Depression. All about the disease, treatment, symptoms.

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

1) Korsakoff’s syndrome;

2) Confabulation;

3) Violent memory syndrome.

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

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

— To many cases of paramnesia.

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

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

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

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

According to the dynamics of Korsakov syndrome can be:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Amentia

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

Mandatory, or obligate, symptoms of amentia:

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

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

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

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

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

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

Now about the paroxysmal obscurations of consciousness.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

• Sudden development;
• Conditionality by an external cause;

• Short duration (minutes, hours, less often days);

• Accompanied by a clouded consciousness;

• On exit-full or partial amnesia.

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

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

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

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

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

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

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

This group of syndromes includes:

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

Now in order about each of them.

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

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

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

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

Stupor Syndromes

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

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

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

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

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

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

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

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

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

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

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

Lucid Catatonic Syndromes

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

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

Catatonic Stupor

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

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

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

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

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

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

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

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

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

Catatonic Arousal

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

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

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

Paragenesia are quite rich. This:

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

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

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

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

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

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

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

From optional, or additional, optional symptoms:

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

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

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

Coprophagia (I believe you can not translate).

There are three types of catatonic arousal.

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

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

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

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

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

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

This is, you might say, the very salt of psychiatry. This rather extensive group includes syndromes, in which the structure is dominated by delusions and hallucinations-both together and separately. This:

Paranoid syndrome. At the core-the primary systematized delirium;

Hallucinosises. It is based on hallucinations, both true and pseudo. Delirium may be present, but it is secondary, arising from what is heard, seen, felt — in short, it interprets existing hallucinations;

Paranoid syndrome. The basis — a combination of delusions, often persecuting, and hallucinations;

Paraphrenic syndrome. At the core-delirium fantastic, large-scale content (just fantastic and scope-its distinctive features for paraphrenic syndrome), plus all the same hallucinations and phenomena of mental automatism.

The sequence in which the syndromes are given is not random. Except for hallucinosis, which can be considered separately, other syndromes are given in the order in which there is a complication and progressive development of symptoms in the classic case of the same schizophrenia (again-in the classic, this is not a dogma, but rather a General pattern that allows other variants of the beginning and development): paranoid syndrome — paranoid syndrome — Kandinsky syndrome — clerambault — paraphrenic syndrome.

Paranoid syndrome. He’s paranoid. The name comes from the Greek word paránoia, meaning “insanity”. The main, or obligate, symptom of paranoia is delirium. Not obsessive, not super-valuable ideas, but delirium — in all its fantasy and unreality, with the reinforced concrete of the belief in one’s own rightness, with the senselessness and futility of persuasion: “why, in fact, do you climb with your counterarguments? Are you a messenger of the dark forces?” Get out, you infernal bastard!»

If you remember the symptoms of thinking disorders, it will be the primary systematized delirium. That is, this is not an interpretation of what the voices whispered (which, by the way, does not happen with paranoia), and not an attempt to justify their depressive state (“This is me for being so spiritless, incompetent, invertebrate and sometimes arthropod”). This delirium crystallizes by itself: here the person something there to itself thought, suspiciously looked sideways, and suddenly: “Eureka! I know who killed John F. Kennedy and — not to get up twice-Laura Palmer! And about microchips, which stamps the order of masons, too, I know! And who does not know — a sucker. And who is the word of the cross say the Mason chipsaway”.

The content of delusional ideas can be very different-invention, greatness (well, or at least special significance), jealousy, persecution, hypochondriac.

For the first time paranoia was identified as a separate disease in 1863 by K. L. Kalbaum, stressing that this mental disorder primarily affects the mental activity.

It is customary to distinguish between acute and chronic paranoid syndrome.

Acute paranoid syndrome usually occurs in the form of an attack. It dawns on a person: this is it! From this point on, everything that happens around is interpreted in favor of the idea that had the honor to overshadow the patient. “Cars at the entrance? Yes, they did it on purpose: the color scheme, the numbers, and the selection of brands-all to one, all to my intergalactic coronation. The birds out there are also not just flying — rehearsing a festive flight. No, holiday emptying is not included in the script, it is, the cost of rehearsal. The police look clearly with a touch of obsequiousness — well, clear stump, the Emperor is known and appreciated.” The systematization of delusions in acute paranoid syndrome is usually shallow — so, General sketches. That is, the list of vassal planets and peoples, most likely, will not be. As well as a list of personal achievements and special signs confirming the claim to the throne. “The king, just the king. Very pleasant. My dears.” But the mood corresponding to delirium is Yes, it is in abundance.

Chronic paranoid syndrome is characterized by both the duration of the course — months and years — and the nature of delusions. They are more detailed, they are built in a clear delusional system with a lot of details and evidence (albeit on a curved logic, but no less tooth-crushing). If this is delirium of persecution — then with a clear description: who, why, what he did, what he wants. If the delirium of jealousy-with a list of lovers, timing of events and interpretation of each delay in the Elevator, the store or (God forbid) on someone’s birthday, as well as an inventory of underwear: in this she goes to the neighbor below, in this to the commanding lover, and in this gives the homeless as part of humanitarian aid. It is characteristic to encapsulate delirium-by analogy with a splinter or splinter, which used to cause pain, but over time were tightened in a connective tissue capsule and bother less — that is, the delirium itself has not gone away, but the attitude towards it has become much calmer. Emotions are less pronounced, but can periodically accumulate and give affective outbursts. But the activity in the search for evidence in the fight for his innocence, in knocking on the doors and writing letters (if virulently orientation of the delirium, for example) is simply amazing. Another characteristic feature: over time, as a rule, the delusional system expands and includes all new objects. Chased by black realtors? The mayor’s office and the FSB joined them. Did the wife give the neighbor and the boss? Now she took on the service of a working hostel and a Gypsy village. The news anchor was in love and did this with his eyebrows right off the screen? Now two orchestras and a Cossack chorus so eyes and undress, even before the faithful awkward!

From facultative symptoms-as a rule, affective disorders, depending on the content of delirium: light euphoria before the coronation or jitters before the Inquisition.

The inability at this stage in the development of science to objectify hallucinations is not exactly a problem for psychiatry, but certainly a factor that creates discomfort in the sirloin. Again, the flag, the drum and the anchor opponents. Say — and how to verify the authenticity of complaints? What if the patient made a pathognomonic [43] gray gelding error in relation to the truth? Perhaps one day we will objectify hallucinations. The main thing is not to regret what he did.

Hallucinosises. Their main, predominant, obligate symptom is hallucinations. These can be either true or pseudo-hallucinations, with localization in any of the analyzers: visual, auditory, olfactory, tactile-as well as in any combination. The difference between hallucinosis and delirium and oneiroid is that the mind in hallucinosis is not clouded, and the patient is always aware of who he is, where he is and when he is. The difference between hallucinosis and paranoid syndrome is that in hallucinosis, although delirium may be present (secondary, sensual-the psyche must at least somehow justify what the patient sees, hears or smells!), but it does not dominate, but only accompanies hallucinations, being an additional, or optional, symptom. Actually hallucinations as a symptom were already considered above in the section of disorders of perception. As for the classification of hallucinations, they are usually divided as follows.

Adrift:

Acute hallucinations. Occur suddenly, acutely; the influx of hallucinations is accompanied by fear, anxiety; the patient does not find a place, rushes, tries to do something or at least hide.

Chronic hallucinations. As a rule, very long, can stretch for years. They are either continuous or undulating. The emotions that accompany chronic hallucinosis are usually not as vivid as in acute hallucinosis, since the patient has time to get used to hallucinations, but when the hallucinations increase, at their peak, they can be quite intense.

Residual hallucinosis. They in some cases end acute psychosis of any origin, accompanied by delusions and hallucinations. At the stage of residual hallucinosis, delirium stops, there are only auditory (in the vast majority of cases) hallucinations, to which the patient has already formed a criticism, that is, he understands that he hears not neighbors, not Metatron and not devils, but a product of his own psyche. Further, as a General rule you should recovery. Or at least remission.

By the form:

Verbal hallucination. It is based on auditory hallucinations, or “voices”. The voice can be one or several, they can sound from anywhere: from the next apartment, from passing cars, from the moon, from the Kremlin (not to be confused with the new year’s address of the President). If these are pseudo-hallucinations, then the voices are more often heard in the head, felt as induced, made, or resemble sounding thoughts — but voiced so that the usual mental monologue or dialogue that a person conducts quietly with himself, in comparison with them is much more silent, pale and indistinct. Although the patient may often find it difficult — whether he caught his own thought or it was a hallucination.

Visual hallucination. It is manifested by the influx of visual hallucinations — both single, for example Cheburashka in the refrigerator, and multiple, sometimes resembling a separate stage production, only for one viewer and, for his convenience, right around him. In this case, the characters can be so bright that it is impossible to distinguish them from the real ones. Put pressure on the eyeball, you say? Well, at the next visit of the Prince of Darkness with his infernal dance you can do so, it will amuse them very much.

As particular variants, the following types of visual hallucination can be distinguished:

Van Bogart’s visual hallucinosis, which occurs in leukoencephalitis. It is characterized by increased drowsiness, i.e. sleep attacks that can not be fought, and in the intervals between sleep there are colorful visual hallucinations in the form of brightly colored animals, butterflies, fish, and all this-against the background of increasing anxiety, anxiety, they say, what kind of jungle in the ward?!

Peduncular hallucinosis, hallucinosis or Lermitte. It occurs when the brain stem is affected in the area of the third ventricle and legs of the brain (hence the name: pedunculi in Latin — “legs”): hemorrhage, tumor — or due to other causes. In this case, hallucinations usually occur in the evening and have the appearance of something small, kaleidoscopic and nimble-like a dance of cockroaches or a military parade of mice-saboteurs. At the same time, the patient perceives such hallucinations quite calmly and distantly, fully aware that they are more hallucinations than the machinations of imperialism. Other types of visual hallucinations (Pic, Charles bonnet) [44] are mentioned in the section symptoms of perception disorders.

Tactile hallucination. Presented, respectively, tactile, or tactile, hallucinations. One of his private options — the so-called dermatozoic delirium Ekboma, in which the patient (usually elderly) feels crawling on the skin and under the skin of insects, worms, bugs, and further on entomological reference, why it is restless, saddened and obsessed with hatred for oborzevshim arthropods and others like them. It is also found in cocaine and amphetamine intoxication.

Olfactory hallucination. The smells that the patient thinks are overwhelmingly unpleasant, although there are exceptions. But most often it smells of decay, decomposition or perceived as a poison gas. A special variant is Gabek’s olfactory hallucinosis, in which the patient (usually older than 40 years) believes that he does not just smell unpleasant, but actually stinks and reeks, in connection with which attempts are made either of a palliative [45] nature, like deodorants and perfume in megadoses, or radical-like suicidal attempts.

By reason of occurrence, or by etiology:

In General, there can be a lot of reasons, but as a separate unit it is accepted to allocate alcoholic and atherosclerotic hallucinosis.

Alcoholic hallucinosis, in contrast to alcoholic delirium, occurs: a) without clouding of consciousness and b) is exhausted by auditory hallucinations. It lasts for weeks and months and often turns into a chronic form, and this is for years.

Atherosclerotic hallucinosis is more common in women. Hallucinations — both visual and auditory-have long been criticized, and they are perceived as hallucinations, with a degree of fear or irony, depending on the mood. As the atherosclerotic changes deepen, with the increase of dementia, the criticism of hallucinations disappears, and they become an alternative reality for the patient.

In addition to secondary sensory delirium, facultative symptoms in hallucinosis are represented by affective disorders — most often depressive and subdepressive, as well as anxiety and fear.

Paranoid syndrome

Delirium in paranoid syndrome, being a mandatory, obligate symptom, is not as clearly systematized as in paranoid, and is not necessarily represented by any one idea (monoidea). If for a paranoid syndrome with delusions of poisoning, for example, the poisoner-one and uses strictly so-and-so, then for a paranoid number of well-wishers can be represented by all the numerous Medici family.

In most cases when paranoid syndrome delusion is in the nature of persecuting (from lat. persecutio-persecution) – this either brad relations (when seems, that surrounding as something not so look, something not the think and at all are happy would strangle, Yes nurture not allows), either brad special meaning — when all in surrounding environment not simply so, it specifically so rigged, to hint patient. Ah, you understood, about than; either brad impact — on choice, ranging from witchcraft on insidiously stolen hair and ending secret; either delirium of poisoning (you can make a list of poisons yourself), or actually delirium of persecution, when the forces of evil and the government moved from hints to fighting (well, or at least conceived the capture of the patient in order to do something purely unnatural).

Hallucinations under this syndrome-true or false, more often auditory, but can be represented and in the form of smells; or instead of hallucinations can be present senestopatii-there prickled, here gurgled, and here is in this place bites and chomps. The main thing that unites such hallucinations is the correspondence to the content of delirium: if you poison with gas, you will feel the smell, if you are affected by rays or witchcraft — there will be a burning or malaise, and the voices in delirium will not sing “many years” at all. From facultative symptoms — more often affective (of which, again, more often depressive than manic, affect, which is understandable — after all, it is clearly not to give a medal for exemplary behavior, and often poisoned still not laughing gas), anxiety, fear, insomnia.

For — acute, subacute or chronic.

Kandinsky-Clerambault Syndrome

The syndrome got its name from the names of two psychiatrists who described it: V. H. Kandinsky and G. de clerambault. The basis of this syndrome is a triad:

1) hallucinations (and more often-pseudo-hallucinations);

2) delusional ideas (usually-harassment and / or exposure);

3) the phenomena of mental automatism.

What is meant by mental automatism? These are phenomena of mental activity of the person (in this case it is more appropriate to speak-the patient), which he perceives and regards as spontaneous, arising and proceeding in addition to his desire and will, often with the feeling that they were “made” for him from somewhere outside. What is very important, the patient perceives these thoughts, actions, feelings as alien, not belonging to him: not just the hand with the ax twitched-it pulled the devil. Criss-cross. And so thirteen times.

Often, by the way, the basis of delirium lies just an explanation of where such control could come from, the impact. Sources are very different — from representatives of pandemonium to angels and directly to the Creator (in this connection, the statement that someone’s hand was directed by the Lord himself is perceived by a psychiatrist with a lively professional interest), from elementary radio transmitters to the most complex psychotronic emitters with torsion generators and noospheric control.

What greatly disturbs and even frightens the patient is that his ” I ” in connection with such influences and control from the outside is not what it used to be. It is no longer perceived as simple and complete as before. It no longer has those reliable walls, the armor that protected the cozy world from prying eyes and encroachments.

In total it is accepted to allocate three variants of mental automatism:

1) sensory (sensory, senestopathic);

2) associative (ideative);

3) motor (kinesthetic, motor).

And two more options:

hallucinatory and delusional.

And, a little apart — Capgras syndrome.

Now more about each of them.

Sensory automatism. He’s senestopathic. Why? But because of the unusual sensations (remember the definition of a senestopatii) that someone deliberately causes the patient. And this peristaltic wave, from the esophagus to the rectum and back, is all of THEM. And the delay of the chair-too, customs did not miss THEM. And this burning sensation on the skin is special. And cold. And the skin tightens — this is THEIR special device.

Associative, or ideational, automatism. Here moderation and all sorts of other enemy manipulations concern thoughts and images, as well as emotions. This is an influx of thoughts, or mentalism — when no one asked them, and did not want to think about it at all, but they will rush, as they begin to think!

• An open thoughts, it is a blockage, or sperrung: thought and thought — and all plugging, then I do not think even through enormous effort of will and incentive autopedia;

• putting thoughts in your head. Do not delude yourself, useful, as a rule, do not invest;
• extracting thoughts from the head, weaning them from the patient, robbing him: “what did I want to think about? Damn, I already thought, but these scoundrels again all far-fetched stolen»;
• symptom of “openness of thought”: “Everyone knows what I’m thinking, all my thoughts are open, like a book, that’s just the plot is pumped up and the presentation is such that the teacher of literature would be suicidal on the second paragraph»;

• a symptom of “the echo of thoughts”. “That’s why you repeated what I thought? On purpose? Mimicking? Or can you just repeat my thoughts aloud after me?»;

• imposed, evoked emotions: “it Is not I who laugh or cry, but I who Express myself in this way, an anonymous vile person»;
• “unwinding of memories”: “I do not want to, but they are read from me, and I become an involuntary witness to it.”

Motor, aka motor, or kinesthetic, automatism. It concerns actions and movements that the patient does not perceive as his own, taking the role of a doll, a puppet, a robot. It is not he who walks, moves his arms and legs — it is he who is controlled. Even if you can’t see the threads going up, you can’t see the control hand from an obscene place, you can’t see the operator with the remote control-that doesn’t mean anything! It means that they manage more subtly and imperceptibly. Yes, and someone else speaks for him, too. Yes, and someone else said that, too, so please, no offense.

The hallucinatory version of the Kandinsky-clerambault syndrome implies that the leading symptom in it is hallucinations. They are the main part of all the symptoms in this case, and the delirium and phenomena of mental automatism only complement and color the picture.

In the delusional version, respectively, in the first place and in importance, and in terms of symptoms is delirium: persecution, possession or possession, exposure. Hallucinations and elements of mental automatism are not so pronounced, but they are present.

Capgras. The main symptom is a violation of recognition of people: relatives, friends, relatives, just well-known. No, no, the fact that you did not recognize a classmate, so that he was already rich-this in itself is not a symptom, you could just forget it for a few years. It’s a little different: you are sure that you know perfectly well what the real ones look like, and these are duplicates, and not extra — class. “What are you saying? It’s not them — it’s just disguised doppelgangers. Yes, the actors were picked up. And the one over there does not play well at all, you can immediately see that there are not enough personnel in the bodies. But this is worse: physically it is he, and the spiritual stuffing was taken out and instilled some demon. Get out, you bastard.” The opposite happens when the patient begins to “recognize” strangers. “Yes, Yes, this one owes me and hasn’t given it back for a month. Yes, and don’t pretend you don’t know me! And that beauty over there… you know. And also sees as if for the first time, here after all this… as it… from a family of sturgeon, here!”There is a symptom of Fregoli, when, according to the patient, he is pursued by the same people who constantly change their appearance so that he does not recognize them. They say they have a whole Arsenal in store – from false mustaches to inflatable busts of number five, plus plastic surgeons-virtuosos in the van escort, so figs relax…

Paraphrenic syndrome

Paraphrenic syndrome is a kind of culmination in the progress of all hallucinatory-delusional symptoms in the patient. Of all the series of hallucinatory-delusional syndromes, the most vivid and memorable. It was first described in 1913 by Emil Kraepelin [48], giving it the name paraphrenia (from Greek. para — in this context “without”, and phren-mind) and highlighting several of its variants.

What does paraphrenic syndrome include? Almost everything that was found in previous hallucinatory-delusional syndromes:

• hallucinations; of the phenomena of mental automatism; delusions.

Paraphrenic delirium has several important differences. For all its diversity it has characteristic features:

• it is, as a rule, delirium of greatness, it is fantastic, bright, magnificent and monumental. The vast majority of Napoleons, emperors of countries and galaxies, illegitimate children of oligarchs and secret owners of oil rigs in addition to the average drug cartel-just such patients. Minus Bonaparte himself, the emperors of the countries and further down the list — but only on presentation of strong evidence (oil in a three-liter jar and poppy-hemp bouquet are not considered). This may be the nonsense of reformation, and only on a global scale-like exclusive rights to know the last word of the Lord, which all in this world will end. This may be the delirium of persecution — but such that it must be at least a wild hunt. Well, Goblin counterintelligence would do, too. But to chase, plot, complete and final Apocalypse for a couple of regions and millions of victims!

These are retrospective interpretations: the patient explains all the facts from his own life based on his delirium. Why was I born on such and such a date? At the behest of the intergalactic Imperial Alliance. Why in Big Hangovers? For the purpose of conspiracy-hidden from the galactic lumpen proletariat. Why did the Scion of the Imperial family allow a morganatic marriage with a person from a neighboring village? Not morganatic, but very dynastic, you don’t understand anything. She also actually of the Imperial kind, just the fall from the star to the barn her lost memory;

• these are confabulations, or false memories, subject to the same delusional ideas. “What kind of construction battalion? No, I spent two years on the far reaches of the constellation Cancer. No, I didn’t winter and didn’t freeze anything. Kept watch, protected the Galaxy from the invasion of the red intelligent mold. Even the order has received, in all wall, only it is impossible to see to the simple person in any way»;
• this is false recognition. “Are you sure you know your companion well? Really? And that she runs an underground brothel for alien minorities? That’s it. Oh, and there’s one of them going. He’s just a customs officer encrypted, so it’s easier to smuggle contraband.”

Downstream distinguish:

• acute paraphrenia;
• chronic paraphrenia.

For acute paraphrenia, in addition to acute development and relatively rapid flow, is characterized by affect-bright, pronounced, ranging from anxiety-depressive to manic, with a touch of euphoria and even episodes of ecstasy. Delirium is unsystematic, its plot arises suddenly, under the influence of the current moment, and can easily change. As one of the variants of false recognition, which, by the way, in acute paraphrenia is more common than in chronic, may take place delirium intermetamorphosis: the patient will assure you that a whole group of friends (not one, not two, as in the symptom of Fregoli, but many) – this is not who they say they are. They are changelings. Or parasites in other people’s bodies. Or astral universes and masters are expelled. In short, humanity is in danger. Delirium of special significance — “the sun is slightly dimmed for me today, thank you” – is also more common in acute paraphrenia.

For chronic paraphrenia is characterized by a more systematic and stable, without any noticeable changes in the plot delirium. More often-greatness. The affect is more scanty and even: “Well, I am the king, the king. Very pleasant. My dears. You don’t have to bend the knee.” The relevance of experiences is much less pronounced than in acute course.

Variants of paraphrenic syndrome were described by Kraepelin. This:

• systematized paraphrenia, when systematized ideas of greatness, ideas of persecution, antagonistic delirium prevail (two opposing camps-say, angels and devils-fight to the death for the possession of his immortal soul. And a recipe for hopless moonshine);
• unsystematic paraphrenia-corresponding to acute paraphrenia;
• hallucinatory paraphrenia — when it is in the foreground there is an influx of verbal hallucinations or pseudo-hallucinations. They can praise, sing Hosanna, and carry the good news that there is no Fig to wait for, the Messiah is already here — and then the patient is most reasonable to expect delirium of greatness. They can divide into groups and call each to itself (not to be confused with election platforms), then, most likely, delirium will be antagonistic. They can and a lot of nasty things to say and to promise, then it makes sense to expect the patient has delusions of persecution;
• confabulatory paraphrenia. With it, the leading symptom will be confabulations, and the patient will suddenly remember where he buried a Golden woman (mother-in-law does not count) or lost an oil rig. And yet-tormented by stories of titled relatives who sleep and see him, dear, on the carpet arm in arm with the Princess. And screams, screams in his sleep…

In addition, the group of paraphrenic syndromes can be attributed to the syndrome (aka delirium) Cotard, described by the French psychiatrist J. Cotard in 1880. Its other name is melancholic paraphrenia. It is characterized by nihilistic-hypochondriacal delirium (especially for the hypochondriac version of this syndrome) and depressive delirium with ideas of the destruction of the world (for the depressive version). In both cases, the patient himself becomes the center of all events: this is his spinal dryness, continuous scabies, gangrene of all the viscera and complete replacement of the brain with alveococcus. This is because of him in the world of financial crisis, global warming, smoothly passing into the ice age, nuclear war and the flood – so, polirnut for sure, so that certainly no one survived. Well, in General, the mood is not to hell.

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.

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.

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.

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.