How to treat violations of the emotional-volitional sphere. Violations of the emotional-volitional sphere of children and adolescents. Causes and consequences of emotional disorders in children

Quite often, parental care is mainly focused on the physical health of their child, while the emotional component is left almost unattended. This is due to the fact that most parents consider the early symptoms of emotional disorders to be temporary, and therefore harmless.

The place of emotional disorders in the mental development of a child seems to be one of the key aspects of his life, due to the fact that these disorders affect his attitude towards his parents and his environment in general. To date, there is a tendency towards an increase in emotional disorders in children, in the form of reduced social adaptation and a tendency to aggressive behavior.

· 1 Causes

· 2

· 3 Diagnosis of violations

· 4

There are many reasons for the occurrence of emotional disorders in a child, so parents should be especially careful when various pathological signs appear. As a rule, specialists establish the final diagnosis when registering 3 signs of emotional instability.

The most common causes of emotional disturbances are:

· Physical characteristics, taking into account past illnesses in infancy;

Inhibition of mental and mental development;

Improper upbringing of the child in the preschool period;

Improper nutrition, namely insufficient intake of necessary substances, which significantly affects the development of the baby;

Also, these above reasons are divided into two large groups:

1. Biological.

This causal group includes a characteristic type of nervous system. For example, in the presence of attention deficit disorder, a child may subsequently develop a pathological process in the brain, which is formed as a result of a difficult course of pregnancy and childbirth of his mother.

2. Social

This group determines the process of interaction of the child with other people and the environment. For example, if a child already has experience of communicating with the age group of people, his peers and the primary group for him - the family, then in some cases such socialization can also harm him.

If a child is constantly subjected to denial by adults, then he unconsciously begins to displace the information received, which comes from the environment.

The emergence of new experiences that do not coincide with his conceptual structure, they begin to be perceived negatively, which eventually forms a certain stress for him.

In the absence of understanding from peers, the child develops emotional experiences (rage, resentment, disappointment), which are characterized by acuteness and duration. Also, constant conflicts in the family, demands on the child, lack of understanding of his interests, also causes emotional disturbances in the mental development of the child.

Classifications of emotional disorders and their symptoms

The difficulty in identifying emotional-volitional disorders resulted in the fact that a number of psychologists have formed different views on these types of disorders. For example, the psychologist G. Sukhareva noted that emotional disturbances in primary school age are often observed in children suffering from neurasthenia, which was distinguished by his excessive excitability.

Psychologist Y. Milanich had a different idea of ​​these disorders. He found that 3 groups of emotional disorders belong to emotional-volitional disorders;

Acute emotional reactions, which are characterized by the coloring of certain conflict situations, which manifested itself in aggression, hysteria, reactions of fear or resentment;

A state of increased tension - anxiety, timidity, decreased mood.

Dysfunction of the emotional state, which manifested itself in a sharp transition from positive emotional phenomena to negative ones and also in the opposite order.

However, the most detailed clinical picture of emotional disorders was made by N.I. Kosterina. She divides emotional disorders into 2 large groups, which are characterized by an increase in the level of emotionality and, accordingly, its decrease.

The first group includes such states as:

Euphoria, which is characterized by an inadequate increase in mood. A child in this state, as a rule, has increased impulsivity, impatience and a desire for dominance.

Dysphoria is the opposite form of euphoria, characterized by the manifestation of such emotions as: anger, irritability, aggressiveness. It is a type of depressive disorder.

Depression is a pathological condition characterized by the manifestation of negative emotions and behavioral passivity. The child in this state feels depressed and dreary mood.

Anxiety Syndrome - a condition in which the child feels unreasonable anxiety and pronounced nervous tension. It is expressed in a constant change of mood, tearfulness, lack of appetite, hypersensitivity. Often this syndrome develops into a phobia.

Apathy is a serious condition in which the child feels indifference to everything that is happening around, and is also characterized by a sharp decrease in initiative functions. Most psychologists argue that the loss of emotional reactions is combined with a decrease or complete loss of volitional impulses.

Paratamia is a characteristic disorder of the emotional background, in which the experience of one specific emotion is accompanied by external manifestations of absolutely opposite emotions. Often seen in children with schizophrenia.

The second group includes:

· The syndrome of hyperactivity and attention deficit, is distinguished by such symptoms as motor disorientation, impulsivity. It follows that the key features of this syndrome are distractibility and excessive motor activity.

· Aggression. This emotional manifestation is formed as part of a character trait or as a reaction to environmental influences. In any case, the above violations need to be corrected. However, before correcting pathological manifestations, the main causes of diseases are first identified.

Diagnosis of violations

For the subsequent therapy of disorders and its effectiveness, it is very important to timely diagnose the emotional development of the child and his disorders. There are many special methods and tests that assess the development and psychological state of the child, taking into account his age characteristics.

Diagnosis of preschool children includes:

· Diagnosis of the level of anxiety and its assessment;

· Study of psycho-emotional state;

Luscher color test;

Study of self-esteem and personal characteristics of the child;

· The study of the development of volitional qualities.

Seeking psychological help is necessary if the child experiences certain difficulties in learning, communicating with peers, behavior, or he has certain phobias.

Also, parents should pay attention if the child experiences any emotional experiences, feelings, and also if his condition is characterized as depressed.

Ways to correct emotional disorders

A number of domestic and foreign scientists in the field of psychology distinguish a number of techniques that allow correcting emotional and volitional disorders in children. These methods are usually divided into 2 main groups: individual and group, but this division does not reflect the main goal of correcting mental disorders.

Mental correction of affective disorders in children is an organized system of psychological influences. This correction is mainly aimed at:

mitigation of emotional discomfort,

Increased activity and independence

· Suppression of secondary personal reactions (aggressiveness, excessive excitability, anxiety, etc.).

Correction of self-esteem;

Formation of emotional stability.

World psychology includes 2 main approaches to the psychological correction of a child, namely:

· Psychodynamic approach. He advocates the creation of conditions that allow the suppression of external social barriers, using methods such as psychoanalysis, play therapy and art therapy.

· Behavioral approach. This approach allows you to stimulate the child to learn new reactions aimed at the formation of adaptive behavioral forms and vice versa, suppresses non-adaptive forms of behavior, if any. It includes such methods of influence as behavioral and psycho-regulatory trainings, which allow the baby to consolidate the learned reactions.

When choosing a method of psychological correction of emotional disorders, one should proceed from the specifics of the disorder, which determines the deterioration of the emotional state. If a child has intrapersonal disorders, then an excellent way would be to use game therapy (not computer), and the method of family psychocorrection has also proven itself well.

If there is a predominance of interpersonal conflicts, group psychocorrection is used, which allows you to optimize interpersonal relationships. When choosing any method, the severity of the child's emotional instability must be taken into account.

Such methods of psychological correction as game therapy, fairy tale therapy, etc. work effectively if they correspond to the mental characteristics of the child and the therapist.

The age of a child up to 6 years (preschool period) is the most important period of his development, since it is during this period that the child’s personal foundations, volitional qualities are formed, and the emotional sphere is rapidly developing.

Volitional qualities develop mainly due to conscious control over behavior, while maintaining certain behavioral rules in memory.

The development of these qualities is characterized as the general development of the personality, that is, mainly by forming the will, emotions and feelings.

Therefore, for a successful emotional-volitional upbringing of a child, parents and teachers need to pay special attention to creating a positive atmosphere of mutual understanding. Therefore, many experts recommend that parents form the following criteria for their child:

· When communicating with a child, it is necessary to observe absolute calmness and in every possible way show your benevolence;

You should try to communicate with the child more often, ask him about something, empathize, and be interested in his hobbies;

· Joint physical labor, play, drawing, etc. will safely affect the condition of the child, so try to give him as much attention as possible.

· It is necessary to ensure that the child does not watch films and does not play games with elements of violence, as this will only aggravate his emotional state;

Support your child in every possible way and help him build confidence in himself and in his abilities.

Part I. Violations in the development of the emotional-volitional sphere in children and teenagers

Educational questions.

1. Typology of violations in the development of the emotional-volitional sphere.

2. Psychological and pedagogical characteristics of children and adolescents with disorders of the emotional-volitional sphere.

3. Psychopathy in children and adolescents.

4. Character accentuations as a factor contributing to the emergence of emotional and volitional disorders.

5. Children with early autism (RDA).

1. The concept of violation of the emotional-volitional sphere in defectology defines neuropsychic disorders (mainly of mild and moderate severity). *

The main types of disorders in the development of the emotional-volitional sphere in children and adolescents include reactive states (hyperactivity syndrome), conflict experiences, psychasthenia and psychopathy (psychopathic forms of behavior), and early childhood autism.

As you know, the child's personality is formed under the influence of hereditarily determined (conditioned) qualities and factors of the external (primarily social) environment. Since the process of development largely depends on environmental factors, it is obvious that unfavorable environmental influences can cause temporary behavioral disorders, which, once fixed, can lead to abnormal (distorted) development of the personality.

Just as for normal somatic development, an appropriate amount of calories, proteins, minerals and vitamins is necessary, so for normal mental development, the presence of certain emotional and psychological factors is necessary. These include, first of all, the love of neighbors, a sense of security (provided by the care of parents), the education of correct self-esteem, and along with the development of independence in actions and behavior) adult guidance, which includes, in addition to love and care, a certain set of prohibitions. Only with the right balance of attention and prohibitions, appropriate connections are formed between the “I” of the child and the outside world, and a small person, while maintaining his individuality, develops into a person who will definitely find his place in society.

The versatility of emotional needs that ensure the development of the child, in itself indicates the possibility of a significant number of adverse factors in the external (social) environment, which can cause disturbances in the development of the emotional-volitional sphere and deviations in the behavior of children.

2. Reactive States are defined in special psychology as neuropsychiatric disorders caused by adverse situations (developmental conditions) and not associated with an organic lesion of the central nervous system. The most striking manifestation of reactive states (MS) is hyperactivity syndrome, acting against the background of a "prolonged" state of general mental excitability and psychomotor disinhibition. The causes of MS can be varied. So, the circumstances that traumatize the child's psyche include such a psychophysiological disorder as enuresis (bedwetting that persists or often recurs after the 3rd year of life), often observed in somatically weakened and nervous children. Enuresis can occur after a severe nervous shock, fright, after a debilitating somatic disease. In the occurrence of enuresis, there are also such reasons as conflict situations in the family, excessive severity of parents, too deep sleep, etc. Aggravate reactive states with enuresis ridicule, punishment, hostile attitude of others towards the child.

The presence of certain physical and psychophysiological defects in a child (strabismus, deformities of the limbs, the presence of lameness, severe scoliosis, etc.) can lead to a reactive state, especially if the attitude of others is incorrect.

A common cause of psychogenic reactions in young children is a sudden strong irritation of a frightening nature (fire, attack by an angry dog, etc.). Increased susceptibility to mental trauma is observed in children with residual effects after infections and injuries, in excitable, weakened, emotionally unstable children. The most susceptible to mental trauma are children belonging to a weak type of higher nervous activity, easily excitable children.

The main distinguishing feature of MS is inadequate (excessively expressed) personal reactions to influences from the environment (primarily social) environment. For reactive states, the state is characteristic psychological stress And discomfort. MS can manifest as depression (a sad, depressed state). In other cases, the main symptoms of MS are: psychomotor agitation, disinhibition, inappropriate actions and actions.

In severe cases, there may be a disorder of consciousness (clouding of consciousness, impaired orientation in the environment), causeless fear, temporary "loss" of some functions (deafness, mutism).

Despite the difference in manifestations, a common symptom that connects all cases of reactive states is a severe, depressing psycho-emotional state that causes an overstrain of nervous processes and a violation of their mobility. This largely determines the increased tendency to affective reactions.

Mental developmental disorders may be associated with severe internal conflict experiences when opposite attitudes towards close people or to a particular social situation that have great personal significance for the child collide in the mind of the child. Conflict experiences (as a psychopathological disorder) are long-term, socially conditioned; they acquire dominant importance in the mental life of the child and have a sharp negative impact on his characterological features and behavioral reactions. The causes of conflict experiences are most often: the unfavorable position of the child in the family (conflicts in the family, family breakdown, the appearance of a stepmother or stepfather, parents' alcoholism, etc.). Conflict experiences can arise in children abandoned by parents, adopted and in other cases. Another reason for persistent conflict experiences can be the above-mentioned shortcomings of psychophysical development, in particular, stuttering.

The manifestations of severe conflict experiences are most often isolation, irritability, negativism (in many forms of its manifestation, including speech negativism), depressive states; in some cases, the result of conflict experiences is a delay in the cognitive development of the child.

Persistent conflict experiences are often accompanied by violations ( deviations) behavior. Quite often, the cause of behavioral disorders in this category of children is the improper upbringing of the child (excessive guardianship, excessive freedom or, on the contrary, lack of love, excessive severity and unreasonable exactingness, without taking into account his personal - intellectual and psychophysical capabilities, determined by the stage of age development). A particularly serious mistake in the upbringing of a child is the constant pejorative comparison of him with children with better abilities and the desire to achieve great achievements from a child who does not have pronounced intellectual inclinations. A child who is humiliated and often punished may develop feelings of inferiority, reactions of fear, timidity, anger and hatred. Such children, who are in constant tension, often develop enuresis, headaches, fatigue, etc. At an older age, such children may rebel against the dominant authority of adults, which is one of the reasons for antisocial behavior.

Conflict experiences can also be caused by traumatic situations in the conditions of the school team. Of course, the emergence and severity of conflict situations is influenced by the individual personality and psychological characteristics of children (the state of the nervous system, personal claims, range of interests, impressionability, etc.), as well as the conditions of upbringing and development.

Also quite a complex neuropsychiatric disorder is psychasthenia- a violation of mental and intellectual activity, due to weakness and a violation of the dynamics of the processes of higher nervous activity, a general weakening of the neuropsychic and cognitive processes. The causes of psychasthenia can be severe violations of somatic health, violations of the general constitutional development (due to dystrophy, metabolic disorders in the body, hormonal disorders, etc.). At the same time, factors of hereditary conditioning, dysfunctions of the central nervous system of various origins, the presence of minimal brain dysfunction, etc., play an important role in the occurrence of psychasthenia.

The main manifestations of psychasthenia are: a decrease in overall mental activity, slowness and rapid exhaustion of mental and intellectual activity, decreased performance, phenomena of mental retardation and inertia, increased fatigue during psychological stress. Psychoasthenic children are extremely slowly involved in educational work and get tired very quickly when performing tasks related to the performance of mental and mnemonic actions.

Children of this category are distinguished by such specific character traits as indecision, increased impressionability, a tendency to constant doubts, timidity, suspiciousness, and anxiety. Often, the symptoms of psychasthenia are also a state of depression and autistic manifestations. psychopathic development by psychasthenic type in childhood is manifested in increased suspiciousness, in obsessive fears, in anxiety. At an older age, obsessive doubts, fears, hypochondria, increased suspiciousness are observed.

3.Psychopathy(from Greek - psyche- soul, pathos disease) is defined in special psychology as pathological temperament, manifested in unbalanced behavior, poor adaptability to changing environmental conditions, inability to obey external requirements, increased reactivity. Psychopathy is a distorted version of the formation of personality, it is a disharmonic development of the personality with sufficient (as a rule) safety of the intellect. Studies of domestic scientists (V.A. Gilyarovskiy, V.R. Myasishchev, G.E. Sukhareva, V.V. Kovalev, etc.) showed the dialectical interaction of social and biological factors in the origin of psychopathy. Most of the psychopathy is due to external pathological factors that acted in utero or in early childhood. The most common causes of psychopathy are: infections - general and brain, craniocerebral injuries - intrauterine, birth and acquired in the first years of life; toxic factors (for example, chronic gastrointestinal diseases), intrauterine development disorders due to alcohol intoxication, exposure to radiation, etc. Pathological heredity also plays a certain role in the formation of psychopathy.

However, for the development of psychopathy, along with the main ( predisposing) the cause that causes congenital or early acquired insufficiency of the nervous system is the presence of another factor - the unfavorable social environment and the absence of corrective influences in raising a child.

Purposeful positive impact of the environment can more or less correct the child's deviations, while under adverse conditions of upbringing and development, even mild deviations in mental development can be transformed into a severe form of psychopathy (G.E. Sukhareva, 1954, etc.). In this regard, biological factors are considered as initial moments,background that can cause psychopathic development of the personality; play a decisive role social factors, mainly conditions for the upbringing and development of the child.

Psychopathy is very diverse in its manifestations, therefore, its various forms are distinguished in the clinic (organic psychopathy, epileptoid psychopathy, etc.). Common to all forms of psychopathy is a violation of the development of the emotional-volitional sphere, specific anomalies of character. The psychopathic development of the personality is characterized by: weakness of will, impulsiveness of actions, gross affective reactions. The underdevelopment of the emotional-volitional sphere is also manifested in a certain decrease in working capacity associated with the inability to concentrate, to overcome the difficulties encountered in the performance of tasks.

Most clearly, violations of the emotional-volitional sphere are expressed with organic psychopathy, which is based on an organic lesion of the subcortical cerebral systems. Clinical manifestations in organic psychopathy are different. In some cases, the first manifestations of a mental disorder are detected already at an early age. In the anamnesis of these children, there is a pronounced fearfulness, fear of sharp sounds, bright light, unfamiliar objects, people. This is accompanied by intense and prolonged screaming and crying. At early and preschool age, psychomotor anxiety, increased sensory and motor excitability come to the fore. At primary school age, psychopathic behavior manifests itself in the form of unbridledness, protest against the rules of social behavior, any regime, in the form of affective outbursts (pugnacity, running around, noisy, and later - school absenteeism, a tendency to vagrancy, etc.).

In other cases of organic psychopathy, attention is drawn to the following feature of the behavioral reactions of children, which sharply distinguishes them from their peers already at preschool age. Relatives and educators note the extreme unevenness of their mood; along with increased excitability, excessive mobility, these children and adolescents often have a low, gloomy-irritable mood. Children of senior preschool and primary school age often complain of vague pain, refuse to eat, sleep poorly, often quarrel and fight with their peers. Increased irritability, negativism in various forms of its manifestation, unfriendly attitude towards others, aggressiveness towards them form a pronounced psychopathological symptomatology of organic psychopathy. Especially clearly these manifestations are expressed at an older age, in the puberty period. Often they are accompanied by a slow pace of intellectual activity, memory loss, increased fatigue. In some cases, organic psychopathy is combined with a delay in the psychomotor development of the child.

G.E. Sukhareva identifies two main groups of organic psychopathy: excitable(explosive) and brakeless.

At the first (excitable) type, unmotivated mood swings are observed in the form of dysphoria. In response to the slightest remarks, children and adolescents have violent reactions of protest, leaving home and school.

Organic psychopaths of the uninhibited type are characterized by an increased background of mood, euphoria, and uncriticality. All this is a favorable background for the formation of the pathology of drives, a tendency to vagrancy.

With a hereditary burden of epilepsy in children, personality traits characteristic of epileptoid psychopathy. This form of psychopathy is characterized by the fact that in children, with initially intact intelligence and the absence of typical signs of epilepsy (seizures, etc.), the following features of behavior and character are noted: irritability, irascibility, poor switching from one type of activity to another, "stuck" on their experiences, aggressiveness, egocentrism. Along with this, thoroughness and perseverance in the performance of educational tasks are characteristic. These positive features must be used as a support in the process of corrective work.

With a hereditary burden of schizophrenia, schizoid personality traits can form in children. These children are characterized by: poverty of emotions (often underdevelopment of higher emotions: feelings of empathy, compassion, gratitude, etc.), lack of childish spontaneity and cheerfulness, little need for communication with others. The core property of their personality is egocentrism and autistic manifestations. They are characterized by a kind of asynchrony of mental development from early childhood. The development of speech overtakes the development of motor skills, and therefore, children often do not have self-service skills. In games, children prefer solitude or communication with adults and older children. In some cases, the originality of the motor sphere is noted - clumsiness, motor awkwardness, inability to perform practical activities. General emotional lethargy, which is found in children from an early age, lack of need for communication (autistic manifestations), lack of interest in practical activities, and later - isolation, self-doubt, despite a fairly high level of intellectual development, create significant difficulties in education and education of this category of children.

Hysterical psychopathic development is more common in childhood than other forms. It manifests itself in pronounced egocentrism, in increased suggestibility, in demonstrative behavior. At the heart of this variant of psychopathic development is mental immaturity. It manifests itself in a thirst for recognition, in the inability of a child and a teenager to volitional effort, which is the essence of mental disharmony.

Specific Features hysteroid psychopathy are manifested in pronounced egocentrism, in the constant demand for increased attention to oneself, in the desire to achieve the desired by any means. In social communication there is a tendency to conflict, to lie. When confronted with life's difficulties, hysterical reactions occur. Children are very capricious, like to play a team role in a peer group and show aggressiveness if they fail to do so. Extreme instability (lability) of mood is noted.

psychopathic development by unstable type can be observed in children with psychophysical infantilism. They are distinguished by immaturity of interests, superficiality, instability of attachments, and impulsiveness. Such children have difficulties in long-term purposeful activity, they are characterized by irresponsibility, instability of moral principles, and socially negative forms of behavior. This variant of psychopathic development can be either constitutional or organic.

In practical special psychology, a certain relationship has been established between incorrect approaches to raising children, pedagogical errors and the formation of psychopathic character traits. So, the characterological traits of excitable psychopaths often arise with the so-called "hypo-guardianship" or direct neglect. The formation of “inhibited psychopaths” is favored by the callousness or even cruelty of others, when the child does not see affection, is subjected to humiliation and insults (the social phenomenon of “Cinderella”). Hysterical personality traits are most often formed in conditions of "hyper-custody", in an atmosphere of constant adoration and admiration, when the child's relatives fulfill any of his desires and whims (the phenomenon of "family idol").

4. In adolescence there is an intensive transformation of the psyche of a teenager. Significant shifts are observed in the formation of intellectual activity, which is manifested in the desire for knowledge, the formation of abstract thinking, in a creative approach to solving problems. Volitional processes are intensively formed. A teenager is characterized by perseverance, perseverance in achieving the goal, the ability to purposeful volitional activity. Consciousness is actively formed. This age is characterized by disharmony of mental development, which often manifests itself in emphasis character. According to A.E. Lichko, the accentuation (sharpness) of individual character traits in students of different types of schools varies from 32 to 68% of the total contingent of schoolchildren (A.E. Lichko, 1983).

Character accentuations – these are extreme variants of a normal character, but at the same time they can be a predisposing factor for the development of neuroses, neurotic, pathocharacterological and psychopathic disorders.

Numerous studies by psychologists have shown that the degree of disharmony in adolescents is different, and the very accentuation of character has different qualitative features and manifests itself in different ways in the behavior of adolescents. The main variants of character accentuations include the following.

Dysthymic personality type. The features of this type of accentuation are periodic fluctuations in mood and vitality in adolescents. During the period of mood rise, adolescents of this type are sociable and active. During a period of mood decline, they are laconic, pessimistic, begin to be burdened by a noisy society, become dull, lose their appetite, and suffer from insomnia.

Adolescents of this type of accentuation feel conformably among a small circle of close people who understand and support them. Important for them is the presence of long-term, stable attachments, hobbies.

Emotive personality type. Adolescents of this type are characterized by variability of moods, depth of feelings, increased sensitivity. Emotive teenagers have a developed intuition, are sensitive to the assessments of others. They conformally feel in the family circle, understanding and caring adults, constantly striving for confidential communication with adults and peers significant to them.

alarm type.The main feature of this type of accentuation is anxious suspiciousness, constant fear for oneself and one's loved ones. In childhood, anxious adolescents often have a symbiotic relationship with their mother or other relatives. Adolescents experience a strong fear of new people (teachers, neighbors, etc.). They need warm, caring relationships. The confidence of a teenager that he will be supported, helped in an unexpected, non-standard situation, contributes to the development of initiative, activity.

introverted type. In children and adolescents of this type, there is a tendency to emotional isolation, isolation. They, as a rule, lack the desire to establish close, friendly relations with others. They prefer individual activities. They have a weak expressiveness, a desire for solitude, filled with reading books, fantasizing, and various kinds of hobbies. These children need warm, caring relationships from loved ones. Their psychological comfort increases with acceptance by adults and support for their most unexpected hobbies.

excitable type. With this type of character accentuation in adolescents, there is an imbalance between excitatory and inhibitory processes. Adolescents of the excitable type, as a rule, are in a state of dysphoria, which manifests itself in depression with the threat of aggressiveness in relation to the entire outside world. In this state, an excitable teenager is suspicious, lethargic, rigid, prone to affective temper, impulsiveness, unmotivated cruelty towards loved ones. Excitable teenagers need warm emotional relationships with others.

Demonstrative type. Adolescents of this type are distinguished by pronounced egocentrism, a constant desire to be in the center of attention, and a desire to “make an impression”. They are characterized by sociability, high intuition, the ability to adapt. Under favorable conditions, when a “demonstrative” teenager is in the center of attention and accepted by others, he adapts well, is capable of productive, creative activity. In the absence of such conditions, disharmony of personal properties according to the hysteroid type is observed - attracting special attention to oneself by demonstrative behavior, a tendency to lie and fantasize as a defense mechanism.

Pedantic type. As emphasized by E.I. Leonhard, pedantry as an accentuated character trait is manifested in the behavior of the individual. The behavior of a pedantic personality does not go beyond the limits of reason, and in these cases the advantages associated with the tendency to solidity, clarity, and completeness often affect. The main features of this type of character accentuation in adolescence are indecision, a tendency to rationalize. Such teenagers are very accurate, conscientious, rational, responsible. However, in some adolescents with increased anxiety, there is indecision in a decision-making situation. Their behavior is characterized by some rigidity, emotional restraint. Such teenagers are characterized by increased fixation on their health.

unstable type. The main characteristic of this type is the pronounced weakness of the volitional components of the personality. Lack of will is manifested, first of all, in the educational or labor activity of a teenager. However, in the process of entertainment, such teenagers can be highly active. In unstable adolescents, there is also an increased suggestibility, and therefore, their social behavior largely depends on the environment. Increased suggestibility and impulsivity against the background of the immaturity of higher forms of volitional activity often contributes to the formation of their tendency to additive (addictive) behavior: alcoholism, drug addiction, computer addiction, etc. Unstable accentuation manifests itself already in primary school. The child completely lacks the desire to learn, unstable behavior is observed. In the personality structure of unstable adolescents, inadequate self-esteem is observed, which manifests itself in the inability to introspection, corresponding to the assessment of their actions. Unstable adolescents are prone to imitative activity, which makes it possible, under favorable conditions, to form socially acceptable forms of behavior in them.

Affectively labile type. An important feature of this type is the extreme variability of mood. Frequent mood swings are combined with a significant depth of their experience. The well-being of a teenager, his ability to work depends on the mood of the moment. Against the background of mood swings, conflicts with peers and adults are possible, short-term and affective outbursts, but then quick remorse follows. In a period of good mood, labile adolescents are sociable, easily adapt to a new environment, and are responsive to requests. They have a well-developed intuition, they are distinguished by sincerity and depth of affection for relatives, relatives, friends, they deeply experience rejection from emotionally significant persons. With a benevolent attitude on the part of teachers and others, such adolescents feel comfortable and are active.

It should be noted that the manifestations of psychopathic development do not always end with the complete formation of psychopathy. In all forms of psychopathic behavior, provided early focused Corrective action in combination (if necessary) with therapeutic measures can achieve significant success in compensating for deviant development in this category of children.

3. Children with early childhood autism syndrome.

Early Childhood Autism (RAD) is one of the most complex disorders of mental development. This syndrome is formed in its full form by the age of three. RDA manifests itself in the following clinical and psychological signs:

impaired ability to establish emotional contact;

Behavioral stereotyping. It is characterized by the presence in the child's behavior of monotonous actions - motor (swinging, jumping, tapping), speech (pronouncing the same sounds, words or phrases), stereotypical manipulations of an object; monotonous games, stereotyped interests.

specific disorders of speech development ( mutism, echolalia, speech stamps, stereotyped monologues, the absence of first-person pronouns in speech, etc.), leading to a violation of speech communication.

In early childhood autism, the following are also characteristic:

Increased sensitivity to sensory stimuli. Already in the first year of life, there is a tendency to sensory discomfort (most often to intense everyday sounds and tactile stimuli), as well as a focus on unpleasant impressions. With insufficient activity aimed at examining the surrounding world, and limiting a variety of sensory contact with it, there is a pronounced “capture”, fascination with certain specific impressions - tactile, visual, auditory, vestibular, which the child seeks to receive again and again. For example, a child's favorite pastime for six months or more may be rustling a plastic bag, watching the movement of a shadow on the wall; the strongest impression can be the light of a lamp, etc. The fundamental difference in autism is the fact that a loved one almost never manages to get involved in the actions with which the child is “enchanted”.

Violation of the sense of self-preservation is noted in most cases already up to a year. It manifests itself both in overcaution and in the absence of a sense of danger.

Violation of affective contact with the immediate environment is expressed:

in the peculiarities of the relationship to the hands of the mother. Many autistic children lack anticipatory posture (stretching the arms towards the adult when the child looks at him). In the arms of the mother, such a child may also not feel comfortable: either “hangs like a bag”, or is overly tense, resists caresses, etc .;

Features of fixing the gaze on the face of the mother. Normally, a child early develops an interest in the human face. Communication with the help of a glance is the basis for the development of subsequent forms of communicative behavior. Autistic children are characterized by avoidance of eye contact (look past the face or "through" the face of an adult);

features of an early smile. The timely appearance of a smile and its direction to a loved one is a sign of the successful effective development of the child. The first smile in most autistic children is not addressed to a person, but rather in response to sensory stimulation that is pleasant for the child (slowing down, the bright color of the mother's clothes, etc.).

Features of the formation of attachment to a loved one. Normally, they manifest themselves as an obvious preference for one of the persons caring for the child, most often the mother, in feelings of separation from her. The autistic child most often does not use positive emotional responses to express affection;

Difficulties in making requests. In many children, at an early stage of development, a directional look and a gesture are formed normally - stretching out a hand in the right direction, which at subsequent stages was transformed into a pointing one. In an autistic child and at later stages of development, such a transformation of gesture does not occur. Even at an older age, when expressing his desire, an autistic child takes the hand of an adult and puts it on the desired object;

Difficulties in the child's arbitrary organization, which can be expressed in the following tendencies:

The absence or inconsistency of the baby's response to an adult's address to him, to his own name;

Lack of eye tracking the direction of the adult's gaze, ignoring his pointing gesture;

lack of expression of imitative reactions, and more often their complete absence; difficulty in organizing autistic children for simple games that require imitation and display (“patties”);

· great dependence of the child on the influences of the surrounding "mental field". If parents show great persistence and activity, trying to attract attention to themselves, then the autistic child either protests or withdraws from contact.

Violation of contact with others, associated with the peculiarities of the development of the forms of the child's address to an adult, find expression in the difficulty of expressing one's own emotional state. Normally, the ability to express one's emotional state, to share it with an adult, is one of the earliest adaptive achievements of a child. It usually appears after two months. The mother perfectly understands the mood of her child and therefore can control it: to comfort the child, relieve discomfort, calm down. Mothers of autistic children often have difficulty even understanding the emotional state of their babies.

Part II. The main content of complex correctional work with children, suffering from emotional and volitional disorders

Educational questions.

1. The main directions of correctional pedagogical work.

4. Therapeutic and health-improving measures.

5. Methods of psychological correction of emotional-volitional disorders.

Psychological and pedagogical assistance to children suffering from emotional and volitional disorders provides for the solution of a number of organizational and pedagogical tasks and the practical implementation of the following areas of correctional work.

Comprehensive study reasons violations of the emotional-volitional sphere in this child, behavioral disorders, the causes that contributed to the emergence of affective reactions. Finding out conditions of education and development child in the family.

Elimination (if possible) or weakening of psycho-traumatic moments (including negative psycho-traumatic social factors, for example, unfavorable living conditions and activities of a child in a family, incorrect pedagogical approach to raising a child, etc.).

Definition and practical implementation of the rational (taking into account the individual characteristics of the child) daily routine and learning activities. Organization of purposeful behavior of the child; formation of adequate behavior in various social situations.

· Establishing a positive close emotional contact with the child, including him in exciting activities (together with the teacher and other children) - taking into account his interests and inclinations. Maintaining positive contact with the child during the entire period of pedagogical work in this educational institution.

Smoothing and gradual overcoming of negative personality traits in children with emotional and volitional disorders (closedness, negativism / including verbal negativism /, irritability, sensitivity / in particular, increased sensitivity to failures /, indifference to the problems of others, to their position in children's group, etc.).

It is important to overcome and prevent neurotic reactions and pathocharacterological disorders: egocentrism, infantilism with constant dependence on others, self-doubt, etc. For this purpose, it is provided:

- prevention of affective reactions, reactive behavior; preventing the emergence of social situations, options for interpersonal contacts between children that provoke affective reactions in a child;

- rational, clear, thoughtful verbal regulation of the child's activities;

- prevention of educational (psychological) overload and overwork, timely switching of the child's attention from this conflict situation to another type of activity, to the discussion of a "new" issue, etc.

Equally important is given to other areas of correctional-pedagogical and correctional-psychological work. These include:

· Formation of socially positive personal qualities: sociability, social activity, the ability to make strong-willed efforts, the desire to overcome the difficulties encountered, to self-affirmation in the team, combined with a benevolent, correct attitude towards others;

Formation of the correct relationships of children in the children's team (first of all, the normalization or establishment of the correct interpersonal relations between a child suffering from emotional-volitional disorders and other children of the educational group / class); conducting explanatory work with the children around the child. Teaching the child to cooperate with other children and adults;

Purposeful formation in children with emotional and volitional disorders game, subject-practical(including artistic and visual), educational and elementary labor activity; carrying out on this basis systematic diverse pedagogical work on the moral, aesthetic education of children, the formation of positive personality traits.

Streamlining and development of orienting and research activities (based on the purposeful formation of sensory perception, visual and auditory gnosis, operations of analyzing a perceived object and a holistic objective situation, etc.);

Introduction to collective forms of activity, involving the child in joint play, subject-practical and educational activities with other children. The formation of the child's teamwork skills: the ability to take into account common rules and the goals of this type of activity, the interests of other children, the ability to obey the requirements of the team, correlate their actions with the work of others, etc.

The development of cognitive interests and needs, the formation of a conscious, responsible attitude to one's duties, performed educational tasks, public assignments, etc.

Formation sustainable motives educational and subject-practical activities appropriate for the age. The development of verbal communication in the course of joint activities with the teacher, with other children (educational, playful, practical).

Upbringing purposefulness and planning activities, the formation of inhibitory ("restraining") reactions, correct self-assessment of one's own activity and behavior.

Active involvement of children in participation in the preparation and holding of holidays, excursions, cultural and sports events.

Development of motor functions, general and fine manual motility, including in the formation of subject-practical activities in its various types. Preparation for mastering the motor act of writing activity.

For this purpose, it is envisaged:

– Development of cognitive activity of children;

- The use of various methods and techniques in the process of correctional and pedagogical work with children, specifically aimed at shaping the activity and independence of children in educational and subject-practical activities (learning tasks with elements of competition, tasks of a creative nature using bright, colorful didactic material; exercises, built on the principle of "small steps", "climbing stairs", etc.);

- Regular classes in various circles, sections, clubs of interest.

Conducted educational and educational activities should be dynamic, varied, interesting and at the same time - should not contain excessive information, a large number of tasks that are difficult to complete independently, which often causes negative emotions, fatigue, and negative behavioral reactions in children.

Psychological * and psychological and pedagogical correction violations of the emotional and volitional sphere observed in children includes: correctional and developmental classes, psychological training, classes according to the system art correction(carried out by means game therapy, music therapy, fine arts: drawing, modeling, application, etc.). Game psychotherapy is of great importance when working with children of senior preschool and primary school age. For role-playing games, social situations are selected that are well understood by the child and relevant to him personally. During the game, the child learns adequate relationships with the people around him. Of great importance is the differentiated selection of plots for games that help the child adapt to his environment (for example: “My family”, where children act as parents, and dolls play the “role” of children; “Our little friends”, “We are builders”, "Cosmonauts", "Our House", "Playing on the Playground", etc.)

The implementation of a complex of medical and health-improving measures provides for:

medical consultation (teachers and parents),

Proper nutrition, diet therapy and herbal medicine;

medical treatment,

physiotherapy,

hydrotherapy and hardening procedures;

therapeutic gymnastics and massage, etc. *

Pedagogical work with the child's family includes a number of activities:

Identification and assessment of the social and living conditions in which the child's family lives;

study and analysis of the conditions for the upbringing and development of the child in the family;

Identification and elimination of incorrect approaches to raising a child in a family (upbringing in conditions of hyper-custody, a lack of educational influence of others / hypo-custody /, overestimated or underestimated requirements for a child by adults when organizing various types of his activities, etc.).

· Development of a unified (for teachers and parents) and adequate understanding of the problems of the child.

- Determination (together with parents) of the correct pedagogical approach to the upbringing and education of the child, taking into account his individual personality and psychological characteristics.

- Formation of a favorable "psychological climate" in the family (normalization of interpersonal relationships within the family - between parents and the child, between the child and other children in the family).

– Teacher Education parents; teaching them some accessible methods of correctional and pedagogical work. Inclusion of parents (as well as close relatives) in correctional and pedagogical work with the child (conducting correctional and developmental classes at home), etc.

Especially attentive, calm and tactful attitude towards a child with psychopathological personality traits is required from teachers and parents. In pedagogical work, one should rely on the positive characterological traits of the child's personality, the active use of techniques encouragement, education on positive examples, distraction from adversely acting moments and aspects of the surrounding life. In working with children suffering from emotional and volitional disorders, a calm, even tone, benevolence combined with exactingness, and the absence of multidirectional attitudes in organizing the activities and behavior of the child are necessary.

For the rehabilitation of autistic children in the complex correctional work, the following areas of correctional work are implemented.

Psychological correction which includes establishing contact with adults, alleviating the background of sensory and emotional discomfort, anxiety and fears, stimulating mental activity aimed at influencing adults and peers, forming purposeful behavior, overcoming negative forms of behavior. The work on this section is carried out by a psychologist.

Pedagogical correction. Depending on the level of development of the nervous system, the knowledge and skills of an autistic child, the nature of his passions and interests, an individual program of his education is created. Based on the data of the psychologist's research, the teacher conducts his own examination, determines specific learning objectives, and develops a work methodology.

Identification and development of creative abilities of children. Music is an important area of ​​life for an autistic child, giving him a lot of positive emotions, and singing often acts as the most important factor in the appearance and development of speech.

Development of general motor skills. Therapeutic physical education in correctional work with autistic children is very important. In connection with the underdevelopment of the functions of the vestibular apparatus, exercises for balance, coordination of movements, orientation in space are of particular importance.

Working with parents of autistic children. The complex of work with parents includes: psychotherapy of family members, familiarization of parents with a number of mental characteristics of a child with RDA, training in methods of raising an autistic child, organizing his regimen, developing self-service skills, preparing for schooling.

5. Basic forms and methods of psychological correction of emotional-volitional disorders

5.1 The main goal of psychological correction of behavioral disorders in children and adolescents with disharmonious development is the harmonization of their personal sphere, family relationships and the solution (elimination) of actual psycho-traumatic problems. In working with children and adolescents suffering from emotional and volitional disorders, the following methods of psychotherapy are widely used: suggestive psychotherapy, group, behavioral, family, rational, self-hypnosis. Psychoanalysis, transactional analysis, Gestalt therapy, autogenic training, etc. are often used. Autogenic training is an ordered use of special exercises and psychological relaxation, helps to manage emotions, restore strength, performance, relieve tension, overcome stressful conditions. Behavioral psychotherapy is based on the principles of behaviorism, helps to change the child's behavior under the influence of a positive stimulus, relieves discomfort, inadequate response. Training as a type of behavioral psychotherapy teaches you how to manage your emotions, make decisions, teaches communication skills, self-confidence. Rational psychotherapy as a method includes methods of clarification, suggestion, emotional impact, study, personality correction, logical argumentation. Occupational therapy is actively used as a link connecting a person with social reality. In fact, this is a treatment by employment, protection from personal decay, creation of conditions for interpersonal communication.

Of particular interest in psychocorrectional work with adolescents with disorders of emotional regulation of behavior is tiered approach proposed by prof. V.V. Lebedinsky (1988). The interaction of a person with the outside world, the realization of her needs can occur at different levels of activity and depth of emotional contact of a child (adolescent) with the environment. There are four main levels of such interaction.

First level field reactivity- Primarily associated with the most primitive, passive forms of mental adaptation. Affective experiences at this level do not yet contain a positive or negative assessment, they are associated only with a general feeling of comfort or discomfort.

At an older age of the child and in adults, this level performs background functions in the implementation of emotional and semantic adaptation to the environment. It provides a tonic reaction of affective processes. The role of this level in the regulation of behavior is extremely large and its underestimation entails significant costs in the psycho-corrective process. Tonic emotional regulation with the help of special daily psychotechnical techniques has a positive effect on different levels of "basal affectivity". Therefore, various psychoregulatory training using sensory stimuli ( sound, color, light, tactile touch) are of great importance in the psycho-correction of behavior.

Second - level of stereotypes- plays an important role in regulating the behavior of the child in the first months of life, in the formation of adaptive reactions - food, defensive, establishing physical contact with the mother. At this level, signals from the surrounding world and the internal environment of the body are already consciously evaluated, sensations of all modalities are affectively evaluated: auditory, visual, tactile, gustatory, etc. The type of behavior characteristic of this level of affective adaptation is stereotypical reactions. Affective stereotypes are a necessary background for ensuring the most complex forms of human behavior. Activation of this level of emotional regulation in the process of psycho-corrective work is achieved by focusing the child (teenager) on sensory (muscular, gustatory, tactile and other) sensations, perception and reproduction of simple rhythmic stimuli. This level, like the first one, contributes to the stabilization of a person's affective life. A variety of psychotechnical techniques widely used by psychologists, such as rhythmic repetitions, "ritual actions", jumps, swings, etc., occupy an important place in the psychocorrective process, especially at the first stages of training. They perform and how relaxing, And How mobilizing means of influence in the correction of the behavior of children and adolescents.

The third level of affective organization of behavior is expansion level- is the next step in the emotional contact of a person with the environment. Its mechanisms gradually begin to be mastered by the child in the second half of the first year of life, which contributes to the formation of active adaptation to new conditions. Affective experiences of the third level are not associated with the very satisfaction of the need, as it was at the second level, but with the achievement of the desired. They are distinguished by great strength and polarity. If at the second level the instability of the situation, uncertainty, danger, unsatisfied desire causes anxiety, fear, then at the third level they mobilize the subject to overcome difficulties. At this level of affective organization of activity and behavior, the child experiences curiosity for an unexpected impression, excitement in overcoming danger, anger, and a desire to overcome difficulties that arise. In the process of psycho-correction, the level of affective expansion is stimulated under the influence of experiences that arise in the process of an exciting game, risk, rivalry, overcoming difficult and dangerous situations, playing “frightening” stories containing a real prospect of their successful resolution.

The fourth level is the level emotional control(highest level of the system basal emotional regulation) - is formed on the basis of "subordination", complementarity and socialization of all previous levels. Adaptive affective behavior at this level rises to the next level of complexity. At this level, the affective basis for the arbitrary organization of human behavior is laid. The behavioral act of the subject is already becoming deed- an action that is built taking into account the attitude of another person towards him. In case of failure of adaptation, the subject at this level no longer reacts to a situation that is significant for him either by leaving, or by physical activity, or by directed aggression, as is possible at the previous levels, he turns to other people for help. At this level, the affective “orientation in oneself” is improved, which is an important prerequisite for the development of self-esteem. Affective experience at this level is associated with empathy for another person. Correction of the emotional and intellectual organization of behavior requires the mandatory inclusion of such psychotechnical techniques as cooperation, partnership, reflection which contributes to the formation of personal reactions humanism, empathy, self-control.

The identified levels of affective organization implement qualitatively different tasks of adaptation. Weakening or damage to one of the levels leads to a general affective maladaptation of the child or adolescent in the surrounding society.

Structural-level study of the basal emotional organization of a personality is important in solving the problem of shaping the individual behavior of children and adolescents and developing effective ways to correct it.

5.2 Behavioral disorders in children and adolescents with developmental disharmony are often based on insufficient voluntary regulation of activity. Relying on activity principle in psychology, it is possible to distinguish the main blocks of the structure of human behavior.

Motivational block- includes the ability of a child (teenager) to identify, realize and accept the purpose of behavior.

Operational-regulatory unit- the ability to plan actions to achieve the goal (both in content and in time for the implementation of activities).

control unit- the ability to control one's behavior and make the necessary adjustments to it.

Difficulties in understanding one's behavior are characteristic of many children and adolescents with disharmony of mental development. They manifest themselves in weak reflection, in ignorance of their "strong" and "weak" personal qualities, as well as in underestimation by a teenager of one or another psychotraumatic situation, contributing to

Emotions in a person act as a special class of mental states, which are reflected in the form of a positive or negative attitude towards the world around, other people and, above all, oneself. Emotional experiences are determined by the corresponding properties and qualities formed in objects and phenomena of reality, as well as certain needs and needs of a person.

The term "emotions" comes from the Latin name emovere, which means movement, excitement and excitement. The key functional component of emotions is the motivation for activity, as a result of which the emotional sphere is called the emotional-volitional sphere in a different way.

At the moment, emotions play a significant role in ensuring the interaction of the organism and the environment.

Emotions are mainly the result of reflecting human needs and assessing the likelihood of their satisfaction, which are based on personal and genetic experience.

How pronounced the emotional state of a person is depends on the importance of the needs and the lack of necessary information.

Negative emotions are manifested as a result of a lack of necessary information that is required to satisfy a number of needs, and positive emotions are characterized by the complete availability of all necessary information.

Today, emotions are divided into 3 main parts:

1. Affect, characterized by an acute experience of a certain event, emotional stress and excitement;
2. Cognition (awareness of one's state, its verbal designation and assessment of further prospects for meeting needs);
3. Expression, which is characterized by external bodily motility or behavior.

A relatively stable emotional state of a person is called mood. The scope of human needs includes social needs that arise on the basis of cultural needs, which later became known as feelings.

There are 2 emotional groups:

1. Primary (anger, sadness, anxiety, shame, surprise);
2. Secondary, which include processed primary emotions. For example, pride is joy.

Clinical picture of emotional-volitional disorders

The main external manifestations of violations of the emotional-volitional sphere include:

• Emotional stress. With increased emotional tension, there is a disorganization of mental activity and a decrease in activity.
• Rapid mental fatigue (in a child). It is expressed by the fact that the child is not able to concentrate, it is also characterized by a sharp negative reaction to certain situations where it is necessary to demonstrate their mental qualities.
• A state of anxiety, which is expressed by the fact that a person in every possible way avoids any contact with other people and does not strive to communicate with them.
• Increased aggressiveness. Most often occurs in childhood, when the child defiantly disobeys adults, experiences constant physical and verbal aggression. Such aggression can be expressed not only in relation to others, but also to oneself, thereby causing harm to one's own health.
• Lack of ability to feel and comprehend the emotions of other people, empathize. This sign, as a rule, is accompanied by increased anxiety and is the cause of mental disorder and mental retardation.
• Lack of desire to overcome life's difficulties. In this case, the child is in a constantly lethargic state, he has no desire to communicate with adults. The extreme manifestations of this disorder are expressed in the complete disregard for parents and other adults.
• Lack of motivation to succeed. The main factor in low motivation is the desire to avoid possible failures, as a result of which a person refuses to take on new tasks and tries to avoid situations where even the slightest doubt about ultimate success arises.
• Expressed distrust of other people. Often accompanied by such a sign as hostility towards others.
• Increased impulsivity in childhood. It is expressed by such signs as lack of self-control and awareness of one's actions.

Classification of violations in the emotional-volitional sphere

Violation of the emotional sphere in adult patients is distinguished by such features as:

• Hypobulia or a decrease in volitional qualities. Patients with this disorder do not have any need to communicate with other people, there is irritability in the presence of strangers nearby, lack of ability or desire to maintain a conversation.
• Hyperbulia. It is characterized by increased attraction in all spheres of life, often expressed in increased appetite and the need for constant communication and attention.
• Abulia. It is distinguished by the fact that a person's volitional drives are sharply reduced.
• Compulsive attraction is an irresistible need for something or someone. This disorder is often compared with the animal instinct, when a person's ability to over the awareness of their actions is significantly suppressed.
• Obsessive desire is a manifestation of obsessive desires that the patient is not able to independently control. Failure to satisfy such desires leads to depression and deep suffering of the patient, and his thoughts are filled with the idea of ​​their realization.

Syndromes of emotional-volitional disorders

The most common forms of disorders of the emotional sphere of activity are depressive and manic syndromes.

1. depressive syndrome

The clinical picture of a depressive syndrome is described by its 3 main features, such as:

• Hypotomy, characterized by a decrease in mood;
• Associative retardation (mental retardation);
• Motor retardation.

It is worth noting that it is the first of the above points that is a key sign of a depressive state. Hypotomy can be expressed in the fact that a person constantly yearns, feels depressed and sad. In contrast to the established reaction, when sadness arises as a result of an experienced sad event, in depression a person loses contact with the environment. That is, in this case, the patient does not show a reaction to joyful and other events.

Depending on the severity of the condition, hypotomy can occur with varying intensity.

Mental retardation in its mild manifestations is expressed in the form of a slowing down of monosyllabic speech and a long reflection on the answer. A severe course is characterized by an inability to comprehend the questions asked and solve a number of simple logical problems.

Motor inhibition manifests itself in the form of stiffness and slowness of movements. In severe depression, there is a risk of depressive stupor (a state of complete depression).

1. manic syndrome

Often, manic syndrome manifests itself in the framework of affective bipolar disorder. In this case, the course of this syndrome is characterized by paroxysmal, in the form of separate episodes with certain stages of development. The symptomatic picture that stands out in the structure of a manic episode is characterized by variability in one patient, depending on the stage of development of the pathology.

Such a pathological condition as a manic syndrome, as well as a depressive one, is distinguished by 3 main features:

• Increased mood due to hyperthymia;
• Mental excitability in the form of accelerated thought processes and speech (tachypsia);
• Motor excitation;

An abnormal increase in mood is characterized by the fact that the patient does not feel such manifestations as melancholy, anxiety and a number of other signs characteristic of a depressive syndrome.

Mental excitability with an accelerated thought process occurs up to a jump of ideas, that is, in this case, the patient's speech becomes incoherent, due to excessive distraction, although the patient himself is aware of the logic of his words. It also highlights the fact that the patient has ideas of his own greatness and denial of the guilt and responsibility of other people.

Increased motor activity in this syndrome is characterized by the disinhibition of this activity in order to obtain pleasure. Consequently, in manic syndrome, patients tend to consume large amounts of alcohol and drugs.

The manic syndrome is also characterized by such emotional disturbances as:

• Strengthening instincts (increased appetite, sexuality);
• Increased distractibility;
• Reassessment of personal qualities.

Methods for correcting emotional disorders

Features of the correction of emotional disorders in children and adults are based on the use of a number of effective techniques that can almost completely normalize their emotional state. As a rule, emotional correction in relation to children consists in the use of play therapy.

Often in childhood, emotional disorders are caused by a lack of gameplay, which significantly slows down mental and mental development.

The systematic motor and speech factor of the game allows you to reveal the capabilities of the child and feel positive emotions from the game process. The study of various situations from life in play therapy allows the child to adapt to real life conditions much faster.

There is another therapeutic approach, namely psychodynamic, which is based on the method of psychoanalysis, aimed at resolving the patient's internal conflict, understanding his needs and the experience gained from life.

The psychodynamic method also includes:

• art therapy;
• Indirect play therapy;
• Fairy tale therapy.

These specific effects have proven themselves not only in relation to children, but also to adults. They allow patients to liberate themselves, show creative imagination and present emotional disorders as a certain image. The psychodynamic approach also stands out for its ease and ease of conduct.

Also, common methods include ethnofunctional psychotherapy, which allows you to artificially form the duality of the subject, in order to realize their personal and emotional problems, as if focusing their gaze from the outside. In this case, the help of a psychotherapist allows patients to transfer their emotional problems to an ethnic projection, work them out, realize them and let them through themselves in order to finally get rid of them.

Prevention of emotional disorders

The main goal of preventing violations of the emotional-volitional sphere is the formation of dynamic balance and a certain margin of safety of the central nervous system. This state is determined by the absence of internal conflicts and a stable optimistic attitude.

Sustainable optimistic motivation makes it possible to move towards the intended goal, overcoming various difficulties. As a result, a person learns to make informed decisions based on a large amount of information, which reduces the likelihood of error. That is, the key to an emotionally stable nervous system is the movement of a person along the path of development.

As a result of studying this chapter, the student should:

know

• the nature and essence of the violations under study;
• theoretical concepts on the problems of disorders of the emotional-volitional sphere and behavior;
• features of an individual approach to persons of this category;
• the specifics of diagnostic and corrective work with this category of children and adolescents;

be able to

• conduct a psychological and pedagogical examination in case of violations of the emotional-volitional sphere and behavior;
• provide psychological assistance to families with these developmental disorders of the child;
• provide psychological support for the education and upbringing of children and adolescents with disorders of the emotional-volitional sphere and behavior;

own

• skills of primary and differential diagnostics;
• skills and techniques for compiling and implementing correctional and developmental programs.

I differ from other people in that I care what they don't care.

person with autism

Features of development in disorders of the emotional-volitional sphere and behavior. general characteristics

Among children with disabilities, i.e. of those who have various deviations in psychophysical and socio-personal development and need special assistance, children stand out in whom disorders in the emotional-volitional sphere, manifested in their behavior, come to the fore. Behavior is used to denote the type and level of human activity, which is predominantly in the form of external actions and deeds.

Being a manifestation of a person's active attitude to the world, behavior is often considered in the context of leading human activities: such as cognition, communication, play, educational and professional activities.

Based on the definition of behavior, two equivalent components are distinguished in it, namely, the need sphere that causes activity, and the actual nature of this activity. "Access" to the first component is provided, first of all, through the analysis of a person's emotional states, their intensity, positivity and negativity of the emotions experienced. It is the emotions experienced by a person that reflect the significance and attractiveness of ongoing events and the world around him in general. Experienced emotional states are the first signals that indicate the satisfaction or dissatisfaction of the actual needs of a person and the "call" for appropriate behavior.

It was the experience that was proposed by L. S. Vygotsky as a "unit of measurement" of the nature of the interaction between the child and the environment. The scientist wrote: “The experience of a child is such a simple unit, in relation to which it is impossible to say what it is - an environmental influence on the child or a feature of the child himself; experience is the unit of personality and environment". “In experiencing, therefore, on the one hand, the environment is given in its relation to me in how I experience this environment; on the other hand, the features of the development of my personality are affected.”

Despite the sufficient variety of classifications of behavioral disorders in general, the basis for qualifying behavior as deviant is the concept of the developmental norm in relation to various manifestations of human activity.

Among the children whom L. S. Vygotsky called "difficult" in the broad sense of the word, scientists singled out a group of children "difficult in the proper sense of the word - delinquents, children with character flaws, psychopaths" . The main feature of such children is a violation or delay in the development of higher socialized forms of behavior, involving interaction with another person, taking into account his thoughts, feelings, behavioral reactions. At the same time, activities not mediated by social interaction, namely, designing, fantasizing, solving intellectual problems, playing alone or on a computer, etc., can proceed at a high level.

According to the common classification of behavioral disorders in children and adolescents by R. Jenkins, the following types of behavioral disorders can be distinguished: hyperkinetic reaction, anxiety, autistic withdrawal, unsocialized aggressiveness, flight reaction, group delinquency.

In the International Classification of Mental and Behavioral Disorders in Children and Adolescents of the latest revision (ICD-10), these disorders are presented under the heading "Behavioral and emotional disorders usually beginning in childhood and adolescence" (F90-F98):

F90 - gynerkinetic disorders.

F91 - conduct disorders.

F91.0 Conduct disorder limited to family environment.

F91.1 - unsocialized conduct disorder.

F91.2 - socialized conduct disorder.

F91.3 Oppositional defiant disorder.

F92 - mixed disorders of behavior and emotions.

F93 - emotional disorders, the onset of which is specific to childhood.

F94 - disorders of social functioning, the onset of which is typical for childhood and adolescence.

F95 - tics.

F98 - Other emotional and behavioral disorders, usually beginning in childhood and adolescence.

Despite the heterogeneity of this group, the following general signs can be distinguished, indicating the presence of various disorders of the emotional-volitional sphere in children:

• - pronounced affective manifestations in relation to others;
• - inconsistency of the specific situation that caused the affect of the intensity of affective manifestations;
• – inability to establish and maintain positive interpersonal relationships with peers and adults;
• - a wide range of moods, with predominant dominance of a negative emotional background;
• - Anxiety-phobic states associated with personal or school problems.

The above features of children and adolescents with disorders of the emotional-volitional sphere and behavior (children with emotional and behavioral disorders- EBD) formed the basis of the law on persons with developmental disabilities in the United States in terms of defining a special group of children and adolescents in need of special assistance. A serious violation in the emotional sphere and behavior, according to this law, is the manifestation of one or more of the following characteristics, observed for a long time and so pronounced that it negatively affects the effectiveness of the educational process.

A. Learning difficulties not related to intellectual, sensory factors and physical health.

B. Failure to build and maintain interpersonal relationships with peers and educators.

C. Inappropriate (inadequate) ways of behaving or expressing emotions under normal circumstances.

D. Predominant depressive state, feeling unhappy.

E. Tendency to develop physical symptoms of fear associated with personal or school problems.

Thus, a child with severe behavioral disorders or severe emotional disorders exhibits age-inappropriate behavior leading to social conflict.

Behavioral disorders always involve causing disturbance to other people. In any society, the following are unacceptable: physical aggression, constant manifestation of unhappiness, motor disinhibition or, conversely, pronounced isolation from people, timidity.

Olga Ogneva
Characteristics of the main violations of the emotional-volitional sphere

Characteristics of the main violations of the emotional-volitional sphere

Violations of the emotional-volitional sphere most often present with increased emotional excitability in combination with severe instability of autonomic functions, general hyperesthesia, increased exhaustion of the nervous system. In children of the first years of life, disturbed sleep(difficulty falling asleep, frequent awakenings, restlessness at night). Affective arousal can occur even under the influence of ordinary tactile, visual and auditory stimuli, especially intensifying in an environment that is unusual for the child.

At older preschool age, children are characterized by excessive impressionability, a tendency to fear, and some are dominated by increased emotional excitability, irritability, motor disinhibition, others have shyness, shyness, lethargy. Most often, there are combinations of increased emotional lability with inertia emotional reactions, in some cases with elements of violence. So, having started crying or laughing, the child cannot stop, and emotions as if acquiring violent character. Increased emotional excitability is often combined with tearfulness, irritability, capriciousness, reactions of protest and refusal, which are greatly enhanced in a new environment for the child, as well as with fatigue.

emotional disorders dominate in the structure of the general maladjustment syndrome, characteristic of these children especially at an early age. In addition to increased emotional excitability, one can observe a state of complete indifference, indifference, indifference (apatic-abulic syndrome). This syndrome, as well as a joyful, elated mood with a decrease in criticism (euphoria, is noted with lesions of the frontal lobes of the brain. Others are possible: weakness of willpower, lack of independence, increased suggestibility, the occurrence of catastrophic reactions in so-called frustration situations.

It is conditionally possible to distinguish three most pronounced groups of so-called difficult children who have problems in emotional sphere:

Aggressive kids. Of course, in the life of every child there have been cases when he showed aggression, but highlighting this group, attention is drawn to the degree of manifestation of an aggressive reaction, the duration of action and the nature of the possible causes, sometimes implicit, causing affective behavior.

emotionally- disinhibited children. These kids are overreacting to everything. violently: if they express delight, then as a result of their expressive behavior they turn on the whole group, if they suffer, their cries and groans will be too loud and defiant.

Anxious children. They are embarrassed to loudly and clearly express their emotions, quietly experiencing their problems, afraid to draw attention to themselves.

TO major factors affecting emotional and volitional disorders, relate:

natural features (type of temperament)

social factors:

Type of family education;

The attitude of the teacher;

Relationships around.

In development emotional-volitional sphere distinguish three groups violations:

mood disorders;

Conduct disorders;

psychomotor disorders.

Mood disorders can be roughly divided into 2 kind: with reinforcement emotionality and its decrease.

The first group includes such conditions as euphoria, dysphoria, depression, anxiety, fears.

The second group includes apathy, emotional dullness.

Euphoria - high spirits, not associated with external circumstances. A child in a state of euphoria described as impulsive striving for dominance, impatient.

Dysphoria is a mood disorder, with a predominance of angry-dreary, gloomy-dissatisfied, with general irritability and aggressiveness. A child in a state of dysphoria can be described as sullen, angry, harsh, unyielding.

Depression is an affective state characterized by negative emotional background and general passivity of behavior. A child with low mood describe as unfortunate, gloomy, pessimistic.

Anxiety syndrome is a state of causeless concern, accompanied by nervous tension, restlessness. An anxious child can be defined as insecure, constrained, tense.

Fear - emotional condition arising in the event of awareness of impending danger. A preschooler who is afraid looks timid, frightened, withdrawn.

Apathy is an indifferent attitude to everything that happens, which is combined with a sharp drop in initiative. An apathetic child can be described as lethargic, indifferent, passive.

emotional dullness - flatness emotions, primarily the loss of subtle altruistic feelings while maintaining elementary forms emotional response

Behavioral disorders include hyperactivity and aggressive behavior: normative-instrumental aggression, passive-aggressive behavior, infantile aggressiveness, defensive aggression, demonstrative aggression, purposefully hostile aggression.

Hyperactivity is a combination of general motor restlessness, restlessness, impulsiveness of actions, emotional lability, violations concentration of attention. A hyperactive child is restless, does not complete the work he has begun, his mood quickly changes. Normative - instrumental aggression is a type of children's aggressiveness, where aggression is used in mostly as a norm of behavior in communication with peers.

An aggressive child is defiant, restless, pugnacious, enterprising, does not admit guilt, demands the submission of others. His aggressive actions are a means to a specific end, so positive emotions they are tested upon reaching the result, and not at the time of aggressive actions. Passive-aggressive behavior characterized by whims, stubbornness, the desire to subjugate others, unwillingness to observe discipline. Infantile aggressiveness is manifested in the child's frequent quarrels with peers, disobedience, making demands on parents, and the desire to offend others. Defensive aggression is a type of aggressive behavior that manifests itself both in the norm (an adequate response to external influences) and in a hypertrophied form, when aggression occurs in response to a variety of influences. The occurrence of hypertrophied aggression may be associated with difficulties in decoding the communicative actions of others. Demonstrative aggression is a kind of provocative behavior aimed at attracting the attention of adults or peers.In the first case, the child uses verbal aggression in an indirect form, which manifests itself in various statements in the form of complaints about a peer, in a demonstrative cry aimed at eliminating a peer.In the second case, when children use aggression as a means of attracting the attention of their peers, they most often use physical aggression - direct or indirect, which is involuntary, impulsive character(direct attack on another, threats and intimidation - as an example of direct physical aggression or the destruction of the products of the activity of another child in the case of indirect aggression).

Violation of the emotional-volitional sphere older preschoolers as a state renders in mostly negative, a disorganizing effect on the results of the activities of children of primary school age. The influence of anxiety on the development of personality, behavior and activities of the child is negative. character. The cause of anxiety is always the internal conflict of the child, his disagreement with himself, the inconsistency of his aspirations, when one of his strong desires contradicts another, one need interferes with another.

Children with violation of the emotional-volitional sphere characterized by frequent manifestations of anxiety and anxiety, as well as a large number of fears, and fears and anxiety occur in those situations in which the child, it would seem, is not in danger. Anxious children are particularly sensitive, suspicious and impressionable. Also, children often characterized by low self-esteem, in connection with which they have an expectation of trouble from others. This characteristic of those children whose parents set impossible tasks for them, demanding that children are not able to perform

Causes emotional disorders troubles children:

Inconsistency of requirements for the child at home and in kindergarten;

-disruption of the day;

Excess information received by the child (intelligent overloads);

The desire of parents to give their child knowledge that does not correspond to his age;

Unfavorable position in the family.

Frequent visits with the child to crowded places;

Excessive severity of parents, punishment for the slightest disobedience, fear of the child to do something wrong;

Decreased motor activity;

Lack of love and affection from parents, especially mother.

Literature:

1. Alyamovskaya V. G., Petrova S. N. Warning psycho-emotional stress in preschool children. M., Scriptorium, 2002.- 432s.

2. Karpova, G. Z World of feelings and emotions of a preschooler.: Educator of a preschool educational institution -2011. -N 8.-S. 119-121.

3. Smirnova E. O. Development of will and arbitrariness in early and preschool age. M.; Voronezh, 1998.-34s.

Emotions - this is one of the most important mechanisms of mental activity, producing a sensually colored subjective total assessment of incoming signals, the well-being of a person's internal state and the current external situation.

The general favorable assessment of the present situation and the available prospects is expressed in positive emotions - joy, pleasure, peace, love, comfort. The general perception of the situation as unfavorable or dangerous is manifested by negative emotions - sadness, longing, fear, anxiety, hatred, anger, discomfort. Thus, the quantitative characteristic of emotions should be carried out not along one, but along two axes: strong - weak, positive - negative. For example, the term "depression" means strong negative emotions, and the term "apathy" indicates weakness or complete absence of emotions (indifference). In some cases, a person does not have enough information to evaluate a particular stimulus - this can cause vague emotions of surprise, bewilderment. Healthy people rarely, but have conflicting feelings: love and hate at the same time.

Emotion (feeling) is an internally subjective experience, inaccessible to direct observation. The doctor judges the emotional state of a person by affect (in the broadest sense of the term), i.e. according to the external expression of emotions: facial expressions, gestures, intonation, vegetative reactions. In this sense, the terms "affective" and "emotional" are used interchangeably in psychiatry. Often one has to deal with a discrepancy between the content of the patient's speech and facial expression, tone of expression. Facial expressions and intonation in this case allow us to assess the true attitude to what was said. The statements of patients about love for relatives, the desire to get a job, combined with the monotony of speech, the lack of proper affect, testify to the unsubstantiated statements, the predominance of indifference and laziness.

Emotions are characterized by some dynamic features. Prolonged emotional states correspond to the term " mood”, which in a healthy person is quite mobile and depends on a combination of many circumstances - external (luck or defeat, the presence of an insurmountable obstacle or expectation of a result) and internal (physical ill health, natural seasonal fluctuations in activity). A change in the situation in a favorable direction should lead to an improvement in mood. At the same time, it is characterized by a certain inertia, so the joyful news against the background of sad experiences cannot evoke an immediate response in us. Along with stable emotional states, there are also short-term violent emotional reactions - a state of affect (in the narrow sense of the word).

There are several main emotion functions. The first one, signal, allows you to quickly assess the situation - before a detailed logical analysis is carried out. Such an assessment based on the general impression is not completely perfect, but it allows us not to waste too much time on the logical analysis of insignificant stimuli. Emotions generally signal us about the presence of any need: we learn about the desire to eat by feeling hungry; about the thirst for entertainment - from a feeling of boredom. The second important function of emotions is communicative. Emotionality helps us communicate and act together. The collective activity of people involves such emotions as sympathy, empathy (mutual understanding), distrust. Violation of the emotional sphere in mental illness naturally entails a violation of contacts with others, isolation, misunderstanding. Finally, one of the most important functions of emotions is shaping behavior person. It is emotions that allow us to assess the significance of a particular human need and serve as an impetus for its implementation. So, the feeling of hunger prompts us to look for food, suffocation - to open the window, shame - to hide from the audience, fear Ha- flee. It is important to bear in mind that emotion does not always accurately reflect the true state of internal homeostasis and the features of the external situation. Therefore, a person, when hungry, can eat more than is necessary for the body, feeling fear, he avoids a situation that is not really dangerous. On the other hand, the feeling of pleasure and satisfaction (euphoria) artificially induced with the help of drugs deprives a person of the need to act despite a significant violation of his homeostasis. The loss of the ability to experience emotions in a mental illness naturally leads to inaction. Such a person does not read books and does not watch TV, because he does not feel bored, does not take care of clothes and cleanliness of the body, because he does not feel shame.

According to the influence on behavior, emotions are divided into sthenic(prompting to action, activating, exciting) and asthenic(depriving activity and strength, paralyzing the will). The same traumatic situation can cause excitement, flight, frenzy, or, conversely, numbness in different people (“legs buckled with fear”). So, emotions give the necessary impetus to take action. The direct conscious planning of behavior and the implementation of behavioral acts are performed by the will.

Will is the main regulatory mechanism of behavior that allows you to consciously plan activities, overcome obstacles, satisfy needs (drives) in a form that promotes greater adaptation.

Attraction is a state of a specific human need, a need for certain conditions of existence, dependence on their presence. Conscious drives we call desires. It is practically impossible to list all the possible types of needs: their set is unique and subjective for each person, but several needs that are most important for most people should be indicated. These are physiological needs for food, safety (self-preservation instinct), sexual desire. In addition, a person as a social being often needs to communicate (affiliative need), and also seeks to take care of loved ones (parental instinct).

A person always has several competing needs that are relevant to him at the same time. The choice of the most important of them on the basis of an emotional assessment is carried out by the will. Thus, it allows you to realize or suppress existing drives, focusing on an individual scale of values ​​- hierarchy of motives. Suppressing a need does not mean reducing its relevance. The inability to realize the actual need for a person causes an emotionally unpleasant feeling - frustration. Trying to avoid it, a person is forced either to satisfy his need later, when conditions change to more favorable (for example, an alcoholic does when he receives a long-awaited salary), or to make an attempt to change his attitude to the need, i.e. apply psychological defense mechanisms(see section 1.1.4).

Weakness of will as a property of a person or as a manifestation of a mental illness, on the one hand, does not allow a person to systematically satisfy his needs, and on the other hand, leads to the immediate fulfillment of any desire that has arisen in a form that is contrary to the norms of society and causes maladaptation.

Although in most cases it is not possible to associate mental functions with any particular nervous structure, it should be mentioned that experiments indicate the presence in the brain of certain centers of pleasure (a number of regions of the limbic system and septal area) and avoidance. In addition, it has been noted that damage to the frontal cortex and pathways leading to the frontal lobes (for example, during a lobotomy operation) often leads to loss of emotions, indifference and passivity. In recent years, the problem of functional asymmetry of the brain has been discussed. It is assumed that the emotional assessment of the situation mainly occurs in the non-dominant (right hemisphere), with the activation of which states of melancholy, depression are associated, while when the dominant (left) hemisphere is activated, an increase in mood is more often observed.

8.1. Symptoms of emotional disorders

Emotional disorders are an excessive expression of a person's natural emotions (hyperthymia, hypothymia, dysphoria, etc.) or a violation of their dynamics (lability or rigidity). It is necessary to speak about the pathology of the emotional sphere when emotional manifestations deform the behavior of the patient as a whole, cause serious maladaptation.

Hypothymia - persistent painful lowering of mood. The concept of hypothymia corresponds to sadness, melancholy, depression. Unlike the natural feeling of sadness due to an unfavorable situation, hypothymia in mental illness is remarkably persistent. Regardless of the current situation, patients are extremely pessimistic about their current condition and available prospects. It is important to note that this is not only a strong feeling of longing, but also an inability to experience joy. Therefore, a person in such a state cannot be amused by either a witty anecdote or pleasant news. Depending on the severity of the disease, hypothymia can take the form of mild sadness, pessimism to a deep physical (vital) feeling, experienced as "mental pain", "chest tightness", "a stone in the heart". This feeling is called vital (precordial) longing, it is accompanied by a sense of catastrophe, hopelessness, collapse.

Hypothymia as a manifestation of strong emotions is classified as a productive psychopathological disorder. This symptom is not specific and can be observed during exacerbation of any mental illness, it often occurs in severe somatic pathology (for example, in malignant tumors), and is also included in the structure of obsessive-phobic, hypochondriacal and dysmorphomanic syndromes. However, this symptom is primarily associated with the concept depressive syndrome, for which hyothymia is the main syndrome-forming disorder.

Hyperthymia - persistent painful elevation of mood. Bright positive emotions are associated with this term - joy, fun, delight. In contrast to situationally determined joy, hyperthymia is characterized by persistence. For weeks and months, patients constantly maintain an amazing optimism, a feeling of happiness. They are full of energy, show initiative and interest in everything. Neither the sad news, nor the obstacles to the implementation of plans do not violate their general joyful mood. Hyperthymia is a characteristic manifestation manic syndrome. The most acute psychoses are expressed by particularly strong exalted feelings, reaching a degree ecstasy. Such a condition may indicate the formation of oneiroid clouding of consciousness (see section 10.2.3).

A special variant of hyperthymia is the condition euphoria, which should be considered not so much as an expression of joy and happiness, but as a complacently careless affect. Patients do not show initiative, are inactive, prone to empty talk. Euphoria is a sign of a wide variety of exogenous and somatogenic brain lesions (intoxication, hypoxia, brain tumors and extensive decaying extracerebral neoplasms, severe damage to the liver and kidney function, myocardial infarction, etc.) and may be accompanied by delusional ideas of grandeur (in paraphrenic syndrome, in patients with progressive paralysis).

term moriya denote foolish careless babbling, laughter, unproductive excitement in deeply mentally ill patients.

Dysphoria They call suddenly arising bouts of anger, anger, irritation, dissatisfaction with others and with themselves. In this state, patients are capable of cruel, aggressive actions, cynical insults, rude sarcasm and bullying. The paroxysmal course of this disorder indicates the epileptiform nature of the symptoms. In epilepsy, dysphoria is observed either as an independent type of seizures, or is included in the structure of the aura and twilight stupefaction. Dysphoria is one of the manifestations of the psycho-organic syndrome (see section 13.3.2). Dysphoric episodes are often also observed in explosive (excitable) psychopathy and in patients with alcoholism and drug addiction during the period of withdrawal.

Anxiety - the most important human emotion, closely related to the need for security, expressed by a sense of an impending vague threat, internal unrest. Anxiety - sthenic emotion: accompanied by throwing, restlessness, anxiety, muscle tension. As an important signal of trouble, it can occur in the initial period of any mental illness. In obsessive-compulsive disorder and psychasthenia, anxiety is one of the main manifestations of the disease. In recent years, sudden onset (often against the background of a traumatic situation) panic attacks, manifested by acute anxiety attacks, have been isolated as an independent disorder. A powerful, unfounded feeling of anxiety is one of the early symptoms of an incipient acute delusional psychosis.

In acute delusional psychoses (syndrome of acute sensual delirium), anxiety is extremely pronounced and often reaches a degree confusion, in which it is combined with uncertainty, misunderstanding of the situation, a violation of the perception of the world around (derealization and depersonalization). Patients are looking for support and explanations, their look expresses surprise ( bewilderment effect). Like the state of ecstasy, such a disorder indicates the formation of a oneiroid.

Ambivalence - simultaneous coexistence of 2 mutually exclusive emotions (love and hate, affection and disgust). In mental illness, ambivalence causes significant suffering to patients, disorganizes their behavior, leads to contradictory, inconsistent actions ( ambivalence). The Swiss psychiatrist E. Bleuler (1857-1939) considered ambivalence as one of the most typical manifestations of schizophrenia. Currently, most psychiatrists consider this condition to be a non-specific symptom observed, in addition to schizophrenia, in schizoid psychopathy and (in a less pronounced form) in healthy people prone to introspection (reflection).

Apathy - Absence or a sharp decrease in the severity of emotions, indifference, indifference. Patients lose interest in relatives and friends, are indifferent to events in the world, indifferent to their health and appearance. The speech of patients becomes boring and monotonous, they do not show any interest in conversation, facial expressions are monotonous. The words of others do not cause them any resentment, embarrassment, or surprise. They may claim that they feel love for their parents, but when meeting with loved ones they remain indifferent, do not ask questions and silently eat the food brought to them. The unemotionality of patients is especially pronounced in a situation that requires an emotional choice (“What food do you like best?”, “Who do you love more: dad or mom?”). The absence of feelings does not allow them to express any preference.

Apathy refers to negative (deficit) symptoms. Often it serves as a manifestation of the end states in schizophrenia. It should be borne in mind that apathy in patients with schizophrenia is constantly increasing, passing through a number of stages that differ in the degree of severity of the emotional defect: smoothness (leveling) of emotional reactions, emotional coldness, emotional dullness. Another cause of apathy is damage to the frontal lobes of the brain (trauma, tumors, partial atrophy).

Symptom to be distinguished from apathy painful mental insensitivity (anaesthesiapsychicadorosa, mournful insensitivity). The main manifestation of this symptom is not the absence of emotions as such, but a painful sense of one's own immersion in selfish experiences, a consciousness of the inability to think about anyone else, often combined with delusions of self-blame. Often there is a phenomenon of hypesthesia (see section 4.1). Patients complain / that they have become “like a piece of wood”, that they have “not a heart, but an empty tin can”; lament that they do not feel anxiety for young children, are not interested in their success at school. The vivid emotion of suffering indicates the severity of the condition, the reversible productive nature of the disorders. Anaesthesiapsychicadolorosa is a typical manifestation of a depressive syndrome.

Symptoms of impaired emotional dynamics include emotional lability and emotional rigidity.

Emotional lability - this is extreme mobility, instability, ease of emergence and change of emotions. Patients easily move from tears to laughter, from fussiness to nonchalant relaxation. Emotional lability is one of the important characteristics of patients with hysterical neurosis and hysterical psychopathy. A similar condition can also be observed in syndromes of clouding of consciousness (delirium, oneiroid).

One of the options for emotional lability is weakness (emotional weakness). This symptom is characterized not only by a rapid change in mood, but also by the inability to control external manifestations of emotions. This leads to the fact that each (even unimportant) event is experienced vividly, often causing tears that arise not only during sad experiences, but express tenderness and delight. Weakness is a typical manifestation of vascular diseases of the brain (cerebral atherosclerosis), but it can also occur as a personality trait (sensitivity, vulnerability).

A 69-year-old patient with diabetes mellitus and severe memory disorders vividly experiences her helplessness: “Oh, doctor, I was a teacher. The students listened to me with their mouths open. And now sourdough sourdough. Whatever my daughter says, I don’t remember anything, I have to write everything down. My legs do not walk at all, I can hardly crawl around the apartment ... ". All this the patient says, constantly wiping her eyes. When asked by the doctor who else lives with her in the apartment, she answers: “Oh, our house is full of people! It is a pity that the deceased husband did not live. My brother-in-law is a hardworking, caring person. The granddaughter is intelligent: she dances, and draws, and she has English ... And her grandson will go to college next year - he has such a special school! The patient pronounces the last phrases with a triumphant face, but the tears continue to flow, and she constantly wipes them with her hand.

Emotional rigidity - stiffness, stuckness of emotions, a tendency to long-term experience of feelings (especially emotionally unpleasant ones). Expressions of emotional rigidity are vindictiveness, stubbornness, perseverance. In speech, emotional rigidity is manifested by thoroughness (viscosity). The patient cannot move on to a discussion of another topic until he fully speaks out about the issue of interest to him. Emotional rigidity is a manifestation of the general torpidity of mental processes observed in epilepsy. There are also psychopathic characters with a tendency to get stuck (paranoid, epileptoid).

8.2. Symptoms of disorders of the will and inclinations

Disorders of the will and drives are manifested in clinical practice as behavioral disorders. It should be borne in mind that the statements of patients do not always accurately reflect the nature of existing disorders, since patients often hide their pathological inclinations, they are ashamed to admit to others, for example, that they are lazy. Therefore, the conclusion about the presence of violations of the will and inclinations should be made not on the basis of declared intentions, but based on an analysis of the actions performed. So, the statement of the patient about the desire to get a job looks unfounded if he has not been working for several years and does not attempt to find employment. It should not be taken as an adequate statement of the patient that he likes to read if he read the last book several years ago.

Allocate quantitative changes and perversions of drives.

Hyperbulia - a general increase in the will and inclinations, affecting all the main inclinations of a person. An increase in appetite leads to the fact that patients, while in the department, immediately eat the food brought to them and sometimes cannot resist taking food from someone else's bedside table. Hypersexuality is manifested by increased attention to the opposite sex, courtship, immodest compliments. Patients try to draw attention to themselves with bright cosmetics, catchy clothes, stand at the Mirror for a long time, putting their hair in order, and may engage in numerous casual sexual intercourse. There is a pronounced craving for communication: any conversation of others becomes interesting for patients, they try to join in the conversations of strangers. Such people strive to provide patronage to any person, give away their belongings and money, make expensive gifts, get into a fight, wanting to protect the weak (in their opinion). It is important to bear in mind that the simultaneous increase in inclination and will, as a rule, does not allow patients to commit obviously dangerous and gross illegal acts, sexual violence. Although such people usually do not pose a danger, they can interfere with others with their obsession, fussiness, behave carelessly, and mismanage property. Hyperbulia is a characteristic manifestation manic syndrome.

Typobulia - general decrease in will and inclinations. It should be borne in mind that in patients with hypobulia, all the main drives, including physiological ones, are suppressed. There is a decrease in appetite. The doctor may convince the patient to eat, but he takes food reluctantly and in small quantities. A decrease in sexual desire is manifested not only by a decrease in interest in the opposite sex, but also by a lack of attention to one's own appearance. Patients do not feel the need for communication, they are burdened by the presence of strangers and the need to maintain a conversation, they ask to be left alone. Patients are immersed in the world of their own suffering and cannot take care of their loved ones (especially surprising is the behavior of a mother with postpartum depression, who is unable to bring herself to take care of a newborn). Suppression of the instinct of self-preservation is expressed in suicidal attempts. A sense of shame for one's inaction and helplessness is characteristic. Hypobulia is a manifestation depressive syndrome. The suppression of drives in depression is a temporary, transient disorder. The relief of an attack of depression leads to a resumption of interest in life, activity.

At abulia usually there is no suppression of physiological drives, the disorder is limited to a sharp decrease in will. Laziness and lack of initiative of persons with aboulia is combined with a normal need for food, a distinct sexual desire, which are satisfied in the simplest, not always socially acceptable ways. So, a patient who is hungry, instead of going to the store and buying the products he needs, asks his neighbors to feed him. The patient's sexual desire is satisfied by incessant masturbation or makes absurd demands on his mother and sister. In patients suffering from aboulia, higher social needs disappear, they do not need communication, entertainment, they can spend all their days inactive, they are not interested in events in the family and in the world. In the department, they do not communicate with their neighbors in the ward for months, they do not know their names, the names of doctors and nurses.

Abulia is a persistent negative disorder, together with apathy it is a single apathico-abulic syndrome, characteristic of end states in schizophrenia. With progredient diseases, doctors can observe an increase in the phenomena of abulia - from mild laziness, lack of initiative, inability to overcome obstacles to gross passivity.

A 31-year-old patient, a turner by profession, after suffering an attack of schizophrenia left work in the workshop, because he considered it too difficult for himself. He asked to take him as a photographer in the city newspaper, as he used to do a lot of photography. Once, on behalf of the editorial office, he had to compile a report on the work of collective farmers. I arrived in the village in urban shoes and, in order not to get my shoes dirty, did not approach the tractors in the field, but took only a few pictures from the car. He was fired from the editorial office for laziness and lack of initiative. Didn't apply for another job. At home he refused to do any household chores. He stopped caring for the aquarium, which he made with his own hands before the illness. For days on end I lay in bed dressed and dreamed of moving to America, where everything is easy and affordable. He did not mind when relatives turned to psychiatrists with a request to issue him a disability.

Many symptoms described perversions of instincts (parabulia). Manifestations of mental disorders can be a perversion of appetite, sexual desire, the desire for antisocial acts (theft, alcoholism, vagrancy), self-harm. Table 8.1 shows the main terms for ICD-10 drive disorders.

Parabulia are not considered as independent diseases, but are only a symptom. The reasons for the

Table 8.1. Clinical Variants of Attraction Disorders

Note. Terms for which no code is given are not included in ICD-10.

There are gross violations of the intellect (oligophrenia, total dementia), various forms of schizophrenia (both in the initial period and at the final stage with the so-called schizophrenic dementia), as well as psychopathy (persistent personality disharmony). In addition, craving disorders are a manifestation of metabolic disorders (for example, eating inedible during anemia or pregnancy), as well as endocrine diseases (increased appetite in diabetes, hyperactivity in hyperthyroidism, aboulia in hypothyroidism, sexual behavior disorders with an imbalance of sex hormones).

Each of the pathological drives can be expressed in varying degrees. There are 3 clinical variants of pathological drives - obsessive and compulsive drives, as well as impulsive actions.

Obsessive (compulsive) attraction involves the emergence of desires that the patient can control in accordance with the situation. Inclinations that are clearly at odds with the requirements of ethics, morality and legality are never realized in this case and are suppressed as unacceptable. However, the refusal to satisfy the desire gives rise to strong feelings in the patient; in addition to the will, thoughts about an unsatisfied need are constantly stored in the head. If it does not have an obvious anti-social character, the patient performs it at the first opportunity. Thus, a person with an obsessive fear of pollution will restrain the urge to wash his hands for a short time, but he will definitely wash them thoroughly when strangers are not looking at him, because all the time he suffers, he constantly thinks painfully about his need. Obsessional drives are included in the structure of the obsessive-phobic syndrome. In addition, they are a manifestation of mental dependence on psychotropic drugs (alcohol, tobacco, hashish, etc.).

Compulsive attraction - a more powerful feeling, since it is comparable in strength to such vital needs as hunger, thirst, the instinct of self-preservation. Patients are aware of the perverse nature of the attraction, they try to restrain themselves, but with an unsatisfied need, an unbearable feeling of physical discomfort arises. The pathological need occupies such a dominant position that a person quickly stops the internal struggle and satisfies his desire, even if this is associated with gross antisocial acts and the possibility of subsequent punishment. Compulsive attraction can be the cause of repeated violence and serial killings. A striking example of compulsive craving is the desire for a drug during withdrawal syndrome in those suffering from alcoholism and drug addiction (physical dependence syndrome). Compulsive drives are also a manifestation of psychopathy.

impulsive acts committed by a person immediately, as soon as a painful attraction arises, without a previous struggle of motives and without a stage of decision. Patients can think about their actions only after they have been committed. At the moment of action, an affectively narrowed consciousness is often observed, which can be judged by the subsequent partial amnesia. Among impulsive acts, absurd ones, devoid of any meaning, predominate. Often, patients subsequently cannot explain the purpose of the deed. Impulsive acts are a frequent manifestation of epileptiform paroxysms. Patients with catatonic syndrome are also inclined to commit impulsive actions.

Disorders of impulses should be distinguished from actions caused by the pathology of other areas of the psyche. So, refusal to eat is caused not only by a decrease in appetite, but also by the presence of delusions of poisoning, imperative hallucinations that prohibit the patient from eating, as well as a gross disorder of the motor sphere - catatonic stupor (see section 9.1). Acts that lead patients to their own death do not always express the desire to commit suicide, but are also due to imperative hallucinations or clouding of consciousness (for example, a patient in a state of delirium, fleeing from imaginary pursuers, jumps out of a window, believing that this is a door).

8.3. Syndromes of emotional-volitional disorders

The most striking manifestations of affective disorders are depressive and manic syndromes (Table 8.2).

8.3.1. depressive syndrome

The clinical picture of a typical depressive syndrome It is customary to describe in the form of a triad of symptoms: decreased mood (hypothymia), slowing down of thinking (associative retardation), and motor retardation. However, it should be borne in mind that it is a decrease in mood that is the main syndrome-forming sign of depression. Hypothymia can be expressed in complaints of melancholy, depression, sadness. In contrast to the natural reaction of sadness in response to a sad event, longing in depression loses its connection with the environment; patients do not show a reaction either to the good news or to new blows of fate. Depending on the severity of the depressive state, hypothymia can be manifested by feelings of varying intensity - from mild pessimism and sadness to a heavy, almost physical feeling of "a stone on the heart" ( vital anguish).

manic syndrome

depressive syndrome

Depressive triad: decreased mood ideational retardation motor retardation

low self esteem,

pessimism

Delusions of self-accusation, self-abasement, hypochondriacal delusions

Suppression of desires: decreased appetite decreased libido avoidance of contacts, isolation depreciation of life, suicidal tendencies

Sleep disorders: reduced duration early awakening no sense of sleep

Somatic disorders: dry skin, decreased skin turgor, brittle hair and nails, lack of tears, constipation

tachycardia and high blood pressure pupil dilation (mydriasis) weight loss

Manic triad: increased mood, accelerated thinking, psychomotor agitation

Inflated self-esteem, optimism

Delusions of grandeur

Disinhibition of drives: increased appetite hypersexuality desire for communication the need to help others, altruism

Sleep disorder: reduced sleep duration without causing fatigue

Somatic disorders are not typical. Patients do not show complaints, look young; an increase in blood pressure corresponds to the high activity of patients; body weight decreases with severe psychomotor agitation

Slowing down of thinking in mild cases is expressed by slow monosyllabic speech, long deliberation of the answer. In more severe cases, patients have difficulty comprehending the question asked, unable to cope with the solution of the simplest logical tasks. They are silent, there is no spontaneous speech, but complete mutism (silence) usually does not happen. Motor inhibition is manifested in stiffness, slowness, slowness, in severe depression it can reach the degree of stupor (depressive stupor). The posture of stuporous patients is quite natural: lying on your back with outstretched arms and legs, or sitting with your head bowed, resting your elbows on your knees.

Statements of depressed patients reveal a sharply low self-esteem: they describe themselves as insignificant, worthless people, devoid of talents. Surprised that the doctor

devotes his time to such an insignificant person. Pessimistically assess not only their present state, but also the past and future. They say that they could not do anything in this life, that they brought a lot of trouble to their family, they were not a joy for their parents. They make the saddest predictions; as a rule, do not believe in the possibility of recovery. In severe depression, delusions of self-accusation and self-abasement are not uncommon. Patients consider themselves deeply sinful before God, guilty of the death of their elderly parents, of the cataclysms taking place in the country. Often they blame themselves for the loss of the ability to empathize with others (anaesthesiapsychicadorosa). It is also possible the appearance of hypochondriacal delusions. Patients believe they are terminally ill, perhaps with a shameful illness; afraid of infecting loved ones.

Suppression of desires, as a rule, is expressed by isolation, loss of appetite (less often by bouts of bulimia). The lack of interest in the opposite sex is accompanied by distinct changes in physiological functions. Men often experience impotence and blame it on themselves. In women, frigidity is often accompanied by menstrual irregularities and even prolonged amenorrhea. Patients avoid any communication, among people they feel awkward, inappropriate, someone else's laughter only emphasizes their suffering. Patients are so immersed in their experiences that they are unable to care for anyone else. Women stop doing housework, cannot take care of young children, do not pay any attention to their appearance. Men do not cope with their favorite work, unable to get out of bed in the morning, get ready and go to work, lie all day without sleep. Patients have no entertainment, they do not read or watch TV.

The greatest danger in depression is a predisposition to suicide. Among mental disorders, depression is the most common cause of suicide. Although thoughts of passing away are inherent in almost all those suffering from depression, the real danger arises when severe depression is combined with sufficient activity of patients. With a pronounced stupor, the implementation of such intentions is difficult. Cases of extended suicide are described, when a person kills his children in order to "save them from future torment."

One of the most painful experiences in depression is persistent insomnia. Patients sleep poorly at night and cannot rest during the day. Particularly characteristic is awakening in the early morning hours (sometimes at 3 or 4 o'clock), after which the patients no longer fall asleep. Sometimes patients insist that they did not sleep for a minute at night, they never closed their eyes, although relatives and medical staff saw them sleeping ( no sense of sleep).

Depression is usually accompanied by a variety of somatovegetative symptoms. As a reflection of the severity of the condition, peripheral sympathicotonia is more often observed. A characteristic triad of symptoms is described: tachycardia, dilated pupil, and constipation ( triad of Protopopov). The appearance of patients is noteworthy. The skin is dry, pale, flaky. A decrease in the secretory function of the glands is expressed in the absence of tears (“she cried out all her eyes”). Hair loss and brittle nails are often noted. A decrease in skin turgor is manifested in the fact that wrinkles deepen and patients look older than their age. An atypical fracture of the eyebrow may be observed. Fluctuations in blood pressure with a tendency to increase are recorded. Disorders of the gastrointestinal tract are manifested not only by constipation, but also by a deterioration in digestion. As a rule, there is a noticeable decrease in body weight. Various pains are frequent (headaches, cardiac, in the abdomen, in the joints).

A 36-year-old patient was transferred to a psychiatric hospital from the therapeutic department, where he was examined for 2 weeks due to constant pain in the right hypochondrium. During the examination, the pathology was not revealed, however, the man assured that he had cancer, and admitted to the doctor that he intended to commit suicide. He did not object to being transferred to a psychiatric hospital. Depressed on admission, answers questions in monosyllables; declares that he "doesn't care anymore!". In the ward, he does not communicate with anyone, most of the time lies in bed, eats almost nothing, constantly complains about the lack of sleep, although the staff reports that the patient sleeps every night, at least until 5 am. Once, during a morning examination, a strangulation furrow was found on the patient's neck. Upon persistent questioning, he admitted that in the morning, when the staff fell asleep, he tried, while lying in bed, to strangle himself with a noose knitted from 2 handkerchiefs. After treatment with antidepressants, painful thoughts and all unpleasant sensations in the right hypochondrium disappeared.

Somatic symptoms of depression in some patients (especially at the first attack of the disease) may act as the main complaint. This is the reason for their appeal to the therapist and long-term, unsuccessful treatment for "coronary heart disease", "hypertension", "biliary dyskinesia", "vegetovascular dystonia", etc. In this case, they talk about masked (larvated) depression, described in more detail in chapter 12.

The brightness of emotional experiences, the presence of delusional ideas, signs of hyperactivity of the autonomic systems make it possible to consider depression as a syndrome of productive disorders (see Table 3.1). This is also confirmed by the characteristic dynamics of depressive states. In most cases, depression lasts for several months. However, it is always reversible. Before the introduction of antidepressants and electroconvulsive therapy into medical practice, doctors often observed a spontaneous exit from this state.

The most typical symptoms of depression have been described above. In each individual case, their set may vary significantly, but a depressed, dreary mood always prevails. An extended depressive syndrome is considered as a disorder of the psychotic level. The severity of the condition is evidenced by the presence of delusional ideas, lack of criticism, active suicidal behavior, severe stupor, suppression of all basic drives. A mild, non-psychotic variant of depression is referred to as subdepression. When conducting scientific research, special standardized scales (Hamilton, Tsung, etc.) are used to measure the severity of depression.

Depressive syndrome is not specific and can be a manifestation of a wide variety of mental illnesses: manic-depressive psychosis, schizophrenia, organic brain damage and psychogenia. For depression caused by an endogenous disease (MDP and schizophrenia), pronounced somatovegetative disorders are more characteristic, an important sign of endogenous depression is a special daily dynamics of the state with an increase in melancholy in the morning and some weakening of feelings in the evening. It is the morning hours that are considered as the period associated with the greatest risk of suicide. Another marker of endogenous depression is a positive dexamethasone test (see section 1.1.2).

In addition to the typical depressive syndrome, a number of atypical variants of depression are described.

Anxious (agitated) depression characterized by the absence of pronounced stiffness and passivity. The sthenic affect of anxiety makes patients fuss, constantly turn to others with a request for help or with a demand to stop their torment, to help them die. The premonition of an imminent catastrophe does not allow patients to sleep, they may attempt to commit suicide in front of others. At times, the excitement of patients reaches a degree of frenzy (melancholic raptus, raptus melancholicus), when they tear their clothes, make terrible cries, beat their heads against the wall. Anxiety depression is more often observed in the involutionary age.

depressive-delusional syndrome, in addition to a melancholy mood, it is manifested by such delirium plots as delusions of persecution, staging, influence. Patients are confident in severe punishment for committed misconduct; "notice" the constant observation of themselves. They fear that their guilt will lead to harassment, punishment or even the killing of their relatives. Patients are restless, constantly asking about the fate of their relatives, trying to make excuses, swearing that they will never make a mistake in the future. Such atypical delusional symptoms are more typical not for MDP, but for an acute attack of schizophrenia (schizoaffective psychosis in terms of ICD-10).

Apathetic depression combines the effects of melancholy and apathy. Patients are not interested in their future, they are inactive, do not express any complaints. Their only desire is to be left alone. This condition differs from apathico-abulic syndrome by instability and reversibility. Most often, apathetic depression is observed in those suffering from schizophrenia.

8.3.2. manic syndrome

It is manifested primarily by an increase in mood, acceleration of thinking and psychomotor agitation. Hyperthymia in this state is expressed by constant optimism, neglect of difficulties. Any problems are denied. Patients constantly smile, do not make any complaints, do not consider themselves sick. The acceleration of thinking is noticeable in fast, jumping speech, increased distractibility, superficiality of associations. With severe mania, speech is so disorganized that it resembles a “verbal okroshka”. The speech pressure is so great that patients lose their voice, saliva whipped into foam accumulates in the corners of the mouth. Due to their pronounced distractibility, their activity becomes chaotic, unproductive. They cannot sit still, tend to leave home, ask to be released from the hospital.

There is an overestimation of one's own abilities. Patients consider themselves surprisingly charming and attractive, constantly boast of their alleged talents. They try to compose poetry, demonstrate their vocal abilities to others. A sign of extremely pronounced mania is delusions of grandeur.

An increase in all basic drives is characteristic. Appetite sharply increases, sometimes there is a tendency to alcoholism. Patients cannot be alone and are constantly looking for communication. In a conversation with doctors, they do not always keep the necessary distance, turning easily - “brother!”. Patients pay much attention to their appearance, they try to decorate themselves with badges and medals, women use excessively bright cosmetics, clothes try to emphasize their sexuality. Increased interest in the opposite sex is expressed in compliments, immodest offers, declarations of love. Patients are ready to help and patronize everyone around them. At the same time, it often turns out that there is simply not enough time for one's own family. They squander money, make unnecessary purchases. With excessive activity, it is not possible to complete any of the cases, because each time new ideas arise. Attempts to prevent the realization of their desires cause a reaction of irritation, indignation ( angry mania).

A manic syndrome is characterized by a sharp decrease in the duration of a night's sleep. Patients refuse to go to bed on time, continuing to fuss at night. In the morning they wake up very early and immediately get involved in vigorous activity, but they never complain of fatigue, they say that they sleep enough. Such patients usually cause a lot of inconvenience to others, harm their material and social position, but, as a rule, they do not pose a direct threat to the life and health of other people. Mild subpsychotic mood elevation ( hypomania) in contrast to severe mania, it can be accompanied by a consciousness of the unnatural state; delirium is not observed. Patients can make a favorable impression with their ingenuity and wit.

Physically, those suffering from mania appear quite healthy, somewhat rejuvenated. With pronounced psychomotor agitation, they lose weight, despite their wolfish appetite. With hypomania, there may be a significant increase in body weight.

A 42-year-old patient has been suffering from attacks of inappropriately elevated mood since the age of 25, the first of which arose during her postgraduate studies at the Department of Political Economy. By that time, the woman was already married and had a 5-year-old son. In a state of psychosis, she felt very feminine, accused her husband of not being affectionate enough towards her. She slept no more than 4 hours a day, enthusiastically engaged in scientific work, paid little attention to her son and household chores. I felt a passionate attraction to my supervisor. She sent him bouquets of flowers in secret. I attended all his lectures for students. Once, in the presence of all the staff of the department, on her knees she asked him to take her as his wife. Was hospitalized. At the end of the attack, she could not finish her dissertation. During the next attack fell in love with a young actor. She went to all his performances, gave flowers, secretly from her husband invited him to her dacha. She bought a lot of wine to drink her lover and thereby overcome his resistance, she herself drank a lot and often. To the bewildered questions of her husband, she confessed everything with fervor. After hospitalization and treatment, she married her lover, went to work for him in the theater. In the interictal period, she is calm, she rarely drinks alcohol. She speaks warmly of her former husband, regrets a little about the divorce.

Manic syndrome is most often a manifestation of MDP and schizophrenia. Occasionally there are manic states caused by organic damage to the brain or intoxication (phenamine, cocaine, cimetidine, corticosteroids, cyclosporine, teturam, hallucinogens, etc.). Mania is a symptom of acute psychosis. The presence of bright productive symptoms allows us to count on a complete reduction of painful disorders. Although individual attacks can be quite long (up to several months), they are still often shorter than depressive episodes.

Along with typical mania, atypical syndromes of a complex structure are often encountered. Manic delusional syndrome in addition to the affect of happiness, it is accompanied by unsystematized delusional ideas of persecution, staging, megalomaniac delusions of grandeur ( acute paraphrenia). The patients declare that they are called to "save the whole world", that they are endowed with incredible abilities, for example, they are "the main weapon against the mafia" and the criminals are trying to destroy them for this. Such a disorder does not occur in MDP and most often indicates an acute attack of schizophrenia. At the height of a manic-delusional attack, oneiroid clouding of consciousness can be observed.

8.3.3. Apatico-abulic syndrome

Manifested by a pronounced emotional-volitional impoverishment. Indifference and indifference make patients quite calm. They are hardly noticeable in the ward, spend a lot of time in bed or sitting alone, and may also spend hours in front of the TV. At the same time, it turns out that they did not remember a single broadcast they watched. Laziness shows through in all their behavior: they do not wash, do not brush their teeth, refuse to go to the shower and cut their hair. They go to bed dressed because they are too lazy to take off and put on clothes. They cannot be attracted to activities, calling for responsibility and a sense of duty, because they do not feel shame. The conversation does not cause interest in patients. They speak in a monotone, often refusing to talk, declaring that they are tired. If the doctor manages to insist on the need for dialogue, it often turns out that the patient can talk for a long time without showing signs of fatigue. In the conversation, it turns out that patients do not experience any suffering, do not feel sick, do not make any complaints.

The described symptoms are often combined with the disinhibition of the simplest drives (gluttony, hypersexuality, etc.). At the same time, the lack of shame leads them to try to fulfill their needs in the simplest, not always socially acceptable form: for example, they can urinate and defecate right in bed, because they are too lazy to go to the toilet.

Apatic-abulic syndrome is a manifestation of negative (deficit) symptoms and does not tend to reverse development. Most often, the cause of apathy and abulia are the end states in schizophrenia, in which the emotional-volitional defect grows gradually - from mild indifference and passivity to states of emotional dullness. Another cause of apathy-abulic syndrome is an organic lesion of the frontal lobes of the brain (trauma, tumor, atrophy, etc.).

8.4. Physiological and pathological affect

The reaction to a traumatic event can proceed very differently depending on the individual significance of the stressful event and the characteristics of the person's emotional response. In some cases, the form of manifestation of affect is surprisingly violent and even dangerous to others. There are well-known cases of the murder of a spouse on the basis of jealousy, violent fights between football fans, violent disputes between political leaders. A psychopathic personality disorder (excitable psychopathy - see section 22.2.4) can contribute to a gross antisocial manifestation of affect. Nevertheless, we have to admit that in most cases such aggressive actions are committed consciously: participants can talk about their feelings at the time of the act, repent of incontinence, try to smooth out a bad impression by appealing to the severity of the insult inflicted on them. No matter how serious the crime committed, in such cases it is considered as physiological affect and subject to legal liability.

Pathological affect called a short-term psychosis that occurs suddenly after the action of a psychotrauma and is accompanied by clouding of consciousness, followed by amnesia of the entire period of psychosis. The paroxysmal nature of the occurrence of a pathological affect indicates that a traumatic event becomes a starting point for the realization of the existing epileptiform activity. It is not uncommon for patients to have a history of severe head trauma or signs of organic dysfunction since childhood. The clouding of consciousness at the moment of psychosis is manifested by fury, the amazing cruelty of the committed violence (dozens of severe wounds, numerous blows, each of which can be fatal). The surrounding people are not able to correct the actions of the patient, because he does not hear them. The psychosis lasts for several minutes and ends with severe exhaustion: the patients suddenly collapse, sometimes falling into a deep sleep. Upon leaving the psychosis, they cannot remember anything that happened, they are extremely surprised when they hear about what they have done, they cannot believe others. It should be recognized that disorders with pathological affect can only conditionally be attributed to the range of emotional disorders, since the most important expression of this psychosis is twilight clouding of consciousness(see section 10.2.4). Pathological affect serves as the basis for recognizing the patient as insane and exempting him from liability for the crime committed.

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