parties and governments (perhaps, instances, secretaries and bureaucracy as such created not in least with goal put between idefiks and his bright goal as can be more barriers);
  • Sverhtsennye kverulyantskie ideas, when the flow of complaints, carts and other “believe debt bring until your specific findings” reaches critical magnitude and well capable to withdraw from by building even clearly oiled bureaucratic machine;
  • Super-valuable ideas of invention. Especially this concerns principle work perpetual engine, improvements gravitsappy [37] for standard pepelatsa, and also searches universal fuels, suitable as inward, so and in gas tank, and to can be was drive directly from urban sedimentation tank;
  • Super-valuable hypochondriac ideas, when a person does not doubt, he is sure: in the gallbladder he has not just stones, but a whole masonry. And behind it lies cancer. And this is not counting prion disease, the second cancer, entrenched in the prostate, a continuous mosaic of atherosclerotic plaques in the carotid arteries in themselves and a large hemorrhoid in all the medical staff who did not have time to hide.

This also includes:

  • Metaphysical intoxication, when a person is overcome by thoughts about his own destiny, about the structure of the world, about where humanity came from, and where his conscience went, about the fact that if God is omniscient, then why does not he slap his Elohim or whatever they are, who have committed lawlessness and pull each on himself a confessional blanket. And everything would be nothing, but beyond the painful reasonableness, which eats up time, strength and the opportunity to somehow attach themselves to society, it does not go. It is not surprising: even if the necessary oxygen for life can easily be ukontrapupit with due diligence, then the ten commandments to bring to the handle and is quite simple, the main thing — to have a goal and not know the measures;

• Dysmorphogenesis and dysmorphophobia overvalued ideas: it bulged, it would stick out less, but this place is definitely the lack of inches, look like a crocodile and is good except for boots and handbags, the eyes are small (“don’t you dare convince, hentai I watched!”), the hair on the head of some rare… in short, a boon for the plastic surgeon and cosmetologist.

Speaking about additional, facultative symptoms, it should be noted that the subdepressive background, unlike most neurotic syndromes, in the syndrome of super-valuable ideas is not always present (except for hypochondriac, dysmorphic and dysmorphic ideas, where its presence is quite understandable). It is not surprising: what a subdepression, when a person is so purposeful! The set of other symptoms is variable and depends on what kind of idea took and took over brazenly man.

In General, in psychiatric terminology, there are a number of consonant both externally and close in meaning and clinic concepts. Their main root is the same-from the Greek word hēbe, which means “youth”. Someone adds-also puberty, but Echidnu me in mother-in-law, if the ancient Greeks so widely interpreted this word!.. So, you can find such terms as gebefrenia (from the Greek. phren— mind, soul), Gubaidulina (from the Greek. eidos-a species similar to), a heboid, and even a criminal heboid.

And all this is not counting the variations. In order not to burden the reader with academic calculations and an excursion into the stages of development of views of psychiatry on some of the diseases, I will offer a simpler scheme for understanding.

There are two similar to each other in General and differing in their details and, more importantly, in their prognosis of the syndrome (we will not touch the diseases in which these syndromes occur, about them later): this hebephrenic syndrome and heboid syndrome. What they have in common? First of all, the age at which they begin, or manifest. As you can guess from the name – it’s adolescence, adolescence. What else? Remember some of the distinctive features inherent in the “tribe of the young and dumb” (C) Mikhail Uspensky. Remind me? This is an unrecognized genius, a rebel from nature, generously tossing hormonal firecrackers into the flaming furnace of a heated metabolism, this is a General awkwardness and angularity, ranging from protruding knees, elbows, ears and Adam’s Apple (optional) and ending with the inability to think or at least Express themselves a little less radically. Plus pimples on the face, which and without them something itself not likes, plus want, and cannot be, and — Liza — so not give. I. e. this-the entire ungainliness, pretentiousness, caricature plus violation of instincts, until their disinhibition and forth-until impulsivity, when reason loses its power and makes kind of, if his here not stood. Now more about each of the syndromes.

Hebephrenic syndrome. It was described by Kalbaum [39] in 1863 and his follower Ewald Hecker in 1878. Patients with this syndrome is difficult not to notice: they are stupid, behave like children, they grimace, copy the gestures, words and movements of others, their antics are ridiculous and pretentious, like a teenager who either wants to be more noticeable and worse than everyone else, or tries to attract the attention of a girl he liked. in 1949 described the triad characteristic of the hebephrenic syndrome:

1) “Gymnastic” contractions of facial muscles, grimacing — in other words, the patient makes faces;

2) The phenomenon of idle thoughts (the term proposed by Levi Valance in 1926) — wanton actions, actions that are neither impulsive nor due to pathological motives: that is, the patient did it to himself consciously, but without any aim, he did not forced hallucinations, and delusions does not involved here. Simply took and made-hit, broke, broke, chopped small straws, etc.;

3) Unproductive euphoria, meaningless-cheerful mood. “Smiling like a fool” is about from here. Well, if you don’t take into account the competition from Imbeciles.

Optional symptoms are: delusions, hallucinations, catatonic symptoms are often present along with hibernicism. There is a separate type of schizophrenia-its hebephrenic, or Hecker form. Her prognosis, as a rule, is unfavorable, because the personality defect in this course is formed quickly, and it is quite deep.

Heboid syndrome. Described by Kahlbaum in his work of 1884 and 1889 years. In contrast to the hebephrenic syndrome, it is more favorable in prognosis and more mild in its course, although it is also not sugar. To the fore in this syndrome is not so much silliness, how much pretentiousness, but also not so much incomprehensible and wanton acts, how many antisocial behaviour (though at times equally unmotivated and incomprehensible) — hence the term “criminal heboid”. What are the main components of heboid syndrome? This:

• Disinhibition, and often the perversion of instincts. It does not matter whether it is a question of sexual attraction (most often it is about it), about the attraction to alcohol, about the passion for vagrancy or arson, about the desire to experience speed and overload (not to be confused with suicide attempts by jumping from a height). That characteristically, in sexual attraction often present sadistic connotation, and in attraction to alcohol-is missing so cute heart alcoholic hedonistic component, when stimulant-and well on psyche, and warmly on heart of. Desire to inflict pain, torture, torture;

  • the loss of moral values, the concepts of “good”, “evil”, “good”, “bad” – in short, a complete mess on the background of total frostbite;
  • opposition to the generally accepted views and norms of behavior, no matter the case, not the case – “Baba Yaga against”!
  • emotional stupidity, the absence of such qualities as pity, compassion, sympathy, combined with a monstrous egocentrism, when own khochunemogu-Tsar, God and Constitution, and with willingness monetize in move fists, her teeth and fingernails on any about;

• negative and spiteful attitude towards those who are closest, with the desire to make a painful and pobednoe;

  • unwillingness to study, work, the desire for dependency and parasitism.

Often meets interest and attraction to what have most people causes sense of disgust, aversion or of fear — ranging from habits borrow in hands renounce all malware likes and ending breeding any particularly pernicious abominations. Well, morbid interest in alapetite details of wars, disasters and pathoanatomical research of course!

I will mention here another important point characteristic of both hebephrenic and heboid syndromes: the dependence of symptoms on the time of occurrence. Since the syndrome is formed in childhood and adolescence, both the depth and the very content of the disorders is largely related to how much the psyche has managed to form at this point, which attitudes and values have already been laid, and which have not. Thus, if the onset of the disease was in the prepubescent period (11-14 years), patients expressed hatred for their parents and sadistic tendencies; if Manifesto is happening in period with 15 until 17 years, then should expect emphasis on focus on religion, philosophy, history — but devoid constructivism, more appropriate term “metaphysical intoxication”, and not so much enriching personality, how many serving formal justification its opposition all and the entire.

This syndrome occurs not only in schizophrenia. The consequences of brain damage at an early age, psychopathy — all these diseases may well find their expression in the form of heboid syndrome.

The course of the syndrome can also be different: either, once arisen, it lasts and lasts, or it flows in waves, attacks, with periods of remission.

Anorexia nervosa syndrome

The child does not like semolina? Not a problem! Feed it on a spoon: for mother, for the father, for party, for the President, for the state Duma, for favourite tax inspection…

Guide to raising a young extremist


Anorexia nervosa (from Greek. negative prefix an — and orexis-appetite) in ICD-10 is considered as a separate syndrome, and deservedly so. If we exclude

  • psychogenic, or neurotic anorexia, in which the lack of appetite is caused by overexcitation of the cerebral cortex, and a person is not elementary to coffee and a bun, because they are worried about very different problems;
  • late anorexia, which occurs in old age and is associated either with the development of cancer, or with delusional ideas of poisoning;
  • refusal from food on delusional motives — he from age not depends, but clearly subordinated to any delusional the idea of: either relatives-neighbors-the Ministry food industry sleep and see sufferer in a coffin, and to nor one dog not thought about poisoning, either in intestines lodged special colony wand intestinal reasonable, which suits demonstrations against food bombardment and threatens to darn here is the horoscope, see for yourself,
  • that is, a fairly large group of patients who, in addition to persistent refusal to eat, there is a whole group of similar symptoms, which made it possible to highlight this syndrome especially. Moreover, it is not so rare: its prevalence is 1.2 % among women and 0.29 % among men. The composition of patients is also characteristic: 80 % falls on those who are most used to watching the figure and reflecting on its real and (more often) imaginary shortcomings, that is, on the beautiful sex at the age of 12 to 24 years. Older women who have learned the household Tao, and men who are not accustomed to pay attention to the stomach as long as it does not interfere with visually assess the presence and degree of erection, make up the remaining 20 %.

Where does anorexia come from? The etiology of anorexia nervosa is known to the same extent as the detailed home address of the Yeti-give or take a couple of thousand kilometers, and then there is no certainty that the addressee will be home. But there are assumptions: official science is simply obliged to have an opinion on any account and on any occasion. So, it is believed that the cause of anorexia nervosa is a combination of several factors:

  • genetic, because not only a certain relationship with heredity, but also found suspicious genes. Suspects, however, do not hurry to write a confession, but scientists are full of enthusiasm;

• biological. This can include overweight, early onset of the first menstruation and metabolic disorders of three neurotransmitters [41]: serotonin, norepinephrine and dopamine. Exactly how neurotransmitters are involved, no one knows in detail, but the violation of their exchange and functions is established reliably;

• culture. The exciting and eye-caressing shapes immortalized in the classic “pin-up” have now capitulated to shoals of belligerently skinny models. And mass culture causes ideologically unstable individual quite expected possessive reflex: I want the same! Car, jewelry, clothes, ass-that whose heart is closer and sweeter;

• personal. Perfectionism, a tendency to form obsessions and aspirations, uncertainty and low self-esteem-these traits are always just waiting for something to show themselves, and anorexia nervosa for them is a very promising direction.

In order to confidently determine the syndrome of anorexia nervosa, it is necessary to have all the following signs (the text itself is taken from the ICD-10, comments to it are typed in italics):

(a) body weight is maintained at a level at least 15% lower than expected — for a given height and age — (a higher level has been reduced or never achieved), or the Ketele body mass index is 17.5 or lower (this index is determined by the ratio of body weight in kilograms to the square of height in meters). At prepubescent age, you may find yourself unable to gain weight during the growth period;

b) weight loss is caused by the patient himself by avoiding foods that “fatten”, and one or more of the following methods: causing vomiting, taking laxatives, excessive gymnastic exercises, the use of appetite suppressants and / or diuretics;

C) distortion of the image of his body takes a specific psychopathological form, in which the fear of obesity remains as an obsessive and / or super-valuable ideas, and the patient considers acceptable for himself only low weight (in other words, we are talking about dysmorphic and dysmorphic symptoms);

d) General endocrine disorder, including the hypothalamus — pituitary — sex glands axis and manifested in women by amenorrhea, and in men by loss of libido and potency; there may be elevated levels of growth hormone and cortisol, changes in the peripheral metabolism of thyroid hormone and abnormalities of insulin secretion (which is determined by eye, and what laboratory tests, to explain, I believe, is unnecessary);

e) at the beginning of the prepubescent age, the manifestations of the pubertal period are delayed or even not observed (growth stops, girls do not develop breast glands and primary amenorrhea takes place, and boys remain juvenile genitals); with recovery, the teenage period often ends normally, but the first menstruation comes late.

In addition, communication with the patient, you notice that he, even while as a walking guide to the study of the skeleton, continues to complain about its completeness (especially in the area of the skull, joints and lumbar vertebrae), and the pain state of a man often denied flatly: no, nothing serious, a small problem with the weight. The art of intimidating the toilet is honed to perfection, and for causing the vomiting itself it is not necessary to put two fingers in the mouth, it is enough to show one from a distance. As a rule, diets, the energy value of products, as well as particularly perverted ways of absorbing food are known to them to the smallest detail. The mood is often depressed, with subdepressive shade, but there are periods of euphoria, especially in the context of taking the next weight level. And the panic fear of getting better. Even when it’s just necessary for survival.