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Affective Syndromes

When considering the structure of affective syndromes (from lat. affectus-emotional excitement, passion) it is accepted to be guided by three main parameters:

  1. Pole affect-depressive, manic or mixed;
  2. The composition, structure of the syndrome-typical or atypical, simple or complex, harmonious or disharmonious;
  3. Depth, the strength of the manifestations of psychotic or non-psychotic level.

With typical syndromes, everything is more or less simple, they are characterized by triads. This

Depressive triad:

1) low mood;

2) slow-paced thinking;

3) motor retardation and hypobulia (“Can I? Do I want to? I want it?”).

Manic triad:

1) high mood;

2) accelerated pace of thinking;

3) motor excitation and hyperbulia (“Oh, how I can! Oh, how I want to! Everything, and more!”).

Be that as it may, mood is the main, leading symptom. Yes, there can be ideas of nypoleondabest in the manic syndrome and their own planktonogenic and kubistichesky with depression, desires, respectively igogo or lol, as well as intent or attempts to leave this world in depressive affect. But these will be additional, or optional, syndromes. That is, they may or may not be present.

The standard of a typical manic or depressive syndrome may well be those in endogenous psychosis [26] – say, TIR (well, well, let there be a BAR [27]). And, since we are talking about endogeneity, it is worth mentioning the characteristic signs for it: first, the daily fluctuations (“Morning is not good!”), when subjectively a person feels better in the afternoon than in the morning, and secondly:

1) increased heart rate;

2) dilation of the pupils;

3) tendency to constipation.

This is due to the failure of the autonomic nervous system with a predominance of tone of its sympathetic part. Menstrual irregularities, changes in body weight — this is in pursuit, as well as seasonality (well, at least just the frequency) and autochthonous (from Greek. autochthon — local, born here) — that is to say the state came by itself, but not all bastards provoked him.

For atypical affective syndrome is characterized by the fact that the foreground is not the main, and facultative signs (anxiety, fear, obsessive or obsessive phenomena, hallucinations or derealization with depersonalization, etc.).

For a mixed affective syndrome, it is characteristic to attach to the main signs of one affect some one of the opposite triad: for example, agitated depression (when inhibition would be necessary) or manic stupor (when one should expect excitement).

The affective syndromes of non-psychotic level include subaffective syndromes-hypomania and subdepression.

When it comes to complex affective syndromes, they mean their combination with syndromes from other, non-affective groups: manic-delusional, depressive-delusional, depressive-hallucinatory, depressive-paranoid, depressive – or manic-paraphrenic and other terrible expressions that can permanently enter the listener into a stupor.

Let’s look at each of the groups of affective syndromes — depressive, manic and mixed.

Why is it so bad — and all for me?!

Cry of the soul

So, the symptoms of depression. I will immediately make a reservation, so as not to lead the reader into the temptation to find something like this without sufficient reason. Depressive syndrome is not just a bad mood because of a badly spent night, an overly expressive seller in the store, an abundance of moral freaks around and one single crow-sniper, sighting bombed on the head of the only sane person in the radius of its duty barrage. Depressive syndrome is a really painful, painful and disabling disorder of mental activity. It can not be eliminated by simply using dense anti-aircraft fire, firing on a feathered bandit or releasing steam on the one who pushed you into the subway, through genocide (well, or at least slaughter) with a eugenic purpose.

Depressive syndromes can be divided into typical, represented by classic depressive and classic subdepressive syndromes, and atypical. Atypical, in turn, are represented by atypical subdepressive syndromes, simple, complex and masked atypical depressions. Now briefly on points.

Classic depressive syndrome.

It’s a depressive triad:

1) low mood;

2) slow-paced thinking;

3) motor retardation and hypobulia (“Can I? Do I want to? I want it?”). These are diurnal fluctuations of the state characteristic of the endogenous process (i.e., the process that arose inside, out of connection with external causes): very bad in the morning and a little easier in the evening. This is Protopopov’s triad:

1) increased heart rate;

2) dilation of the pupils;

3) tendency to constipation

or the predominance of the tone of the sympathetic Department of the autonomic nervous system.

It’s also insomnia. Thoughts in the spirit of “I-no one, worm, creature trembling, nothing in life has not achieved and unworthy of her, and in all their troubles to blame only me” (perhaps in some ways these thoughts are fair, but it is very destructive). This despair, this longing, which is so strong that it feels like a real pain, tearing, tearing the chest from the inside, claws scratching its way out (it is also called vital longing), a longing so unbearable that it is sometimes easier for a person to commit suicide than to endure it. This is a symptom of Vergaut — when the skin fold of the upper eyelid and the eyebrow at the border of the middle and inner thirds do not form, as usual, a smooth arc, and make an angle — a kind of mournful house, from which the expression of the patient’s face becomes even sadder. This is a complete lack of visible prospects. And-Yes, it is always a danger of suicide.

Classic subdepressive syndrome.

When the mood is reduced less dramatically. Melancholy is present, but not vital, not painfully tearing apart, but more like sadness, depression, pessimism (not militant, but already raised its paws).

Inhibition in the motor and mental sphere takes place, but more in the form of lethargy, a decrease in the desire to strain the mind, memory and body — not because you quickly run out of steam, but because the forces were not, and are not expected. Desires there is, but (hypobulia, remember?) some timid, sluggish, is initially adjusted for the General fatigue of all the precious to yourself.

Self-esteem is naturally reduced. Decision-making, among other things, is hampered by constant doubts about their correctness (for confidence, you need strength and mood).

Now to the atypical syndromes.

Atypical subdepressive syndromes. This:

Astheno-subdepressive syndrome. In its composition, in addition to the features characteristic of the classic subdepressive syndrome, the features of the asthenic syndrome will clearly emerge: weakness, rapid physical and mental exhaustion, fatigue, emotional lability (easily explodes, easily irritated, easily cries, but relatively quickly calms down) and hyperesthesia (the patient is extremely sensitive to either sharp sounds, or bright colors, or sharp smells, or jumps from the touch).

Adynamic subdepression. When her mood is low, but is dominated by a sense of physical helplessness, inability to make a wrong move, total indifference (“What will that bondage — all the same…”), lethargy, drowsiness, modusoperandi and zheleobraznogo.

Anesthetic subdepression. Here, in addition to the reduced mood and the General pessimistic orientation, all motives to do something, to undertake disappear, and also there is a so-called narrowing of affective resonance: first of all it is noticeable by the disappearance of feelings of sympathy and antipathy, proximity and kinship, the ability to empathize — there are simply no emotions and feelings, there is only one dull product of digestive activity, which painfully experiences their loss.

About masked depression, I will tell you more in the section of private psychopathology.

Simple atypical depression

From classical depression, they differ in that in the first place they are present and dominated by one or two additional, facultative symptoms, for which they are called, and not the classical depressive triad, individual symptoms of which are either absent or erased and little expressed. According to which of the facultative symptoms prevail, and is called simple atypical depression. Do not forget that the smoothness and mild severity of depressive symptoms do not mean that atypical depression is harmless: the level of psychotic, and do not forget it. Like masked, it can always suddenly change its course, worsen and even lead to suicide. But back to the varieties.

Adynamic depression. The symptoms are similar to those of the eponymous subdepression, but the lethargy, impotence and lack of motivation are more global and comprehensive; the forces are not just there — they seem to have never been and are not expected in principle; and the ability to hold occupied horizontal surfaces, the patient may well argue with the polyps of the Great barrier reef. Not forget also about signs of endogeneity (on the morning worse, on the evening better, plus triad Protopopova, plus greasy hair and skin faces).

Anaclitic depression (depressio anaclitica; from Greek. anaklitos-leaning, leaning). It can be found in children aged 6 to 12 months, who for some reason had to leave their mother, and their living conditions are far from normal. Such children are inhibited, immersed in themselves, lag behind in development, nothing pleases them, they do not laugh, they do not eat well.

Anhedonic depression. What in life are you used to enjoy? Introduced? And now imagine that there are worthy representatives of the opposite sex, and fine drinks, and the opportunity to go shopping, and not squinting, but in an adult way, but … Sex seems to be a set of meaningless gymnastic exercises, the liquid in the glass just fogs the brain, but does not have the same, the former, taste, smell and play, and shopping just lost Not to mention the balloons that fit to return back to the store — not happy!

Anaesthetic depression. As well as anesthetic subdepression, proceeds with painful realization of that feelings are not present — to the native child, to parents, to the spouse or the spouse. There should be, but in their place is a painful hole. Plus, again, signs of endogeneity.

Asthenic depression, or asthenic-depressive syndrome. Similar to asthenic-subdepressivee, but besides being mood disorders harder and deeper, and the fatigue and exhaustion manifest themselves at any even minimal activity, asthenic symptoms (when the morning more or less, but the later the worse, because the whole tired) superimposed on the endogenous, when it is bad in the morning and in the evening relax a little bit. As a result, it was bad all day.

Vital depression (from lat. vita-life). To be more precise, the basis of the name was the syndrome of vital, or atrial, anguish — the same, tearing, scratching the chest, tearing the heart — with feelings of physical pain in the chest, from which nothing helps.

Nagging depression. You can not even decipher, the main symptom-grumbling, grumbling, dissatisfaction with everything-from the government to the personal genotype.

Dysthymic depression. It, as a rule, falls short of the criteria of depression itself, because its main symptom is a reduced mood. But! It lasts months and years, with brief (day, week) timeouts to a more or less acceptable state. At the same time, there seems to be no external reasons for such a mood. Or, somewhere in the past, there was some trauma or loss, but so much time has passed that all the deadlines for reactive depression are long gone.

Dysphoric depression. Under it dismal mood wears explosive connotation depressed-embittered, nepriyaznennogo, unhappy with all and the entire, – here is you, to example, “so and went would on brazen satisfied mug.”

Ironic depression. It is a depression with a mournful smile on its lips, with a bitter irony to itself and, what makes this depression quite dangerous — with a willingness to pass away from life smiling like this. The risk of suicide with it is quite high.

There are also tearful depression, with a predominance of tearfulness and weakness, and anxiety depression, with a predominance of anxiety on the General dreary background.

Complex atypical depression

The structure is a combination of depressive symptoms and syndromes from other psychiatric groups (paranoid, paraphrenia).

The most common:

Depressive-paranoid syndrome, when depression is combined with delirium (if you want to kill, poison, shoot three times in a particularly perverted form-what fun is there).

Depressive-hallucinatory-paranoid syndrome, when, among other things, there are hallucinations, only reinforcing the conviction of the patient that everything is bad (you can hear voices and hooves of wild hunting, you can smell the gas, which has already begun to penetrate into the room, you can hear an infernal voice that says offensive, but generally fair mischief).

Depressive-paraphrenic syndrome, when depression is present, delirium, too, but the main feature is the nature of delirium: it is fantastic, with a phenomenal scope, its scale is amazing — it is cosmic, apocalyptic and epochal events with the patient in the lead role. As a rule, the culprit or the victim. In any case, suffer him forever, many and for deal.

In the words of one manic-depressive patient, “the disease would have been absolutely unbearable had it not been for these beautiful manic phases.” In fact, one of the main problems of the treatment of manic syndrome is that the patient feels great-both physically and mentally, and sincerely wonders: what can be treated here, why is it all suddenly attached to me, and well, scat, nasty!

As in the case of depressive, manic syndromes can also be divided into several groups: classic, atypical and complex.

Classic manic syndrome. It is, above all, a manic triad:

  1. High mood. In fact, it is not just elevated, it is not good or even excellent — it is radiant. This is happiness that you want to give to others. It is rapture, sometimes and sometimes turning into ecstasy. It is the joy of every second of being. This feeling from the category of ” here poperlo!»;

2) Accelerated pace of thinking. The associative process is accelerated, decisions and conclusions are made with dizzying speed and ease – in a psychotic state, most often to the detriment of their depth, objectivity, productivity and compliance with the realities of the moment. Everything is subordinated to counter the belief that EVERYTHING is FINE and ALL the best — and spit to open a new company in growing sturgeon in wastewater treatment plants sold apartment — in ten years we will bathe in black caviar and money (already, by the way, bought for the occasion).

3) Motor excitation and hyperbole. This is when it is difficult to sit still, when the energy just permeates the whole body, when it seems as if the legs do not touch the ground, as if one push — and you will fly. Besides, there are so many ideas and plans, and they all require immediate execution… by the Way, about ideas and plans. There really are a lot of them. The brain gives birth to more and more with feverish speed, from which sometimes there is a “leap of ideas”: no sooner had to put into words one, as it is replaced by another, and in turn already third-what kind of implementation, when generate something really do not have time! Therefore, quite often hyperbulia remains unproductive or several grandiose projects hang at the stage of the project (if you’re lucky) or at the stage of preparatory work (if you’re less lucky). In relation to the opposite sex — the same song. Seems, if ready love if not all, then the vast majority. And given the burning gaze, extraordinary ease in communication and beating over the edge energy (including through the RIGHT EDGE) – looking for adventure on his awl pricked basis usually finds them.

By the way, there is a phenomenon that explains how a manic companion easily finds a common language with everyone and many people like it — syntonality. This is an amazing ability to penetrate the mood and aspirations of the interlocutor, to be on the same note with him and as if to reflect in a mirror the slightest subtlety of his mood and behavior. Well, how can such a vis-a-vis not charm? True, the greatest degree of severity and subtlety of syntonicity is in the hypomanic state — in manic, the patient sometimes begins to just go ahead, like an armored train with drunken anarchist drivers, but nevertheless.

Don’t forget about the triad of Protopopov:

1) increased heart rate;

2) dilation of the pupils;

3) tendency to constipation.

It is also present here as an indicator of endogeneity (if we are talking about the manic phase of the disease). In addition, as with most psychoses, sleep is disturbed. The shade of this insomnia is interesting. If with depressive or paranoid syndromes, such a sleep disorder is transferred hard and painfully, then with manic any patient will tell you: “What are you! What a dream! I’m fine, just my body does not need so much time to rest! An hour, two or three at the most, and I am fresh and alert again.” And indeed fresh and disgustingly cheerful…

Classic hypomanic syndrome. It’s pretty much the same, except that there’s no such leap of ideas, and the bulk of the plans aren’t as intimidating. Just steadily elevated mood, thinking accelerated — but not so much as to become unproductive. Yes, it takes less time to sleep, Yes, the attitude to yourself, your condition and your problems a little easier, but even a professional can sometimes not notice the difference with a healthy person, especially if the patient desperately does not want to be treated: “WHY??? It’s so good!”And in fact, if it were not for the risk that everything will develop into a psychotic level of manic syndrome — it would be a pity to adjust something.

Atypical manic syndromes.

Fun, or unproductive, or “pure” (as Leonhard called it) mania. Her mood is elevated, with a kind of euphoric tinge. The patient behaves as if he had learned the Tao: everything, the highest wisdom is found, the person is happy, therefore, you can no longer do anything — and so everything is fine. That’s not doing, just enjoying being.

Angry mania. Imagine a slightly intoxicated cheerful ensign with a unit of brakes entrusted to him-recruits who do not just brake, but also try to show the honor. Yet, damn it, will lead to compliance with the Charter and the General concepts of the internal service, more than one MOP on the ridge broken off. And perishing’s throats disrupt here and at all easier simple. Unproductive activities and inconsistent thinking — this is so, in the form of a bonus.

Expansive mania. In addition to high mood and accelerated thinking with ideas of greatness, there is an irresistible thirst for all plans to immediately implement, which causes a lot of trouble to others, and especially to households, since the money for the return of the fullness of the Aral sea by beer lovers and by drinking a couple of echelons with a foam drink is withdrawn from a single family budget.

Resonant mania. With it, the unquenchable thirst for activity is absent. But surrounding from this not particularly easier, because words can be zadolbat not less, than Affairs. If not more. And the patient will talk a lot, regardless of your willingness to listen to him. Reasoning will be as lengthy as it is fruitless, wisdom-exclusively crafty. Plugging the fountain of eloquence is possible only mechanically.

Complex manic syndromes.

Manic-paranoid. The combination of mania with delirium greatness, or relations (me hate for what I such — – forth helpfully merits), prosecution (my blueprint ballistic rubber missiles-poprygunchika want steal intelligence services already six States, on which she, supposedly, will punch).

Manic-hallucinatory-paranoid. The same plus verbal true or pseudo-hallucinations (special services dirty swear, counting the alleged damage, let bad-smelling gases).

Manic-paraphrenic. Here brad acquires fantastic traits and truly galactic scope: if perishing rich, then “Forbes” refuses print the size of the fortune, to not upset rest included in list, if is important something not less than Emperor Galaxies. Well, let it be the lover of the Empress. If children born out of wedlock — something million, no less. Yes, at a glance.

Mixed affective syndromes are represented by agitated depression and manic stupor. Why mixed? Because in their structure, in addition to the main, there is a symptom of the opposite sign of the syndrome: excitement and motor disinhibition in depressive and, conversely, motor and mental retardation in manic.

Agitated depression. When her mood drastically reduced, the ideas of self-accusation, his own insignificance, worthlessness and other things are present, BUT. Instead of, as it should be in classical depression, everything was decorous, sedate, with maskoobraznostyu face, meager movements and thoughts in an hour on a teaspoon, here everything is different. Instead of inhibition-anxiety, anxiety and bustle, with wandering around the room and sighs ” Oh, how it is!”, “Oh, what am I!”, “Oh, what will happen, what will happen!”. And after all, it is likely that it will. At the peak of this bustling cheburkina it may even occur raptus melancholic (from the Greek. melas-dark, black, chole-bile and from lat. raptus-gripping, a sharp movement) – when patient as if explodes from within its melancholy, pain and despair. He sobs, he groans, he rushes, tears his clothes and hair, beats himself or literally killed against the wall. The risk of suicide at such a time is extremely high. Such a condition was first described in psychiatric literature by Yu. V. Cannabich in 1931.

Manic stupor. Mood elevated so that is enough for one small subdepressive nation. A person is not just good: he is the best. So good, that simply not to hand words. Buddha under his ficus religiosa in the moment of enlightenment and close so good was not. All the other manic citizens gush ideas, jump thoughts (Yes, all the crazy squadron) and make a lot of some extra movements — well, purely kindergarten, pants on the straps! A person is already good, he had already gained, learned and did eat. What’s the hurry? Allowed to envy.

Asthenic Syndrome

The name of this syndrome comes from the Greek word astheneia — that is, “powerlessness, weakness”. Perhaps, this is the most common syndrome in psychiatry, and it does not matter-whether it is a psychosis, neuroses or other mental disorders. In fact, it is also one of the most simple syndromes in psychiatry (of course, from the point of view of understanding) and reflects mainly quantitative rather than qualitative changes in the psyche. Do not forget that we are talking about positive, or productive, symptoms. Differences from it asthenic syndrome, which is negative, or deficient, I will explain when it is his turn to describe.

What is asthenic syndrome in its essence, it is easy to understand if we consider the human psyche as an open thermodynamic system. Anticipating the mass immersion of readers in a trance or catatonic stupor from the abundance of terminology, I venture to resort to a simple example. There’s a leaky bucket. It’s mental. It is constantly pouring water. This is a replenishing stock of mental forces (to the limit conditionally, but the essence reflects). The flowing water is the sum of psychic forces that are expended: on study, work, relationships with others, love, hostility, worries about trifles and concern for the vital-in short, all our mental activity.

If the water supply is sufficient, and the flow rate is small, then an equilibrium is established, which can be considered the norm. If the supply of water is running out (the inflow is small or the flow increased) – there is a depletion of mental activity, which is manifested by asthenic syndrome. Accordingly, and approaches to treatment, at least, two: to plug a hole or to make a pressure more.

The reasons leading to mental exhaustion, quite a lot. These are psychoses and neuroses, which draw a lot of energy, and intense mental activity, and violent emotions, and even about the everyday small mischief of life and can not speak — they sometimes pull away forces in small things faster than a flock of piranhas. In addition, we should not forget the factors that can weaken the body as a whole or the brain in particular: injuries, infections, intoxication, long chronic diseases, starvation and lack of sleep.

In total, it is customary to consider two variants of asthenic syndrome: hyperesthetic and hyposthetic.

Hyperesthetic variant (from lat. hyper-and Greek. Genesis-a sense of, sense of, camping on E. literally “heightened sensitivity”). Remember the expression “kindness is the privilege of the strong”? It well illustrates the essence of this option. Exhaustion, weakness here are manifested in the fact that a person does not have the strength to restrain himself, to keep himself in hand.

A person flashes like a match, easily, with a half-turn, from what seems to most a trifle, not worth attention: not so said, not so looked, NOT so SILENT… However, the flash also quickly exhausts itself — the fuel is at the bottom. Emotions are also at odds, they are labile, like the gait of a drunken sailor, their change is easy and unpredictable. It is just as easy to bring tears to the eyes, it is necessary to flash a little bit of a sentimental episode on the screen, an exciting topic in memories or a sentimental scene in a book: weakness — nothing can be done. Most of the time such people go gloomy and dissatisfied with something, the rest of it is used to search for the causes of discontent and gloomy appearance. As a rule, find. Capricious: after all on the, to truly want and be able (Ah okay-okay, simply want),, too, need forces. Hence the variability of appetite, whims in the menu (I want this today, but I can not stand it anymore), other fads. As a rule, with libido and potency, too, there are problems: excited-exhausted-extinguished.

Such patients do not tolerate everything bright and sharp: colors, smells, taste sensations; from a sharp sound they shudder, jump on the spot or give a source of sound to the neck (here as lucky). They do not tolerate waiting and monotonous work-both require patience, and it is catastrophically small.

Attention is also affected, since the strength of the need and it. Distraction, distraction increases, it becomes more difficult to concentrate, to focus on anything. Because of this, the ability to both remember something and quickly remember something is reduced, while such patients often complain of “leaky memory”, although in this case, memory problems are just reversible-it is only necessary to replenish the reserve of forces properly. Violation of attention and memory entails difficulty in solving domestic and social issues. Increasingly, these decisions become stereotypical and shallow (do not forget-creativity and originality need strength), more and more time is required to make decisions themselves, I want to quickly dump everything from myself, and relax, and not to pull!

Like the masses, deprived of ideological leadership, a bright goal and a guaranteed better future, the autonomic nervous system is peddling [25]. There is a complete set of unforgettable sensations: headaches, and sweating, and pale cold hands, and surprises from the heart, which then freezes, then starts to gallop, and then pinches, as if already quite-quite a heart attack — – only an electrocardiogram like an athlete, and the ambulance wearily curses … Sleep, too, to hell-frequent awakenings, dreams of every day-household painful rubbish, and even completely overcomes insomnia. And if previously such a person was sensitive only to the direct hit of lightning or, alternatively, the demolition of a hurricane, now begins to feel so subtle nuances of the weather that they can quite successfully bet on it.

Here in the foreground is not flash and explosive, but complete powerlessness-both physical and mental, emptiness, exhaustion, lethargy, the feeling that all the arable land of the vast homeland plowed personally and that the forces are not just there: THEY will NEVER BE. Hence the General pessimism and zero, if not negative, performance. Sleep is of no use, no pleasure, only a heavy and broken head, like a hangover.

Asthenic syndrome can be combined with a number of other syndromes (manic does not count), in this case they are called, based on the combination: asthenic-subdepressive, asthenic-depressive, asthenic-hypochondriac, asthenic-phobic and other terrible words.

Syndromes. Entry

If the picture of the disease had to be divided into levels of complexity, I would prefer three main gradations: symptoms-syndromes-the actual disease in its entirety. Moreover, the disease should include not only a set of symptoms and syndromes characteristic of each particular nosology, but also reflect the dynamics of these symptoms and syndromes: what was, what will be, than the heart will calm down — and you can no longer go to the fortune-teller.

So, syndromes are the next (after symptoms) step to understanding what happened to the patient. Syndrome (from Greek. syndrome, a cluster, confluence) is not just a set of symptoms. There is no arbitrary combination of them, simply because the card is so laid. Pathogenesis with the layout is not joking, then cry “stick to the soap!” no way. All symptoms are combined in strict accordance with what kind of disease, and what stage we are now seeing. And if the diagnosis was made correctly — and at all it is possible to make cautious predictions.

Of course, the syndrome is not a disease, and to complete the clinical picture often need a lot: from properly collected history (born-baptized-married-what’s amiss) to analyses and abusive-rave reviews specialists. However, the correct recognition of the syndrome can help determine the tactics of further management of the patient (delirium, oneiroid and catatonic syndrome — in the hospital, asthenic-can be treated on an outpatient basis), with prescriptions of drugs (Yes, already at this stage). What can I say — the international classification of diseases 10th revision, aka ICD-10, is mainly based on syndromic approach to classification. And again, knowing the syndromes, we can easily identify a simulant that demonstrates some symptoms, but can not show the whole picture of the disease (there are, of course, the master in this case, but such units).

There is one more subtlety of medical practice: each syndrome it is necessary though time in life to see in the presence of a teacher who will tell you: “Watch and remember, it’s paraphrenic syndrome, and this syndrome Kandinsky — clerambault, it’s the asthenic syndrome of the neurotic, and the depletion of mental activity of a schizophrenic, I feel the difference in each pair and look for patients, is something that words cannot Express or describe it so that you can avoid misunderstandings and double interpretation“. That’s why there is no correspondence study at the doctor. Only personally, internally, through the stage of joyful recognition — “that’s it, I was taught this!” – to the shining peaks of intuition and infallible medical guess (this is almost the same as the military savvy — allows one fleeting glance at the grenade flew into the trench to determine that in fact it mimicked the Northern fur-bearing beast).

All psychopathological syndromes can be divided into positive and negative.

Positive psychopathological syndromes (they are “plus-symptoms”) are new, previously absent in the psyche syndromes, which normally should not be. In other words, it was not — there was add on (however, the pros and positivism come to an end).

Recognizing a certain conventionality of disposition, by the degree of increasing complexity, severity and totality of manifestations, as well as by the degree of disturbance of mental activity and as reversibility decreases, positive syndromes could be arranged in the following order:

  • Asthenic syndromes (positive);
  • Affective symptoms;
  • Neurotic syndromes;
  • Hebeny syndrome;
  • Syndromes of overvalued ideas;
  • Hallucinatory-delusional syndromes;
  • Lucene catatonic syndromes;
  • Syndromes of impaired consciousness;
  • Convulsive disorders;
  • Psychoorganic syndrome (aka organic psychosyndrome — Faberge, self-portrait, fragment, different camera angles).

Negative psychopathological syndromes (they are deficit syndromes, they are “minus symptoms”) are characterized by the fact that from mental activity (such as it should be normal) with the inherent set of qualities and properties of a normal person something of these falls, is lost. Accordingly, damage is caused to mental activity and a personality defect is formed.

According to the degree of increase of negative syndromes can be arranged as follows:

  • Asthenic syndrome (as negative);
  • Change of the subjective “I” (or subjectively perceived change “I”),
  • Objective personality changes;
  • The disharmony of the individual;
  • Reduction of energy potential (REP);
  • A decrease in the level of the individual;
  • The regression of the individual;
  • Amnestic disorder;
  • Total dementia;
  • Mental insanity.

Now we can proceed to a more or less thoughtful consideration of each group of syndromes.

Perversion of the rhythm of sleep and wakefulness-wakefulness at night and drowsiness during the day

Sleep disorders: when a person can not sleep for a long time, sleep comes in the middle of the night or in the morning, against this background, there is discomfort and anxiety.

Paradoxical drowsiness – a person wants to sleep, goes to bed, but (that’s disgusting!) drowsiness disappears.

Repressed drowsiness – when a person wants to sleep and even manages to fall asleep, but dreams and experiences in sleep are so strong and exciting that sleep runs away — and no longer occurs.

Obsessive fears — agraphobia (“and suddenly won’t sleep and what is insomnia?”), hypnophobia) (“what if I fall asleep?”) the get (“night, dark, scary!”), ametantrone (“as well as the fall asleep and die in my sleep?”), liturgiology (“so go to sleep and you’ll be buried without a control opening, you could Wake up already in a coffin is too late!”); oneirophobia (“and suddenly in dream nightmares will show?”), somniloquy — fear to be spoken in the dream (nightmare spy and salivahana), noctambulation — fear of segodenya.

Cataplexy sleep (or pageprofile) — when the patient is at the point of falling asleep while still being conscious, suddenly feels that he could neither move nor utter anything, nor — horror of horrors — really breathe.

Intrasonics disorders:

Dissociated sleep which may be accompanied by motor disorders (worry, legs jerk, feet suck, teeth gnash), viscero-motor disorders (here at least shall not lie — nocturnal enuresis, vomiting, coughing, diarrhea), pain (of ginalgin, or nyktalgia), night terrors, bouts of palpitation, shortness of breath, and pauses in breathing — apnea.

Intermittent sleep — usually light, with difficulty falling asleep, frequent awakenings from the slightest rustle or touch; something superficial on the border between sleep and wakefulness. Most often-with abundance of dreams.

Changes in sleep duration-shortening or increasing sleep duration.

Dreams in mental pathology may be particularly bright, imaginative, different liveliness that said V. H. Kandinsky. They can both reflect what a person raved or hallucinated during the day, and, conversely, – dreamed at night, give the patient food for his hallucinations and delirium in the future.

Dream mentalism – it happens that instead of dreams a person has an influx of thoughts, reflections. In some cases, what was thought in a dream, can be further reflected in the content of delusional or neurotic experiences.

Postranjska disorders:

Sleepwalking (somnambulism, sleepwalking) – when the patient performs actions, it is connected and consistent, automatically, being in the power of deep sleep. Most often, unless they are awakened during these activities, patients do not remember their actions.

Prooecia state, when the patient, moving from sleep to wakefulness, is not aware that he was awake, not distinguish reality from dream, while doing automatic unconscious action, often dangerous to themselves and others (especially if you had nightmares, which had to leg it than heavier), memories of whom are not saved.

Cataplexy of awakening (or polyproplene) when a patient is waking up and being well-oriented in the awakening, for a few seconds or minutes can’t open my eyes, to move, to speak.

Loss of sense of sleep (agnosia sleep, giagnoni) — no feel of sleep, its duration.

Note. Prophetic dreams, “dreams in hand”, as well as the dreams of Indian shamans were not presented above, so as not to give scope to rich imagination and fruitless reasonableness, as well as not to multiply the already numerous psychopathologies.

Sleep Disorder

Do often sleep disorders are sensitive and a clear indicator of the disorder in mental activity; in the event of illness or exacerbation of sleep is one of the first is broken and one of the first to recover. The variety and prevalence of symptoms of sleep disorders allowed to stand out a whole direction in medicine and neuroscience — it is called somnology. Pillow with heraldic, heraldic heraldic cradle and same button mass. And the international classification of sleep disorders as a founding document.

First of all, it makes sense to highlight insomnia, or actually insomnia (“sleep disorder, manifested by a violation of falling asleep, intermittent surface sleep and/or premature awakening“) and hypersomnia (pathological drowsiness). The list of diseases and syndromes in which both conditions occur is very extensive, as well as the causes provoking both (to take at least the true and false Pickwick syndrome ), so for now we will limit ourselves to mentioning them only.

Since it is customary to consider three periods of sleep (prasonissi — asleep, interconnecti — the actual sleep postranecky — awakening), and sleep disturbances, respectively, can be divided into three groups.

Pathology of the Motor Sphere

Submitted to oppression, and strengthening the perversion of physical activity.

Inhibition of motor activity

Hypomimiawhen facial movements are scarce and inexpressive, the amim — they are entirely absent, the face more like a mask.

Hypokinesia (movement inhibition, stupor) — slowing of voluntary movements, and a reduction in their volume and amplitude. Complete immobility is akinesia.

Found depressed hypokinesia where there is a slowdown and an overall reduction in the number of voluntary movements, accompanied by poor-poor depressed facial expressions (the man frozen in grief and had made great efforts already to just move, not to mention other things); manic hypokinesia (usually short, replaced by maniacal excitement): a man so overcome overwhelm his senses that froze in ecstasy, and only the richest facial expression conveys how he is now well. There is also a hallucinatory hypokinesia, especially if hallucinations peremptory or threatening (or both) — the patient stiffens, listening and dreading (“the COMMAND was SIT!!!”); and crazy hypokinesia, usually accompanying delusions of exposure, facial expressions of anxiety and fear (“Ah, THEY began again for me!”).

Mutism (remember the mute button on the TV remote?)- this is when a person can not speak spontaneously or answer a question, despite the fact that he understands speech, as well as in PRINCIPLE able to speak.

Enhancing locomotion

It is represented by obsessive, compulsive and impulsive actions, as well as various variants of hyperkinesia and convulsions.

Obsessive actions are implemented obsessive desire, often having the character of ritual action (say Hello, washed my hands, stepped across the threshold three times touched the jamb).

Compulsive actions are implemented compulsive desire (the same campaign for a beer in a stall on the second stage of alcoholism or dose to the patient puchero issued with heroin addiction). There is no longer a struggle of motives, but the goal is still present.

Impulsive action is action sudden, without a motive, without a target, without much colouring emotions: only that all was quiet, and suddenly the man seemed to explode from the inside like got invisible push and here it already where-that rushed, something ruined, aggressiveness and a tendency to fracture under impulsive action occurs very, very often.

Violent actions are movements and actions that arise by themselves, without any motives, involuntarily, but are perceived by the patient as alien to him, interfering and superfluous, while the consciousness remains clear (ridiculous movements of hands, feet, head, violent cry, crying, laughing, etc.).

The hyperkinesis is, increased physical activity, up to initiation with a loss of focus and expediency motions.

Distinguish euphoric (manic) the hyperkinesis, when revival movements happening against the backdrop of mania (“Oh, del bunch, Oh, I ran”), euphoria; anxiety-depressive hyperkinesis (agitation) that occurs at the height of anxiety and depressive affect and manifested unfocused restlessness (“Oh, now that would be something, Oh, what to do, what to do?”) into the excitation (melancholic raptus); the hallucinatory hyperkinesis when hallucinations frighten the patient or cause him rage, he either flees or tries to attack their alleged source; crazy hyperkinesis (usually with delusions of persecution, or when the patient hides from his pursuers, or he’s on the prowl); a catatonic hyperkinesis — in this case, the action is chaotic, repetitive (the patient may spend hours rocking from side to side or go from corner to corner, or sit-up), with the negativity (try to get him to stop doing it or where to take).

The perversion of locomotor activity (paragenesia).

Negativism — unmotivated opposition, active (when it is possible ogresti) and passive (when the patient will passively let you to do anything against him).

Passive podchinyalas — pathological inclination to execute any instructions without thinking said “follow me” — will go tail all day.

Waxy flexibility (it is catalepsy, from GK. katalēpsis — grasp, hold) — long-term retention of patients attached to or arising postures when the body as though made of wax, including the symptom of “air pillow” (patient, if you remove the pillow from under the head will keep the head on weight, not touching the bed), the fetal position.

Speech stereotypes is a monotonous repetition of certain words (mantras do not count); they are also called stand-up momentum or symptom gramophone records.

Motor stereotypies involuntary, frequent repetition of bizarre postures and movements, devoid of any meaning.

Echopraxia (from Greek. echo-echo and praxia-action) – meaningless copying of the actions of others.

Agonimia (echo + the Greek. mimia — imitation) — mindless copying facial expressions of others.

Echolalia (echo + Greek. lalia — speech) — mindless copying of the speech of others.

Pathology Indicative of Instinct

Strengthening research instinct is manifested by extreme diversity and variability of interests and aspirations: “dramatic circle, the circle of the photo, and I also sing hunting”; also includes dromomania — pathological attraction to a permanent change of habitat, vagrancy (Gypsies and occupational travellers are not in the bill. Well, almost doesn’t count); the oniomania (from the Greek. onios-for sale, mania-madness) – an uncontrollable desire to make purchases, to acquire things without material and personal interest, without looking at the consequences-just to BUY.

Decrease of research instinct-when it is uninteresting not only to do something and learn, it is when you yourself, in General, already uninteresting.

Perversion of research attraction includes kleptomania — pathological attraction to theft, often unnecessary, useless and repetitive things (for example, the twenty-eighth portrait of the President of the country); arson — the attraction to arson or contemplation of the flame.

Therefore, having felt an urgent need for something, do not rejoice prematurely, but ask yourself sternly: “do I need it?»

Pathology of Sexual Desire

Hyposexualitysexual desire or reduced, or absent. In men, this is some form of impotence (when it’s not so much in the problems of the Executive bodies, as in the crisis, what is called “legislative power”), in women — frigidity.

Hypersexuality – increased sexual desire with appropriate behavior in both men (satyriasis) and women (nymphomania).

Sexual perversion

Autoeroticism is Masturbation, Masturbation and narcissism. This should make an important note: a perversion that should be considered when there are episodes caused by the fact that the partner is unavailable or absent, and when, in addition to yourself, no one would EVER need.

Algolagnia (from Greek. algos — pain and lagneia intercourse, lust) — the need to inflict physical pain or moral suffering to achieve sexual pleasure (including orgasm), yourself (masochism) or sexual partner (sadism).

To vicarious forms of sexual perversion previously attributed homosexuality (in men, sodomy, women lesbianism, tribadism), but now, due to certain nuances, as reasoned in the thesis, and politically hard-won, considered it a sign of broadmindedness and their own sexual preferences. There were visionism, voyeurism (spying on naked faces of the opposite sex, stock up on binoculars, as well as drills and micro-cameras), exhibitionism (exposure of the genitals in the presence of persons of the opposite sex — “and look what I HAVE!”), transvestism, fetishism (idol not only created, but also raped), frotterism (that’s really who the crush in public transport just a joy).

Orientation of sexual attraction to inappropriate objects emit:

  • Pedophilia – sexual attraction to minors;
  • Gerontophilia – sexual attraction to the elderly;
  • Bestiality – sexual attraction to animals;
  • Necrophilia – sexual attraction to corpses;
  • Pygmalionism — sexual attraction to photographs, statues, paintings (ideal place of work-art Museum, such a person can not pay a salary).

Pathology of Self-Preservation Instinct

Strengthening the instinct of self-preservation can manifest itself in two opposite forms of behavior:

Passive defensewhen a person runs from danger, hiding, digging trenches and dugouts, bypasses it for the quarter or pretends to be a hose, a corpse (reaction supposed death).

Active-defensewhen the best method of protection is declared an attack, and is now “in the woods, the worst is we.”

The weakening of the instinct of self — preservation — when life becomes uninteresting, indifferent, and even a burden, and even if the mood is not to hell-everything, hide ropes and sharp objects, remove vinegar and medicines.

The perversion of the instinct of self — preservation is when a comrade does not kill himself, but bites hard, suddenly finding something extraordinarily attractive in self-torture, self-mutilation, swallowing all sorts of uneaten items, like family silver. Sometimes, however, the latter has a strictly defined purpose: for example, when a prisoner swallows a piece of razor tied to a thread, in order to cause stomach bleeding and end up in the infirmary, it is no longer a perversion of the instinct of self — preservation, but a simulation and a convict’s ingenuity.

Pathology of Drives

Disorders of drives (needs, instincts) can be manifested in the form of their pathological strengthening, weakening or perversion.

With the increased craving may be in the nature:

a) Intrusive — at the same time encourage the activities occur beyond the will of a patient when he realizes what attracted him in General that are alien, does not correspond to any moral values or interests, even criticism persists to this alien phenomenon, saying, not mine, not mine! A striking example is when alcohol dependence is just beginning to form, and a person feels that he would like to drink, but still realizes that this does not come from within, and he clearly does not agree with it.

b) Compulsive-impulses to activity in this case already dominate, they have destroyed at the root of the struggle of motives: why, when here it is, the desired, and it is vital to me (in other words, has a vital character), give it here! That is, if a drink is not just possible-it is NECESSARY. Ergo bibamus!

C) Impulsive — when wide horizons of consciousness was curled up in a mesh of sight, and the person who received the internal pendel (aka pulse) is taken up, without thinking: wait, wait… It just eliminates the annoying economic-geographical blunder: the money should be in the store, and alcohol — in the body.

The pathology of food craving:

Bulimia (Greek. bulimía from bús — bull and limós — hunger) — a strong irresistible craving for food, the constant feeling of hunger.

Anorexia (from Greek. an-without and orexis-urge to food) – lowering, the lack of appetite or aversion to food.

Parorexia, the perversion of food craving, manifested by eating of inedible substances (earth, lime), — paralexia pregnant peak, Kala (CE). One lady, being pregnant, and did prefer kerosene. It’s hard to say what she thought the husband, from time to time passing her in the hospital a bottle of the coveted fuel, but until the illegal supply of hydrocarbons is not stopped, the lady had to go through several miscarriages.

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