Pathopsychology studies the regularities of disorders of mental activity in comparison with the course of mental processes in the norm.

Pathopsychology is a branch that explores mental disorders using experimental methods.

Psychopathology is a branch of clinical psychiatry that is devoted to the description of mental symptoms and syndromes (talk and observation).

According to its goals and practical tasks to be solved, pathopsychology is aimed at providing specific practical assistance to clinicians dealing with mental disorders in various mental disorders.

Pathopsychology, like any other branch of psychology, studying the psyche, has its own specifics, since its subject is not just the psyche, but the psyche, disturbed by one or another mental disorder. The most complete and accurate definition of the subject of pathopsychology was given by B.V. Zeigarnik: “Pathopsychology as a psychological discipline proceeds from the patterns of development and structure of the psyche in the norm. She studies the regularities of the disintegration of mental activity and personality traits in comparison with the regularities of the formation and course of mental processes in the norm, she studies the regularities of distortions of the reflective activity of the brain.

Pathopsychology, considering mental disorders, qualifies psychopathological phenomena in terms of modern psychology, using a categorical apparatus common to all branches of psychology. Pathopsychology, being a branch of psychology, uses the entire arsenal of methods accumulated by psychological science, and experiment occupies a leading place among them. Due to the specifics of the subject and the practical problems it solves, we can say that pathopsychology is an experimental science. In pathopsychology, a great deal of experience has been accumulated in the experimental study of the psyche of patients, and this experience is very useful for psychopathology.

Modern systems approach to the study of mental disorders requires their comprehensive consideration, so the data of the clinical analysis should be supplemented by the data of the pathopsychological study. Therefore, in recent years, there has been a clearer trend towards the convergence of the practice of studying mental disorders in psychology and psychopathology: clinicians are increasingly using psychological experimental methods of research, and in pathopsychology (and clinical psychology in general) a significant role is assigned to the descriptive approach.

Pathopsychological examination is aimed at solving the following problems:

1. Dif. Diagnosis of mental illness (observation, conversation, anamnesis ...) diagnosis has extremely serious consequences for the individual.

differential methods. Diagnostics: in 99% according to the results of the implementation of experimental methods aimed at studying cognitive processes. Extremely rare personality questionnaires and questionnaires (they lie, suffer from cognitive disorders). Sometimes projective methods are used

1. Assessment of the severity of cognitive and emotional disorders.
2. Evaluation of the dynamics of cognitive and emotional disorders in the process of treatment and rehabilitation.
3. Solving the problems of forensic-psychological and medical-labor examination.

2. History of the development of pathopsychology

The history of pathopsychology is connected with the development of psychiatry, neurology and experimental psychology.

At the end of the XIX century. psychology began to gradually lose the character of a speculative science, in its research methods of natural science began to be used. The experimental methods of W. Wundt and his students penetrated into psychiatric clinics - into the clinic of E. Kraepelin, into the largest psychiatric clinic in France in the Salpêtrière, where P. Janet held the post of head of the laboratory for more than 50 years; experimental psychological laboratories were also opened in psychiatric clinics in Russia - in the laboratory of V. M. Bekhterev in Kazan, then in the laboratory of V. F. Chizh in Yuryev, I. A. Sikorsky in Kyiv, etc.

Pathopsychology as an independent branch of psychological science began to take shape at the beginning of the 20th century. So, in 1904, V. M. Bekhterev wrote that the latest advances in psychiatry were largely due to the clinical study of the patient’s mental disorders and formed the basis of a special section of knowledge - pathological psychology; it has already helped to solve many psychological problems, and in the future, most likely, it will provide even more help.

It was in the works of V. M. Bekhterev that the most clear ideas about the subject and tasks of pathopsychology at the initial stages of its formation were contained, namely, the study of abnormal manifestations of the mental sphere, since they illuminate the tasks facing the psychology of normal people. Courses in general psychopathology and pathological psychology were taught at the Psychoneurological Institute organized by V. M. Bekhterev. In the literature of those years, it is referred to as "pathological psychology."

In one of the first generalizing works on pathopsychology, "Psychopathology as applied to psychology," the Swiss psychiatrist G. Sterring wrote that a change in one or another constituent element as a result of an illness mental life makes it possible to find out in which processes it takes part and what significance it has for the phenomena of which it is a part.

In the 20s. 20th century works on medical psychology by well-known foreign psychiatrists appear: "Medical Psychology" by E. Kretschmer, which interprets the problems of decay and development from the standpoint of constitutionalism, and "Medical Psychology" by P. Janet, in which the author dwells on the problems of psychotherapy.

The development of domestic pathopsychology was distinguished by the presence of strong natural science traditions. IM Sechenov attached great importance to the convergence of psychology and psychiatry. However, the founder of the pathopsychological trend in Russia was not I. M. Sechenov, but V. M. Bekhterev, who organized extensive experimental psychological studies of mental disorders.

The representative of the reflex concept, V. M. Bekhterev, expelled introspection from the sphere of science, declaring the only scientific method objective.

In the works of the school of V. M. Bekhterev, rich concrete material was obtained on the features of associative activity, thinking, speech, attention, mental performance in different categories of patients compared with healthy people of the appropriate age, sex and education.

The principle of qualitative analysis of violations of psychological activity, adopted at the school of V. M. Bekhterev, has become a tradition in Russian psychology.

V. M. Bekhterev, S. D. Vladychko, V. Ya. Anifimov and other representatives of the school developed many methods for the experimental psychological study of the mentally ill, some of them (the method of comparing concepts, defining concepts) were among the most used in Soviet pathopsychology .

The requirements for methods formulated by V. M. Bekhterev and S. D. Vladychko have retained their significance for modern science:

Simplicity (to solve experimental problems, subjects should not have special knowledge and skills);

Portability (the ability to study directly at the patient's bedside, outside the laboratory environment);

Preliminary testing of the technique on a large number of healthy people of the appropriate age, gender, education.

A prominent role in determining the direction of domestic experimental psychology was played by a student of V. M. Bekhterev - A. F. Lazursky, head of the psychological laboratory at the Psychoneurological Institute founded by V. M. Bekhterev, organizer of his own psychological school.

The scientist made a great contribution to the development of the methodology of pathopsychology. A natural experiment developed by him for the needs of pedagogical psychology was introduced into the clinic. It was used in organizing the leisure of patients, their occupations and work activities.

A significant stage in the development of pathopsychology was the work of G. I. Rossolimo "Psychological profiles. A method for the quantitative study of psychological processes in normal and pathological conditions", which became widely known in Russia and abroad. This was one of the first attempts at test research: a system was proposed for examining mental processes and evaluating them on a 10-point scale.

In 1911, a book by A. N. Bernshtein was published, devoted to the description of the methods of experimental psychological research; in the same year, F. E. Rybakov published his Atlas for the Experimental Psychological Study of Personality. Thus, by the 20s. 20th century a new field of knowledge began to take shape - experimental pathopsychology.

The development of ideas about pathopsychology in the post-revolutionary period

An important role in the development of pathopsychology as a certain field of knowledge was played by the ideas of L. S. Vygotsky on objective activity, which were later developed in general psychology by his students and colleagues: A. N. Leontiev, A. R. Luria, P. Ya. Galperin , L. I. Bozhovich, A. V. Zaporozhets and others.

L. S. Vygotsky expressed the theses that:

The human brain has different principles of organization than the animal brain;

The development of higher mental functions is not predetermined by the morphological structure of the brain alone; mental processes do not arise as a result of the mere maturation of brain structures, they are formed in vivo as a result of training, education, communication and appropriation of the experience of mankind;

The defeat of the same areas of the cortex has different meaning at different stages of mental development.

L. S. Vygotsky laid the foundation for the study of the decay of thinking with his experimental research.

Following the tradition of V. M. Bekhterev, V. N. Myasishchev strove for a combination of psychiatry and psychology and the introduction of objective methods for examining patients in psychiatric clinics. Techniques for objective registration of the emotional components of a person's mental activity were developed; The electrocutaneous characteristic of a person (ECC) recorded with a galvanometer was used as an objective indicator.

A number of works were devoted to the analysis of the structure of the labor activity of patients. On the basis of these studies, V. N. Myasishchev put forward the thesis that a violation of working capacity should be considered as the main manifestation of a person’s mental illness and that the indicator of working capacity serves as one of the criteria mental state sick.

During the years of the Great Patriotic War pathopsychologists got involved in the rehabilitation work in the neurosurgical hospital. Disorders of mental activity and their recovery become the subject of pathopsychological research.

The data of S. Ya. Rubinshtein, B. V. Zeigarnik, A. R. Luria on the structure of reading, writing, and thinking disorders in patients with vascular pathology, Alzheimer's disease, and the consequences of brain injury made it possible to substantiate the following point of view: mental illness proceeds according to biological patterns that cannot repeat patterns of development. Even in those cases when the disease affects the youngest, specifically human parts of the brain, the psyche of a sick person does not acquire the structure of the psyche of a child at an early stage of his development. The fact that the patient cannot think and reason at a high level indicates the loss of complex forms of behavior and cognition, but does not mean a return to the stage of childhood. That is, the disintegration of the psyche is not a negative of its development. Different types of pathology lead to qualitatively different patterns of decay.

The most important ideas of L. S. Vygotsky were developed in the works of A. N. Leontiev, who was especially careful in developing the problem of activity. He formulated the following basic principle: internal mental activity arises in the process of interiorization of external practical activity and has the same structure as practical activity. Thus, by studying practical activity, we learn the patterns of mental activity. This provision played a huge role in the development of the methodology of pathopsychology. B.V. Zeigarnik repeatedly pointed out that it is possible to understand the patterns of mental activity disorders only by studying the practical activity of the patient, and to correct mental activity disorders by managing the organization of practical activity.

Another theory that played an important role in the development of pathopsychology is the theory of relations by V. N. Myasishchev, according to which a person's personality is a system of relationships with the outside world. These complex relationships are expressed in his mental activity. Human relations in a developed form are a system of individual, selective, conscious connections of a person with various parties objective reality.

Mental illness changes and destroys the existing system of relationships, and violations in the system of personality relationships, in turn, can lead to illness. It was through such contradictory relationships that V. N. Myasishchev considered neuroses.

The development of ideas about pathopsychology in the modern period

One of the leading problems in the field of pathopsychology is the problem of disintegration cognitive activity. Work in this area is carried out in different directions: changes in the personality component in the structure of disorders of cognitive processes are being studied, the question of the relationship between disorders of cognitive processes and the process of updating knowledge is being developed. Another line of research is aimed at psychological analysis personality disorders observed in a psychiatric clinic.

Recently, pathopsychological research in experimental practice has expanded significantly: forensic psychiatric and labor.

The problem of labor and social rehabilitation now attracts the attention of representatives of various specialties; the network of laboratories for the restoration of both individual dysfunctions and the working capacity of sick people is expanding. The participation of psychologists is becoming not only necessary, but often the leading factor in both the rehabilitation sphere and the prevention of mental illness.

Pathopsychological research in children's neuropsychiatric institutions has received particular development. Techniques are being developed to facilitate the early diagnosis of mental retardation; analysis of complex pictures of dementia and underdevelopment in childhood is carried out in order to search for additional differential diagnostic signs and symptoms; on the basis of L. S. Vygotsky's position on the zone of proximal development, a number of teaching experiment methods are being developed aimed at identifying prognostic important signs of children's learning ability (psychological laboratory of the neuropsychiatric hospital No. 6).

Along with research work, a lot of work is being done to develop and test research methods. The growth of research and practical work in the field of experimental pathopsychology also manifests itself in the fact that in the scientific societies of both psychologists and psychiatrists and neuropathologists there are sections that unite and coordinate research in the field of pathopsychology. At the all-Union congresses of psychologists, the reports of pathopsychologists were widely presented, which concentrated around the following problems:

The value of pathopsychology for the theory of general psychology;

Compensation problem;

The problem of pathopsychology of thinking and personality.

M. M. Kabanov, Yu. F. Polyakov, V. V. Nikolaeva, V. M. Kogan played an important role in the development of pathopsychological research in different years. Pathopsychological research in children's neuropsychiatric institutions has received particular development. Techniques are being developed that contribute to the early diagnosis of intellectual disorders, the identification of additional differential diagnostic signs of mental illness in children, methods of psycho-correctional work (S. Ya. Rubinshtein, V. V. Lebedinsky, I. Λ. Korobeinikov, Λ. Ya. Ivanova, A. S. Spivakovskaya).

3. The main problems hindering the development of domestic pathopsychology in present stage

1. An outdated psychodiagnostic tool (developed in the 30-60s of the XX century). extreme conservatism of the psychiatric system
2. Lack of integration with foreign clinical psychology: methodological and ideological differences
3. Lack of introduction of modern cognitive sciences into neurophysiology (?)

Questions

What does pathopsychology study?

Pathopsychology is a branch of psychological science related to applied areas of knowledge. The subject is the study of the regularities of the disintegration of mental activity and personality traits in comparison with the regularities of the formation and course of mental processes in the norm, the study of the regularities of distortion of the reflective activity of the brain. The object is mental disorders, mental anomalies that combine a wide range of neuropsychic abnormalities, diverse in clinical manifestations, severity and nosological nature, but common in terms of a shallow level of mental disorders bordering on the areas of normal and health.

Correlation of pathopsychology with other disciplines

First of all, it is necessary to say about the sciences that played a leading role in the development of pathopsychology. This is general psychology and psychiatry.

Define personality

Personality is a special systemic quality of an individual, which he acquires in the process of age development when interacting with their social environment.

Determine the basic principles for constructing a pathopsychological study

Conducting a pathopsychological study includes several stages: an experiment, a conversation with a patient, observation, analysis of the life history of a sick person (a medical history written by a doctor), comparison of experimental data with a life history.

What package of experimental methods should be used in pathopsychological studies?

For a long time, the method of quantitative measurements of mental processes dominated psychological research. This method reached its extreme expression in the test studies of Binet-Simon, which were aimed at identifying mental capacity. But this method reveals only the final results of the work, the process itself, the attitude of the subject to the task, motives, personal attitudes are not revealed. Systemic qualitative analysis This is the basic principle of pathopsychological research. It is aimed not at the measurement of individual processes, but at the study of a person performing a real activity. Namely, on a qualitative analysis of various forms of the disintegration of the psyche, the disclosure of the mechanisms of disruption of activity and on the possibility of its restoration. Pathopsychological experiment is the mutual activity of the experimenter and the subject. Therefore, its construction cannot be rigid. The main difference between such an experiment and a general psychological one is that we cannot always see the peculiarity of the patient's attitude to the experiment, which depends on his morbid condition. From this we can conclude the following: 1. Mentally ill often not only do not try to complete the task, but also misinterpret experience or actively oppose instructions; 2. The peculiarity of the pathopsychological experiment also lies in the diversity, a large number of methods used; 3. The fulfillment of experimental tasks has a different meaning for different patients; 4. In his conclusion, the pathopsychologist has to operate with a system of concepts that characterize the personality of the patient as a whole, along with the characteristics of individual processes; 5. A pathopsychological study reveals the real layer of the patient's life because the presented activity, the experimenter's remarks cause an equally real experience of the subject. Usually, 89 methods, selected in accordance with the objectives of the study, are sufficient to examine one patient. In the course of the study, the methods are usually applied from simpler to more complex (with the exception of patients with expected aggravation or simulation).

How do theory and the results of empirical research in pathopsychology correlate?

As a rule, mental illness is caused by pathology of the brain and manifests itself in the form of disorders of mental activity. Mental illnesses are classified as gross reflection disorders. real world with behavioral disorders (psychosis), and milder changes in mental activity (neurosis, psychopathy, some types of affective pathology). The causes of mental illness are internally conditioned (endogenous) and externally conditioned (exogenous). The former are determined mainly by constitutional and genetic factors - these are, for example, schizophrenia and manic-depressive psychosis. The latter are due to the influence of the external environment - such as alcoholic or infectious psychoses, traumatic epilepsy, etc.

What characterizes such a violation of the state of consciousness as stunning?

Stunning - its pronounced degree borders on stupor (complete switching off of consciousness with the preservation of unconditioned reflexes), however, the patient manages to “stir up” and he comes to a short time into consciousness. In the absence of strong stimuli from the outside (energetic shouting, shaking), the patient again plunges into hibernation. After recovery from severe stunning, amnesia for the period of impaired consciousness is almost complete. With an average degree of stupefaction (somonolence), drowsiness is less deep; the patient does not speak, but answers questions, although with a considerable delay; comprehension of the environment is disturbed, and partial amnesia is observed during recovery. With a lighter stun (obnubilation) there is a slight darkening of consciousness, fluctuating in intensity, with difficulty comprehending the situation, understanding the meaning of what is happening and someone else's speech, the patient is drowsy, speaks slowly and little.

name characteristics oneiroid

Oneiroid - is characterized by the predominance of influxes of fantastic visual pseudo-hallucinatory experiences in patients, reminiscent of dreams or daydreams. Patients are completely disoriented and immersed in their inner world or retain a duality of orientation. Memories of the experience remain partial, and patients usually forget real events, but remember painful fantastic experiences. More common in severe infections and schizophrenia.

What are the characteristic signs of a delirious state of consciousness

Delirium - is characterized by the predominance of influxes of bright scene-like true visual hallucinations in patients. Delirious stupefaction usually intensifies in the evening and at night, and during the day there may be periods of relative clarification of consciousness. The patient's behavior depends on the content of psychopathological products. Memories for the period of delirium after recovery remain partial. A typical example is alcoholic delirium tremens.

What is obscuration, what types of obscuration of consciousness do you know?

Qualitative disorders of consciousness are caused by a disorder (disintegration) of consciousness and its “filling from the inside” with pathological content (psychopathological products, more often hallucinatory and delusional), due to which orientation in a specific object environment is disturbed, behavior changes, and after recovery there are no or fragmentary memories of the period of stupefaction consciousness. The disintegration of consciousness is a cortical disruption of connections, i.e. more complex disorder than a simple shutdown of consciousness. In this group, delirium, oneiroid, amentia and twilight states of consciousness are most often distinguished.

What is pseudodementia characterized by?

Pseudo-dementia is an acute or subacute variant of a hysterical reaction, manifested in a kind of disorder of consciousness, in which the patient demonstrates an imaginary decrease in intelligence, corresponding to primitive ideas about dementia: senselessly bulging eyes, a “stupid” face, answers past the questions posed and actions in response to the simplest requests, the behavior of a "jolly jerk", etc. It usually occurs in situations threatening punishment or retribution. Passes without treatment.

What psychoanalytic concepts of understanding the unconscious are you familiar with?

When does the phenomenon of depersonalization occur and how is it characterized?

Depersonalization is a violation of self-consciousness, expressed by alienation from oneself. Subjectively, it is always unpleasant and can exist for a long time or manifest itself in attacks. The feeling of alienation from one's own "I" can concern both individual somatic or mental functions, and the personality as a whole. It usually only appears in adolescence. In the form of separate episodes, it can occur in healthy people against the background of overwork, excitement or lack of sleep, but most often occurs with depression or schizophrenia.

There is somatopsychic and autopsychic depersonalization. In the first case, there is a feeling of alienation of the whole body or its parts, or even their disappearance. In the second case, there is a feeling of alienation of one's individual mental functions or one's "I" as a whole. When it comes to individual mental functions, patients talk about the disappearance of feelings, report that their own speech, thoughts, or the past seem alien to them.

What are the psychological mechanisms of impaired perception

Perception is the mental process of reflecting an object or phenomenon as a whole, in the aggregate of its properties and parts. In some pathological conditions, especially in mental and nervous diseases, perceptual processes may be disturbed. However, there are such deviations of perception that can be observed in quite healthy people (for example, illusions). Perceptual disorders can be divided into three main groups: illusions, hallucinations, and sensory synthesis disorders. Illusions are a distorted perception of a real-life object or phenomenon (there are visual, auditory, tactile, etc.). Depending on the causes, there are: physical (a spoon in a glass), physiological (illusions of heels, counter-rotation) and mental (during exaltation, ecstasy, etc.). Hallucinations are perceptual disorders when a person, due to a mental disorder, sees, hears, feels something that does not exist in reality (there are also visual, auditory, olfactory, etc.). There are true hallucinations - they unfold in real space and pseudo-hallucinations - there is no complete sensory-bodily clarity of images (I "seem" to see ...) Sensory synthesis disorders - a violation of the integration of sensory information (derealization - the loss of a certain property of reality (decrease, increase) and disorders " body schemes" - a violation of the perceptions of one's body (weight, organs)).

What tests can check the features of the patient's perception?

Perceptual disturbances are revealed especially clearly when situational pictures are exposed. In addition to the fact that patients do not catch the plot, they also show a number of other characteristic phenomena. Not understanding the meaning of the plot, they often describe individual objects without seeing their plot connection. Separate parts of the drawing merge, mix with the background, images of objects are not recognized. The object of recognition is determined by the part of the picture on which the patient fixes his attention. So, the patient calls the mushroom a tomato, if the head of the mushroom appeared as part of it, or he sees a cucumber in the mushroom, if he fixes attention on its stem. Therefore, when a drawing is presented to the patient, it is often indifferent: they show him a part of it or the whole.

What diseases cause impaired perception?

In the literature on psychopathology, there are descriptions of the following perceptual disorders: hyperesthesia / hypothesia (increasing / weakening perception by strength); anesthesia (loss of sensation), depersonalization (disorder in self-perception), loss of complex feelings; distorted perception of the surrounding world (for example, “déjà vu”), illusions, hallucinations, etc.

Patients with neuroses and neurosis-like states have disturbances in pain sensitivity - for example, increased pain sensation, the so-called "psychogenic" pains. In patients with schizophrenia, difficulties in recognizing objects are mostly associated with the apato-abulic syndrome and emotional ambivalence. With psychopathy of various types, both an increase in sensitivity and rigidity and a decrease in sensitivity are observed, also with an increase in emotional tone.

Perceptual disturbances in various mental illnesses have different causes and different forms of manifestation. Great importance in violations of perception belongs to the personality factor.

What are the features of perceptual impairment in schizophrenia?

In patients with schizophrenia, difficulties in recognizing objects are mostly associated with the apato-abulic syndrome and emotional ambivalence. Despite the "intellectual" orientation of the study, the patients showed no interest in the task, did not respond to the experimenter's assessment, and did not correct their mistakes. The activity of patients is characterized by extreme curtailment, lack of search activity, which is so pronounced in the norm. The statements of the patients are extremely laconic, unemotional, and basically only generalize ascertaining some plot or subject content of the pictures: "Some kind of misfortune", "The man is thinking."

What perceptual disturbances can be observed in manic-depressive disorders?

Manic-depressive psychosis is a disease that occurs in the form of a change in depressive and manic phases, separated by states with the complete disappearance of mental disorders. This disease does not lead to personality changes and defects in the intellectual and emotional-volitional spheres. Symptoms of a manic state: disinhibition, swagger, foolishness, unrealistic aspirations and actions. There is no connection between their activities and real events in their lives.

Can there be perceptual disturbances in psychopathy?

Psychopathy is the total and relative stability of pathological character traits, expressed to a degree that violates social adaptation(a tendency to unusual behavior, a sharp unreasonable change in mood as a permanent personality trait, and not as an episode).

With psychopathy of various types, both an increase in sensitivity and rigidity and a decrease in sensitivity are observed, also with an increase in emotional tone.

How is perception impaired in organic brain lesions?

In the practice of a pathopsychologist, it is often necessary to make a diagnosis between an organic brain disease and schizophrenia. In this case, attention, memory, thinking, signs of exhaustion should be carefully examined. Working with this group requires not only knowledge in the field of pathopsychology, but also in neuropsychology.

In diseases of the brain, there are signs of increased exhaustion, memory loss, difficulty in operating with abstract concepts, figurative meaning, inertia of thinking. More accurate information for differentiating two organic diseases (for example, Pick's disease or Alzheimer's disease), the establishment of a brain lesion is obtained by using special tests from neuropsychology.

As a result of organic changes in the brain, psychopathic personality disorders, asthenic disorders, and a decrease in the level of intellectual processes are noted. Psychopathic personality disorders are characterized by a narrowing of the range of interests, some passivity, sometimes vice versa, explosive irritability and rudeness. Asthenic disorders are expressed in increased exhaustion, irritable weakness. If there is an intellectual decline, then there is a decrease in criticism, carelessness, euphoria, anger, tearfulness.

What is the clinic of perception disorders in somatogenic disorders of mental activity.?

Psychosomatic diseases are physical diseases or disorders caused by affective tension (conflicts, discontent, mental suffering, etc.). Psychosomatic reactions can occur not only in response to mental emotional influences, but also to the direct action of stimuli. Representations, imagination can also influence the somatic state of a person.

What is delirium?

Delusions are incorrect judgments and conclusions caused by the disease that do not correspond to the true state of affairs, which are not influenced by dissuasion and disrupt the patient's adaptation to the environment. Always arises on a painful basis; it stems not so much from knowledge and experience as from an internal affective-mental state. The person is covered (emotionally involved) with a false belief, although it is unacceptable for other people of this culture or subculture (i.e. this belief is not a religious dogma or superstition). Such a delusion is also called a primary delusion, during its formation one can often notice a certain phasing (delusional mood, perception and interpretation of external events, followed by "crystallization" of the delusional idea itself). With primary delirium, the patient "believes" in his ideas, he "feels" that he is right. Secondary delusions (delusional, overvalued ideas) can be explained and understood in conjunction with other psychopathological phenomena such as hallucinations or mood changes.

What variants of delirium do you know?

According to the content, four main forms of delusions are distinguished: 1) delusions with low self-esteem (self-abasement, sinfulness, physical deficiency or dysmorphomania, nihilistic delusions - the belief in the cessation of body functions, their disappearance or decay); 2) delusions with increased self-esteem (different types of delusions of grandeur, wealth, invention, etc.); 3) presecutory delusions (delusions of persecution and 4) mixed forms of delusions (Querulanism or litigation, various variants of the “double symptom”, etc.)

According to the structure, two main varieties of delusions are distinguished: unsystematized (scrappy, figurative) and systematized (interpretative delusions).

In addition, delirium can be divided into: paranoid (the patient relies in thinking on an initially false premise, but formally correct, plausible system of evidence); paraphrenic (systematized, but in its content is very unusual and is formed in close relationship with delusions of perception); paranoid (there is no longer sufficient harmony in reasoning and strict selection of facts, there are contradictions and absurdities

What is the difference between delusion and incorrect judgments?

What are the characteristics of delusions in schizophrenic disorders?

Schizophrenia is a mental illness, the causes of which are unknown, the participation of a genetic factor is allowed. Disorder of cognitive functions, speech disorders, symptoms of cattanonic, delusional, affective, neurosis-like registers, dissociative disorders personal development. Delusional fantasizing is inaccessible to correction, it determines behavior, very figuratively.

What is the manifestation of delirium in affective disorders?

Affect is a strong, violent, but relatively short-term emotional reaction to an external stimulus, which completely captures the human psyche and predetermines a single global reaction to the situation (rage, anger, horror, etc.). Delusions are incorrect judgments and conclusions caused by the disease that do not correspond to the true state of affairs, which are not influenced by dissuasion and disrupt the patient's adaptation to the environment.

Is delusion observed in psychopathy, neurosis, how do they differ from delirium in psychosis?

Psychopathy is the total and relative stability of pathological character traits, expressed to a degree that violates social adaptation (a tendency to unusual behavior, a sharp unreasonable change in mood as a permanent personality trait, and not as an episode). Psychopathy is essentially a pathology, an anomaly of character that determines the entire mental makeup of a person, leaving its imprint on his mental warehouse. Psychopathies are not exposed throughout life drastic changes and prevent them from adjusting to the social environment.

Character pathology (psychopathy) is always characterized by three features (the so-called “Gannushkin-Kebrikov criteria”): totality; stability; maladaptation. The absence of at least one criterion excludes psychopathy.

Nervoz is a functional disorder of the central nervous system, manifested in emotional disorders, behavior and neurovegetative regulation of internal organs. the cause of which is a traumatic situation, as a result of which important life relationships for the patient are violated. Neuroses fit under the definition of "borderline states" and belong to the so-called "minor psychiatry", which studies diseases outside the psychotic state. These diseases are characterized not only by low intensity, but also by short duration. The concept of “borderline states” includes prenosological neurotic disorders, clinically formed neurosis-like reactions and conditions, psychopathy, neurosis-like and psychopathic disorders in somatic diseases, etc.

Unlike psychopathy, only a part of the personality suffers in neuroses, a critical attitude towards the disease is preserved, the determining influence belongs to lifetime environmental influences.

Psychosis is a deep mental disorder that manifests itself in a violation of the reflection of the real world, the possibility of its knowledge, changes in behavior and attitude to the environment. P. develop most often after shock, super-strong mental trauma (life threat, etc.). With psychosis, there is no personal processing of psychotrauma.

What are the characteristic signs of delirium in the pathocharacterological development of personality?

Pathocharacterological (abnormal) personality development arise under the influence of chronic psychogenic traumatization, improper upbringing and other unfavorable socio-psychological factors.

What types of delusions can be observed in patients with epilepsy?

Epilepsy is a polyethological disease, the leading role is genetic factors, effects on the central nervous system. Intellectual disorders, psychoorganic syndrome, personal and neurotic reactions, psychotic disorders. Slowness, stiffness of all mental processes. As a rule, twilight clouding of consciousness occurs, after which residual (lost relevance) delirium remains, the content of which is based on fragmentary memories of the period of clouded consciousness. Brad is distinguished by concreteness, simplicity and routine content. Delusions are incorrect judgments and conclusions caused by the disease that do not correspond to the true state of affairs, which are not influenced by dissuasion and disrupt the patient's adaptation to the environment.

Features of delirium in patients with hydrocyanic psychosis.

What types of memory impairment do you know?

From childhood, the ability to memorize improves, the apogee is 20-25 years old, unchanged until 40-45 years old, then worsens. There are three main groups of memory disorders: hypermnesia, hypomnesia and paramnesia. Hypermnesia (intensification, sharpening of memory) is manifested by increased memories of past life or improved memory of current events. Hypomnesia - or dysmnesia - weakening of mnestic functions up to their complete loss. It can be general (concerns memorization and reproduction) and partial (cannot remember something at the moment or memorization is impaired). The complete loss of the ability to retain and reproduce previously acquired knowledge is called amnesia. Paramnesia is a perversion, deceptions of memory (false memories) resulting from a violation of the distribution of recalled events in time and space, distortion of previously experienced events, filling in memory gaps with conjectures and fantasies, etc.

Psychological mechanisms of memory impairment

The most common disorders of direct memory include "Korsakov's syndrome" (impaired memory for current events) and progressive amnesia (when the disorders extend to any events, and there is also a mutual overlap of events and disorientation in time and space).

With oligophrenia, semantic and mechanical memory are impaired. In epilepsy, mediated memory worsens. In these diseases, the leading role in their mechanisms belongs to personality-motivational and emotional disorders. The decrease in memory and attention in patients with neuroses often reflects internal anxiety and restlessness.

The ratio of memory impairment and attention

Attention disorders are observed in various mental and somatic diseases.

With neurosis and schizophrenia, there is a deterioration in active attention (concentration, switchability, stability). In patients with organic diseases and local lesions of the brain, repetitions of the same action, difficulties in switching, increased distractibility, exhaustion of attention, etc. are noted. In somatic patients (for example, tuberculosis, with traumatic or vascular diseases, etc.), difficulties in concentration attention, slow working out, switching difficulties, narrowing the scope of attention. With alcoholization diencephalic syndrome, there is a decrease in concentration and stability of attention. In epilepsy, switching difficulties and a decrease in the stability of attention are noted.

B.V. Zeigarnik writes that many types of attention disorders are private disorders of mental performance, which are the result of mental or somatic diseases.

Direct and mediated memory. What are the features of ratios in various diseases?

Memory is a specific form of mental reflection of reality, which ensures the accumulation, preservation and reproduction of information.

Designate research methods for various memory options

Memory is examined in the process of conversation and observation of the patient. In a conversation, you can check the preservation of memory for recent and more distant events of personal and social life, personal stock of knowledge, reproduction of dates, names of people around, and also to identify deceptions of memory. Answers to questions make it possible to judge the degree and nature of memory impairments, especially in comparison with data from observation of his behavior and materials from experimental psychological research. Memory tests are almost always included as subtests in comprehensive intelligence testing batteries. They can also be used on their own to study various characteristics memory (volume and strength of long-term, operational, visual and auditory memory). D. Wexler developed a test battery for the study of individual mnestic functions: 1) awareness orientation; 2) orientation in time and space; 3) mental control (counting down from 20, naming the letters of the alphabet, counting from 1 to forty through 3 units); 4) logical memory (reproduction of stories); 5) reproduction of rows of numbers in forward and reverse order; 6) reproduction of geometric figures; 7) reproduction of paired word associations. Ability to remember - recall read 10 simple words. Visual memory - sets of drawings, portraits. Indirect memorization - the selection of a picture that is suitable in meaning (Leontiev's method), etc.

Methods for studying memory disorders: the method of memorizing 10 words; learning stories; pictogram method; indirect memory method

Research methods and ways to correct dynamic memory disorders

Psychological Mechanisms and Clinical Phenomenology of Thought Disorders

Thinking is a mental process of reflecting the most essential properties of objects and phenomena of reality, as well as the most significant connections and relationships between them, which ultimately leads to obtaining new knowledge about the world.

Three main types of thinking disorders: 1) violations of the operational side of thinking (the ability to use the main operations of thinking is lost, most often generalizations and distractions); 2) violations of the personal (motivational) component of thinking (the regulatory motivational function of thinking is violated, its criticality with the phenomena of: 1) actualization of the latent properties of concepts, 2) "diversity" of thinking, 3) "disconnection" of thinking); 3) violations of the dynamics of mental activity (inertia or lability of thinking (either slowness or "jumping" of thoughts).

Clinical classification of thinking disorders: quantitative (disorders of the associative process) and qualitative (pathology of judgments and inferences). Pathology of the associative process: 1) Violation of the pace of thinking (accelerated or slow - by the number of associations per unit of time); 2) Violation of the mobility of thinking (detailed - the goal of reasoning goes through many side details; detailed - detailing with getting stuck on side associations, but returning to the main topic of thought; viscous - an extreme degree of thoroughness); 3) Violations of the purposefulness of thinking (resonant thinking - the goal of reasoning escapes, idle talk; ataxic-associative thinking - the complete absence of a logical connection between associations “flies with wings under water”; paralogical thinking - there is also no logic between associations, but formal logic is clearly violated; symbolic thinking - individual, incomprehensible to others symbolism). Pathology of judgments and conclusions - delusional, obsessive and dominant ideas. Nonsense - see Questions 22, 23. Overvalued ideas - based on a real, but insignificant fact that the patient overestimates and takes an undeservedly large place. Obsessive ideas - the appearance in the mind of persistent thoughts that the patient evaluates as ridiculous, but cannot eliminate them. Dominant ideas - occupies an undeservedly large place in the mind of a person - "sticking" of attention ...

Psychological, including psychoanalytic theories of thought disorders

Explain the psychological mechanisms of violation of the processes of generalization and abstraction

The distortion of generalization processes - the essential properties of objects, phenomena and the existing connections between them are not taken into account at all during the operation of generalization. At the same time, it cannot be said that the patient cannot single them out by abstraction, on the contrary, he takes extremely general signs and connections as the basis for generalization, but they are random in nature. (combining a fork, a table and a shovel according to the principle of hardness). The decrease in the level of generalization consists in the fact that direct ideas about objects and phenomena dominate in the judgments of patients; operating with general features is replaced by the establishment of purely specific relationships between objects. When performing an experimental task, such patients are not able to select from all possible signs those that most fully reveal the concept.

In what diseases are violations of purposefulness and dynamism of thinking observed?

What is the clinical characteristic of a violation of the motivational component of thinking?

The connection between a violation of thinking and a change in the motivational sphere is observed when different forms mental illnesses. Already in the analysis of that type of pathology of thinking, which we called "distortion of the level of generalization", one can, in essence, speak of a violation of the motivational component of thinking.

Significant, essential is for a person that which has acquired meaning in his life. It is not the frequency of occurrence of this or that attribute or property of an object that makes it significant or significant, but the meaningfulness, the role that this attribute played in a person's life. The essentiality of a sign and property, the significance of the object or phenomenon itself depends on what meaning they have acquired for it. A phenomenon, an object, an event can acquire a different meaning in different life conditions, although knowledge about them remains the same.

At the same time, the meaning of things, the totality of our knowledge about them, remain stable. Despite the fact that the personal orientation and content of motives may turn out to be different, the main practical activity forms the stability of the objective meaning of things.

What research methods do you know about thinking disorders?

1. Classification method - (options: classification of objects and their images, figures, concepts). Direction - the study of mental operations and the dynamics of thinking. Additional features - assessment of the pace of work, the ability to switch, features of the distribution of attention, etc.

2. The method of exclusion of objects - Characteristics of the text material. Types of possible decision errors, their psychological qualification and diagnostic value.

3. Blank methods.

4. The ratio of metaphors, proverbs and phrases - the transfer of the figurative meaning of proverbs.

5. Explanation of plot pictures - establishing the sequence of events. The need for repeated presentation during the same study. Typical mistakes of patients with various diseases.

6. The study of associations (free associations, reciprocal associations, associations by opposite).

What are the features of thinking disorders in patients with psychosis?

Lability of thinking is observed in patients with manic-depressive psychosis in the manic phase of the disease. The comprehension of the situation, the possibility of analysis and synthesis in these patients are often not impaired, however, the fulfillment of any experimental task did not evoke a definite strategy for their thinking. Patients do not think about the question addressed to them, do not delve into the meaning of the task. They act impulsively. When asked what is the commonality and difference between the concepts of "table" and "chair", one of the patients answers: "They have in common that the table and the chair have four legs, and the difference is that the chair has a back, the table does not ". When folding pictures in a sequential order, patients of this type, having comprehended the plot, lay them out in any order.

Typical characteristics of thought disorders in patients with hydrocyanic psychosis

What thinking disorders can be observed in patients with epilepsy?

A type of violation of the thought process, which is based on the inertia of the connections of past experience. In these cases, patients cannot change the chosen way of their work, change the course of their judgments, switch from one type of activity to another.

Such disorders are often found in patients with epilepsy, sometimes in patients with long-term consequences of severe brain injuries, with some forms of mental retardation.

Such patients are sometimes able to work, but they do it with frequent breakdowns, lose their previous qualifications and perform work that does not require the acquisition and use of new knowledge. The quality of their mental products is not high, the pace of work is slow.

Experimental psychological research reveals the slowness and stiffness of their intellectual processes. Even in those cases when they can generalize the material (identify the main feature in the experiment on the classification of objects, understand the conditionality of the instruction), they make erroneous decisions if they need to switch to a new way of solving the problem. Changing conditions make it difficult for them to work.

What thinking disorders are found in patients with psychoorganic syndrome?

Psychoorganic syndrome is a symptom complex of psychological manifestations of an organic lesion of the central nervous system. decrease in memory, weakening of the productivity of intellectual activity, changes in affectivity, behavioral disorders ... The insufficiency of the intellectual sphere becomes most noticeable with additional load, manifesting itself as low productivity of activity. Reducing criticism in assessing one's capabilities and behavior.

Explain the etiopathogenesis of speech disorders.

Speech is the process of verbal communication, the expression of a thought. Speech disorders can occur both as a result of congenital underdevelopment of all or individual parts of the speech system, and in various diseases, especially with lesions of the speech zones of the cerebral cortex.

Speech disorders are a wide range of psychopathological phenomena manifested in speech behavior. (speech excitation, stereotypes, pretentiousness, slowing down, disintegration of speech, uneven tempo and rhythm, “mumbling” speech, chanted speech, etc.)

Speech disorders with local brain lesions are studied by neurolinguistics (a section of neuropsychology), and speech disorders and correction with a delay in its development are studied by speech therapy (a branch of pedagogy).

What are the speech defects?

In speech therapy, the terms "speech underdevelopment" and "speech disorder" are often used for speech disorders. Speech underdevelopment - implies a qualitatively lower level of speech function or the speech system as a whole. Speech disorders are deviations from the norm in the process of functioning of the mechanisms of speech activity, which are divided into speech disorders and speech disorders. writing. Disorders of oral speech can be caused by violations of the pronunciation side of speech (phonation, external design of the utterance) and structural-semantic (internal) design of the utterance (systemic speech disorder). 1. Disorders of phonation formation of speech (dysphonia (aphonia) - the absence or disorder of phonation due to pathological changes in the vocal apparatus; bradilalia (bradyphrasia) and takhilalia (tachyphrasia) - a pathologically slow or accelerated rate of speech; stuttering - a violation of the tempo-rhythmic organization of speech, due to convulsive state of the muscles of the speech apparatus; dyslalia (tongue-tied speech) - a violation, shortcomings in the sound pronunciation of phonemes with normal hearing and preserved innervation of the speech apparatus; rhinolalia (twang) - a violation of the timbre of the voice and sound pronunciation due to anatomical and physiological defects of the speech apparatus (cleft palate, etc.). ); dysarthria (tongue-tied speech) - a violation of pronunciation without a disorder in the perception of speech by hearing, reading and writing, due to a lack of innervation of the speech apparatus. 2. Disorders of the structural and semantic design of speech (alalia (dysphasia, hearing-mutism) - the absence or underdevelopment of speech due to organic damage to speech the outer zones of the cerebral cortex in the prenatal or early period of a child's development (sometimes motor - does not pronounce words well and sensory - does not understand speech well); aphasia (loss of speech) - complete or partial loss of speech (after it has already been formed), due to local lesions of the brain (it can be sensory, acoustic-mnestic, opto-mnestic, motor, dynamic, semantic)

Disorders of written speech (dyslexia - a partial specific violation of the reading process (sometimes acoustic, optical, motor); dysgraphia - a partial specific violation of the writing process)

What are neologisms in speech, stereotypes?

Neologisms are the creation of non-existent words. Stereotypes - monotonous repetition, shouting out individual words or phrases, speech turns. In this case, the patient does not expect an answer, is not interested in the content of the statement.

What are the causes of intellectual disability?

What is the impact of the motivational sphere on the ability to work?

Reveal the impact of disability on the formation of personality

Do you take into account the presence of changes in mental capacity for work in the process of pathopsychological research?

How does the decrease in labor efficiency affect the results of corrective work?

What anomalies of the ionic-personal sphere do you know?

Emotional disorders - features of the flow of emotional processes and reactions.

Underdevelopment of emotions - the absence or small reaction to the environment; emotional lability - the instability of the emotional background, its dependence on external circumstances, frequent mood changes; emotional inadequacy - inconsistency of the main shade of mood, paradoxicality or dullness of emotional reactions; emotional coldness - lack of emotional reactions associated with interpersonal relationships; emotional coarsening - a pronounced devastation with a loss of attachment to loved ones.

Emotional disorders are usually classified as stress, crisis, frustration. According to some authors, stress can be the cause of mental illness. Euphoria, depression

Frustration is a specific emotional state that occurs when, on the way to achieving a goal that a person has outlined, there is some kind of obstacle or resistance that is either insurmountable or perceived as such. Therefore, the signs of frustration are as follows: the presence of a need (motive, goal or plan) and the presence of resistance (obstacles). In situations of frustration, a person can manifest himself either as a mature person or as an infantile one. Adaptive behavior increases motivation, increases the level of activity to achieve the goal, while maintaining the goal itself. Unconstructive or infantile behavior will manifest itself as aggression outside or on oneself, or even entail avoiding resolving a difficult situation for the individual.

A crisis is a condition that occurs when a person encounters an obstacle in life. important goals, which for some time is insurmountable using the usual methods of solving problems. There is a period of disorganization, disorder, during which many different attempts at resolution are made. Eventually, some form of adaptation is achieved, which may or may not be in the best interest of the individual. The risk of mental disorders reaches highest point in a certain crisis situation. Having overcome the crisis, a person acquires new forms of adaptation in difficult situations for him, but if the crisis drags on, mental disorders may appear. The following types of crises are distinguished: development crises; occasional crises; typical crises. In the active form of assistance, the work is carried out by the counseling and education service at the mental health centers before the onset of the crisis.

What disorders of emotional states are observed in patients with neurotic conditions?

Patients with neurosis have painful emotional-affective reactions of irritation, negativism, fear, etc., as well as emotional states(fear, asthenia, low mood, etc.) In patients with obsessive-compulsive disorder, high sensitivity and anxiety are observed. In patients with hysteria - the lability of emotions, impulsiveness; in patients with neurasthenia - irritability, fatigue, fatigue, weakness. In all types of neuroses, there is a low frustration tolerance.

What emotional disturbances can be observed in patients with psychosis?

What emotional disturbances are observed in patients with manic-depressive psychosis?

Finally, in people with manic-depressive psychosis, striking changes in the direction of emotions are observed.

Emotional disorders in patients with epilepsy.

With epilepsy, there is a tendency to dysphoria.

Emotional disorders in psychopathic personality disorders

In patients with psychopathy, emotionally aggressive outbursts are noted (with epileptoid, hyperthymic, hysteroid psychopathy) or a tendency to low mood, melancholy, despair, lethargy (with asthenic, psychasthenic, sensitive psychopathy). And with schizoid psychopathy - dissociation of emotional manifestations. Some psychopaths are characterized by emotional inadequacy.

What methods of research in the emotional-motivational sphere do you know?

Self-Esteem Research Methods

Self-esteem is a component of the “I-concept” associated with attitude towards oneself, self-acceptance. Evaluation by a person of himself, his capabilities, qualities and place among other people.

In what diseases is there a decrease in purposefulness, activity of behavior?

What behavioral disorders are observed in psychopathy?

(see question 19)

Loss of socially produced norms of behavior in a number of senile disorders.

What behavioral disorders are found in epilepsy?

Change in character traits. Settlement of drives, intense affect, explosiveness. Infantilism. Depressions with suspicion, discontent, spitefulness are possible.

In what diseases can one observe the formation of pathological needs and motives?

What methods of research of personality disorders do you know?

Personality disorders - emotional instability, lack of formation or violation of the image of "I", unstable interpersonal relationships.

What personality characteristics are most common in schizophrenia?

There are many forms of schizophrenia, for example, schizophrenia with obsessions, with asthenic-hypochondriac manifestations (mental weakness with painful fixation on a state of health), paranoid schizophrenia (persistent systematized delusions of persecution, jealousy, invention, etc.), hallucinatory-paranoid, simple and others. In schizophrenia, a violation of perception, thinking, emotional-volitional sphere is expressed.

In patients with schizophrenia, there is a decrease, dulling of emotionality, a state of apathy (that is, indifference to all phenomena of life). The patient becomes indifferent to family members, loses interest in the environment, loses the differentiation of emotional reactions, he develops inadequacy in experiences. There is a violation of volitional processes: a decrease in volitional effort, reaching a painful lack of will. The increase in the ability to volitional effort indicates progress in the treatment of the patient.

What personality characteristics can you imagine in patients with affective disorders?

What are the personality characteristics of patients with epilepsy?

Epilepsy is usually a chronic disease characterized by episodic disturbances in consciousness and mood. The disease in most cases leads to a gradual change in personality and a kind of decrease in intelligence. At the remote stages of the disease, acute and protracted psychoses can occur.

A characteristic symptom of epilepsy is a sudden convulsive seizure. It has been noticed that sometimes a couple of days before the seizure, harbingers appear in the form of poor health, irritability, headache, etc. During a seizure, the epileptic loses consciousness, falls, convulsions begin, the pupils of the eyes do not react to light. The duration of the seizure is 3-4 minutes. The frequency of seizures can be different: from daily to one or two times a year. There are also seizures that are not accompanied by convulsions, but by a short-term loss of consciousness or its twilight state.

From the point of view of pathopsychology, the observed personality changes according to the epileptic type are stiffness, slowness of all mental processes, a tendency to get stuck on details, thoroughness of thinking, the inability to distinguish the main from the secondary, dysphoria (that is, attacks of mood disorders, usually a combination of malice and sadness) .

The results of the disease are difficulties in using new experience, weakness of combinatorial abilities, deterioration in the reproduction of past experience. Patients remember the offense for a long time, avenge it. Caricature pedantry in everyday life is noted. An essential feature of epileptics is infantilism, expressed in immaturity of judgments, etc. The face of these patients is inactive, inexpressive, mimic reactions are poor, they have avaricious restraint in gestures.

Personality traits in psychoorganic syndrome

Personality disorders in different variants of psychopathy

Typical psychopathological characteristics in suicidal readiness

One of the ways to find out the intentions of suicides is a psychological autopsy. 70-85% of all suicides are committed by people who do not suffer from mental illness. All types of behavior over which a person has real or potential volitional control, but which contribute to progress towards an earlier physical death. Self-destructive behaviors typically include alcohol or drug abuse, ignoring serious illness, overwork, overeating, or smoking. The suicidal equivalent can be disguised as a passion for "death" games, boundless courage for religious or other ideals.

In a state of suicidal crisis, the egocentric features of self-consciousness are activated, combined with its negative attitude towards oneself, with auto-aggression and pessimistic personal attitudes, as well as the internal and situational rigidity of behavioral stereotypes.

pathopsychology

There are several interpretations of the term "pathopsychology" (from the Greek. Pathos - "suffering"). Pathopsychology is a branch of clinical psychology that studies the regularities of the decay of mental activity and personality traits in comparison with the regularities of the formation and course of mental processes in the norm.

V.P. Zinchenko and I.Yu. Levchenko understand pathopsychology as a branch of psychology that studies changes in mental activity in pathological conditions of the brain associated with mental or somatic diseases. In the interpretation of B.V. Zeigarnik pathopsychology studies the regularities of the decay of mental activity and personality traits in comparison with the regularities of the formation and course of mental processes in the norm, the regularities of distortions of the reflected activity of the brain.

The subject is the study of the regularities of the disintegration of mental activity and personality traits in comparison with the regularities of the formation and course of mental processes in the norm, the study of the regularities of distortion of the reflective activity of the brain.

The object is mental disorders, mental anomalies that combine a wide range of neuropsychic abnormalities, diverse in clinical manifestations, severity and nosological nature, but common in a shallow level of mental disorders bordering on the areas of normal and health.

The task of psychopathology is psychodiagnostics in order to clarify the medical diagnosis and justify treatment, in particular psychotherapy and occupational therapy. Pathopsychology provides assistance to patients with mental illness (psychotic patients - schizophrenia, epilepsy, manic-depressive psychosis, oligophrenia, psychoses, consequences of brain injuries, etc.). Such patients are patients of a psychiatric clinic.

Pathopsychology operates with the concepts of general and clinical psychology and uses psychological methods. Pathopsychology works both on the problems of general clinical psychology (when changes in the personality of mental patients and the patterns of mental decay are studied), and private (when mental disorders of a particular patient are studied to clarify the diagnosis, conduct a labor, judicial or military examination).

The main circle of theoretical problems of pathopsychology as a synthesis of general psychological and clinical psychiatric knowledge includes:

The study of the psychological mechanisms of the formation of complex psychopathological syndromes (delusions, hallucinations, etc.); the influence of the individual experience of the patient and his personality on the content and dynamics of these syndromes;

Studying the structure and dynamics of disorders of cognitive activity and the emotional-personal sphere in various mental disorders; the possibility of psychological correction of these disorders;

The study of the personality of patients with various mental disorders; the role of the patient's personality both in the development of painful symptoms and in its psychological correction;

Identification and description of the structure of pathopsychological syndromes of violation of certain types of mental activity (memory, thinking, perception, etc.), as well as pathopsychological syndromes typical of various diseases; the ratio of primary and secondary disorders in the structure of syndromes;

The problem of correlation between the decay and development of the psyche.

Pathopsychology should be distinguished from psychopathology, which focuses on the medical concept of the disease and is part of the general doctrine of human disease, nosology. Pathopsychology is a part of psychiatry and studies the symptoms of a mental illness by clinical methods, using medical concepts: diagnosis, etiology, pathogenesis, symptom, syndrome, etc., the main method of psychopathology is clinical and descriptive.

Pathopsychology is associated with special psychology (in particular, with oligophrenopsychology) and defectology, which is confirmed by the presence of many textbooks for defectological specialties with the inclusion of sections and chapters on pathopsychology, as well as with psychiatry, within the walls of the clinic of which it originated as an applied scientific psychological discipline. and area of ​​practice.

In the structure of pathopsychology, theoretical and applied pathopsychology are distinguished:

Theoretical (academic) pathopsychology studies the general patterns of changes in mental activity in pathological conditions of the brain in comparison with the norm. Its purpose is to assist in understanding the processes that occur in pathological conditions of the brain. Having pathopsychological material, we can reveal the structure of various forms of mental activity (discover the mental factors "responsible" for one or another structure of the patient's cognitive activity). It has been proven that mental illness leads to the disintegration of not only formed processes, motives and needs, but also to the formation of new motives, qualities, traits;

Practical (applied) pathopsychology meets the needs of practice when conducting an examination, evaluating the effectiveness of treatment, especially when using psychopharmacological agents, etc., and also serve additional material when establishing a diagnosis.

In the treatment of psychosomatic patients, the whole range of psychotherapeutic methods is used, each of which is chosen taking into account the nature of the somatic treatment of the patient or arbitrarily. These methods include individual, group, family psychotherapy; conflict-revealing therapy; supportive and educational methods; body-centered treatment; gestalt therapy. Special modifications, for example, long-term homogeneous or mixed group therapy, are often useful in helping the patient with his attitude to assess the disease as an organ suffering, with his inadequate self-perception and difficulty in emotional self-expression.

Conducting a pathopsychological study includes several stages: an experiment, a conversation with a patient, observation, analysis of the life history of a sick person (a medical history written by a doctor), comparison of experimental data with a life history.

The basic principle of pathopsychological research is a systematic qualitative analysis, and is aimed not at measuring individual processes, but at studying a person who performs real activities. Namely, on a qualitative analysis of various forms of the disintegration of the psyche, the disclosure of the mechanisms of disruption of activity and on the possibility of its restoration.

The pathopsychological experiment is a mutual activity of the experimenter and the subject. Therefore, its construction cannot be rigid. The main difference between such an experiment and a general psychological one is that we cannot always see the peculiarity of the patient's attitude to the experiment, which depends on his morbid condition. From this we can conclude the following:

1. Mental patients often not only do not try to complete the task, but also misinterpret experience or actively oppose instructions;

2. The peculiarity of the pathopsychological experiment also lies in the diversity, a large number of methods used;

3. The fulfillment of experimental tasks has a different meaning for different patients;

4. In his conclusion, the pathopsychologist has to operate with a system of concepts that characterize the personality of the patient as a whole, along with the characteristics of individual processes;

5. A pathopsychological study reveals the real layer of the patient's life because the presented activity, the experimenter's remarks cause an equally real experience of the subject.

Usually, during the study, several methods are used from simpler to more complex (with the exception of patients with expected aggravation or simulation).

2) pathopsychology- This is a branch of psychology, borderline between psychology and psychiatry, which studies the patterns of the course of mental activity in various forms of pathology, in comparison with the norm.

E.T. Sokolova:

• Pathopsychology as theoretical discipline deals with the following issues:

o Biological and sociocultural patterns of abnormal development;

o Mechanisms of symptom formation;

o Individual, personal and motivational factors in determining the structure and dynamics of psychopathological syndromes (manic, depressive, hallucinatory-delusional, etc.).

§ How applied Science pathopsychology is used in psychiatry as diagnostic criteria when determining the degree of intellectual decline, when conducting an examination, evaluating the effectiveness of treatment, especially when using psychopharmacological agents.

3.1. The subject and practical tasks of pathopsychology. The difference between psychopathology and pathopsychology.

pathopsychology(from Greek. pathos- suffering) - an area of ​​clinical psychology, borderline between psychology and psychiatry.

The first attempts of pathopsychological research belong to the middle. XIX century., and are associated with the demands of practice. Questions:

1. How to understand what is the role of psychological factors in the occurrence of mental disorders?

2. How to describe the structure of mental disorders in terms of psychology?

3. How can you psychologically help a mentally ill person?

Thus, psychologists begin to work in isolated cases in psychiatric hospitals(see below).

Because pathopsychology is closely connected with maternal disciplines, it is necessary to point out the qualitative features of these connections. Question: why? Answer:

To isolate the range of tasks available to specialists of this profile

This is important for the methodology of pathopsychology

This is necessary for an adequate selection of practical tools

In this regard, it is advisable to turn to the subjects of maternal disciplines:

Ø Psychiatry is a field of knowledge dealing with the diagnosis of mental illness, their etiology (i.e., causes), pathogenesis (i.e., course), as well as the treatment and prevention of mental disorders. General psychopathology- branch of psychiatry. It operates with general medical concepts (symptom, syndrome, etiology, pathogenesis, etc.) and uses general medical criteria for assessing the mental state (blood test, EEG, etc. + criteria according to ICD or DSM classifications). Basic method psychopathology - clinical-descriptive: a combination of long-term observation and clinical conversation.

Ø Psychology- the science of the generation, structure and functions of the mental reflection of reality in the processes of the individual's activity (A.N. Leontiev). Other definitions are also possible.

pathopsychology- This is a branch of psychology that studies the patterns of the course of mental activity in various forms of pathology (mental and somatic), in comparison with the norm. Thus, “Pathopsychology studies the patterns of disintegration of mental processes and personality traits of patients and compares them with the patterns of formation and course of mental processes in the norm” (Bleicher, 1976, p. 9).

Psychopathology ≠ pathopsychology. The object of pathopsychology with psychiatry is common, i.e. mental disorders! But the conceptual apparatus and methods are psychological! Thing:

• Psychiatry: a disease
• Pathopsychology: man and his functioning in society.

Practical tasks of pathopsychology(B.V. Zeigarnik, V.M. Bleikher, V.V. Nikolaeva, N.K. Korsakova):

1. Participation of the pathopsychologist in the establishment disease diagnosis. BUT the diagnosis is never made by one specialist ... Types of diagnosis (according to N.K. Korsakova):

¨ Topical diagnostics- determination of the location of the focus (tumor, hemorrhage, traumatic injury) within the brain. Actually, this is the task of a neuropsychologist, but still ...

¨ Nosological diagnostics(basic for pathopsychology). The psychologist helps the doctor with the diagnosis. The role of a psychologist is important if there are weak, indistinct, blurred, diffuse symptoms and manifestations of mental disorders. Ex: with a clinical picture of the disease sometimes outwardly taking shape according to a neurosis-like type, a pathopsychologist, in a special study, finds disorders of thinking and emotional-personal sphere characteristic of schizophrenia.

¨ Functional diagnostics. The problem of diagnosis is not considered here. The doctor turns to the psychologist to determine the cognitive and personality profiles patient ("psychological portrait of the patient"). This type of diagnostics assumes that the subject will be involved in the process of pharmacological and / or psychotherapeutic treatment, during which it is necessary to evaluate, as it were, longitudinal changes in cognitive processes and emotional and personal characteristics. Thus, here we are talking about the evaluation of the effectiveness of treatment procedures (see below) + long-term follow-up of the patient is required.

¨ individually-personal typological diagnostics. The identity of the patient is diagnosed. For what? Such a diagnosis is needed for the preventive tasks of preventing mental pathology in relation to the so-called. "risk groups". Objective: on the basis of the data obtained, to prevent the actualization of pathological protective mechanisms of the personality, to reach the functioning of conscious mechanisms of co-ownership, for example, in AIDS and oncological diseases. Ex: Do I need to tell the patient that he has cancer? It all depends on the diagnostic data!

2. Expert task. Expertise examples:

1. Labor expertise. Issues on the appointment of a disability group, admission to a certain field of activity are being resolved. Here diagnostics of expert installations is very important:

ü Aggravation - setting the patient to exaggerate his existing violations.

ü Dissimulation is an understatement (for example, in order to quickly leave the hospital, etc.).

In this regard, the psychologist can also participate in the selection of new activities that do not reduce the patient's previous social status, but at the same time are sparing.

2. Military expertise. Question: "Can a person be in certain, harsh conditions?". 1) The question of the possibility of service; 2) The issue of continuing the service of military personnel. It is also important to take into account expert settings + simulation. Do not take: schizophrenics, epileptics, psychopaths, people with mental retardation and mental retardation.

3. Forensic psychological and psychiatric examination. Psychologists take part in this examination in order to resolve questions about the client's sanity at the time of the crime. The decision is made by the court. Here, the simulation of mental illness is already possible.

4. Medical and pedagogical expertise. The psychologist is involved in assessing the child's learning opportunities. We are talking about children with sensory deficits, disorders associated with damage to the motor sphere (ICP), brain disorders, mental retardation, etc. What school should the child go to?

5. Civil expertise. Divorce of parents: with whom does the child stay? The psychological characteristics of the personality of children and parents are important.

3. Description, characteristics of the structure of a mental defect. This refers to scientific goals: recently, diseases that have been little studied have begun to appear. Ex: acute stress disorders and PTSD associated with terrorist attacks, etc. This needs to be investigated in order to properly build psychotherapy and organize an emergency psychological help. Another example: poor ecology, crowded people, monotony, gray spaces, high gray walls, lack of architectural delights and nature lead to apathy and depression (moreover, somatized, with pain, etc.).

4. Evaluation of the effectiveness of treatment(psychopharmacological means or psychotherapy) of patients with mental pathology. Pharmacological treatment of patients with mental disorders (psychosis, depression, borderline disorders) is now developing very intensively. How to conduct such a study? Two groups of patients with the same pathology are taken, one group (control) is given dummy pills (to remove the placebo effect), and the other (experimental) is given the drug.

5. Participation in rehabilitation work. Restoration of the position of the mentally ill in society, family, at work. It is also the prevention of disability (with schizophrenia, organic brain damage). Principles:

o Orientation to the preserved elements of personality and cognitive functions.

o Individual approach.

o Study of the "social climate" that will surround the patient after discharge; This is what psychotherapy is based on.

o Systematic.

6. Participation in psychotherapy. Aspects of:

I. The role of the pathopsychologist in medical psychotherapy:

1) Psychodiagnostics. It allows you to choose one or another form of psychotherapy.

2) Identification of the special properties of the psyche (in particular, personality traits), which the doctor should pay attention to during psychotherapy. Ex: application of projective methods.

II. Psychological psychotherapy. Can be used for:

o Neuroses

o Somatic diseases

o Borderline personality disorder

In pathopsychology, everything is not as structured and unambiguous as in neuropsychology. In the most general form:

pathopsychological symptom- a single phenomenon of impaired mental activity, manifested in a pathopsychological examination (at the same time, it may not manifest itself outside the experimental examination). Ex: slippage, distortion of the generalization process, inadequate association, etc.

There are primary, secondary and tertiary symptoms.

o Primary. Associated with pathology of the brain.

o Secondary. Compensation of primary - psychological mechanisms.

o Tertiary. Also compensation, but on a different level - psychological mechanisms.

Example: pathopsychological syndrome in epilepsy. The leading syndromic factor is a violation of the analytical and synthetic activity of the brain with a sharp violation of the dynamics of nervous processes.

1. Primary violations:

ü change in the dynamics of mental processes (slowness, inertia),

narrowing of the scope of attention, difficulties in its distribution,

ü lack of flexibility, mobility of behavioral programs,

ü General cognitive decline.

2. Secondary violations. Arise as compensation for primary defects:

• confabulation when remembering,
• reasoning,
• a complex of personal characteristics: obsequiousness, politeness, pedantry.

3. Tertiary disorders

Chronic behavioral and emotional tension (expectation of a negative assessment),

Inflated self-esteem, as compensation for chronic failure.

Pathopsychological syndrome- this is a natural combination of symptoms (expressed in psychological terms) caused by an existing mental disorder.

There are other understandings.

V.V. Guldan: Pathopsychological syndrome- this is a combination of signs of violations of mental activity, its intact aspects and individual features mental activity, united by the psychological mechanisms of the functioning of the individual.

F.S. Safuanov: Pathopsychological syndrome is a set of disorders or features of cognitive processes, emotional and behavioral reactions that are relatively specific for a particular clinical nosology and are based on certain psychological mechanisms.

Yu.F. Polyakov: there are psychopathological and pathopsychological syndromes. What is the difference? Differences:

Ø Psychopathological syndromes. They simply state the presence of certain pathological manifestations of the psyche. Example: paraphrenic psychopathological syndrome includes delusions of grandeur, delusions of persecution, mental automatisms and affective disorders.

Ø Pathopsychological syndromes. Mechanisms should be shown here!

This distinction between psychopathological and pathopsychological syndromes follows from the same difference between psychopathology and pathopsychology (see above).

Classifications of pathopsychological syndromes:

I. According to B.V. Zeigarnik: violation of the operational side of thinking, violation of the dynamics of thinking, violation of the motivational component, personal, etc. That these are pathopsychological syndromes, Bleicher (1976) said, but then (in 2002) he revised his views - these are too generalized syndromes.

II. Nose-specific approach to pathopsychological symptoms. As for neuropsychology, the central task is to make a topical diagnosis, for pathopsychology, the main task is to determine the nosological affiliation of the patient (nosological or differential diagnosis). Therefore, pathopsychological syndromes should provide information about nosology (see, for example, the definition of a pathopsychological syndrome according to Safuanov).

1) I.A. Kudryavtsev, worked at the Institute. Serbian. Identified the following pathopsychological syndromes:

§ Schizophrenic (dissociative). Inadequacy of emotions (formality and emasculation), the use of latent signs or subjective criteria in generalization, reasoning, diversity phenomena, slippage in judgments, pretentious statements, a distorted interpretation of figurative meaning, fluctuations in attention, decreased activity.

§ Organic. Low level generalizations, concreteness of associations, misunderstanding of the conditional meaning, difficulties in establishing logical connections, thoroughness, a tendency to excessive detail, a decrease in the amount of memorization, fluctuations in attention and a decrease in activity, fatigue, slowness in the pace of mental activity.

§ Oligophrenic.

§ Psychopathic. Emotional saturation of associations, pretentiousness of judgments, a tendency to evaluative comments, affective reasoning, affective logic, the use of latent signs is possible, distortion of figurative meaning.

§ Psychogenic disorganization.

2) V.M. Bleicher. Introduced the concept of "register-syndrome". Register-syndromes:

Schizophrenic

Affective-endogenous (in the clinic, it corresponds to MDP and functional affective psychoses of late age)

Oligophrenic

Exogenous-organic (in the clinic, it corresponds to brain damage like atherosclerosis, the consequences of TBI, substance abuse, etc.)

Endogenously organic (in the clinic - true epilepsy, primary atrophic processes in the brain)

Personality-abnormal (accentuated and psychopathic personalities and psychogenic reactions largely due to abnormal soil)

Psychogenic-psychotic (reactive psychoses)

Psychogenic-neurotic (neurotic disorders, neurotic reactions).