Psychiatry: A Course of Lectures - V. S. Bitensky 2004

Pathology of Intellectual and Motivational Components Features

Attention

Attention is a neuropsychic process that organizes human behavior and active adaptation to the external environment through the optimal perception of specific stimuli and feedback responses. This determines the selective and directed nature of human mental activity.

Attention manifests itself in the concentration of consciousness on a chosen object or phenomenon, As a result of which this object or phenomenon is reflected by a person more clearly and fully.

A special property of mental phenomena, insofar as they belong to the consciousness of a single individual, is that these phenomena interfere with one another. We are unable to think about different things simultaneously, unable to perform different tasks at the same time, and so on. This property of consciousness is termed the narrowness of consciousness. Everything happens with mental phenomena as if they are trying to mutually displace or suppress one another, as if they are waging a struggle among themselves for a place in consciousness, which is insufficient for all simultaneously. This mutual struggle, displacement, and suppression occur only when mental phenomena are not linked for us into a single whole, but, on the contrary, represent independent thoughts, feelings, and desires. Examining an object while simultaneously listening to unrelated sounds is difficult for us: the one interferes with the other. However, when we listen to a speaker's address and attentively follow their facial expressions, this hardly interferes with one another. A mental phenomenon that dominates at a given moment is said to be in the central field of vision. Other, pushed-aside phenomena occupy the periphery of consciousness and remain there all the longer the less consciously aware we are of them. Objectively, attention is essentially nothing other than the relative dominance of a given idea at a given moment in time; subjectively, being attentive means being concentrated on a given object, phenomenon, or impression.

Attention has no specific content of its own; it manifests itself in perception, thinking, and activity, Supports and characterizes all cognitive processes, awareness, and perception. In it, they act as an activity focused on objects. The connection between consciousness and the object is most clearly and distinctly manifested in attention; the more active conscious activity is, the more distinctly the object stands out, and the more distinctly the object stands out in consciousness, the more intense consciousness itself is. Attention is a manifestation of this connection between consciousness and the perceived object.

Attention is a qualitatively peculiar process based on certain physiological mechanisms. They are closely related to the so-called dominant excitation zones (A. A. Ukhtomsky). When, under certain conditions, some centers enter a state of independent excitation, reactions associated with these excitation zones become dominant, while the rest of the reactions are inhibited. Excitations reaching altered brain zones do not lead to The formation of temporary connections, and the person does not remember them. Zones with optimal excitation are reinforced by extraneous stimuli and inhibit reactions not associated with the action of the dominant centers; this is how the law of dominance manifests itself.

Several Basic Properties of attention are distinguished. Since the presence of attention implies a connection between consciousness and a specific object, the question of the degree of focus or concentration of attention arises first of all. Concentration of attention signifies the presence of a connection with a specific object and reflects the intensity of this connection; thus, a focus emerges in which mental, conscious activity is gathered. Concentration is the focal point, the central fact in which attention is expressed.

The span of attention is determined by the number of homogeneous objects that attention encompasses. The span of attention is a variable magnitude depending on the degree of connectedness among the elements upon which attention is focused, and on The ability to consciously connect and Structure the material.

Closely related to the span of attention is the distribution of attention among a certain number of heterogeneous objects simultaneously present at the center of attention.

The direction of attention should be understood as the selective nature of mental activity, the voluntary or involuntary choice of its object.

The direction of mental activity implies not only the choice of this activity, but also the ability to sustain it. Attracting attention is not all that difficult, but maintaining it over a long period of time is often far from easy. Therefore, the direction of mental activity consists not only in the selective nature of attention, but also in preserving it for a more or less prolonged time.

The stability of attention is determined by the duration for which concentration is maintained. The most essential condition for the stability of attention is the ability to discover new facets and connections within the object upon which it is focused. By uncovering new aspects of an object in their interrelations and interdependencies, attention can remain stable for a very long time. Where consciousness reveals fragmented, impoverished content, lacking the capacity for further development, progression, or deepening into it, conditions are created for easy distraction, and instability of attention inevitably develops. Only a diversity of content and its constant renewal are capable of sustaining attention. Uniformity dulls attention, and monotony extinguishes it.

Activity in carrying out an activity is of exceptionally great importance for the stability of attention. Attention to an object generates a natural need to do something with it. Action, in turn, focuses attention on the object even further. Thus, attention, merging with action and intricately intertwined with it, establishes a robust bond with the object.

The stability of attention does not imply its immobility; it does not preclude shifting. Shifting is the conscious and meaningful transfer of attention from one object to another. In this case, it is clear that shifting attention in any complex and rapidly changing situation implies the ability to orient oneself quickly in the situation and determine whether changes in The Significance of various elements included in it should be taken into account. The ease of shifting varies among individuals: some switch with ease, while for others entering a new activity is a difficult task. Shifting depends on several important conditions: the correlation between the content of the current and subsequent activities, the subject's attitude toward each of these activities, and the individual CHARACTERISTICS OF THE subject, particularly their temperament.

Distraction is caused by various mechanisms—significant diversion and poor shifting of attention. The attention of a "scattered" person can be compared to a child who drops an interesting toy they were just playing with as soon as another is shown to them. Each new impression distracts attention from the previous one; the child is unable to hold both within their field of vision.

Attention in its commonly accepted meaning has two forms: it can be passive or active. These forms differ from one another only in their complexity, representing earlier and later forms. They demonstrate the exact same type of consciousness, but at different periods of psychological development.

There are also instances when our attention is involuntarily attracted by something and we are unable to resist it. In other words, there are things to which we do not consciously pay attention, but which storm our consciousness. This category includes intense stimuli that capture our attention against our will: loud sounds, sharp taste stimuli and strong odors, severe pain. Thus, intensity, quality, repetition, suddenness, novelty, and affinity with the existing content of consciousness are the factors that determine attention. As soon as they arise in consciousness, we are compelled to pay attention to them, even if we had reasons to direct our attention elsewhere.

Attention driven precisely by such factors is attention in its primary stage of development, and it is called passive attention.

However, there are countless instances when an impression not only fails to captivate and hold our attention, but, on the contrary, it seems that we maintain our attention on the impression through our own effort. A geometry problem does not produce as strong an impression on us as a thunderclap. The problem holds only a partial interest for us alongside other experiences. Here, the temptation to deviate from it and turn our attention to something else is constantly present. Nevertheless, we continue to be attentive, but to do so we must use an act of will to sustain our attention—such attention is called active.

Yet there is also a Third Stage in The Development of attention. It is characterized by nothing other than a return to The First stage. When we solve a geometry problem, we gradually begin to take an interest in it, and soon become completely absorbed by it. Quite quickly, The problem of solving the task acquires the same power over our consciousness as a thunderclap at the moment of its appearance in consciousness.

Early childhood is typified by a diffuse, unstable character of attention. The fact that a child, upon seeing a new toy, drops the one they were holding illustrates this point. However, this proposition is not absolute; sometimes a specific object captures a child's attention for a long time. Rather, manipulating that object captivates them so much that, having begun to manipulate it—for example, opening and closing a door, etc.—the child will repeat this action 20, 40 times or more. This fact indicates that already at an early age a child is capable of maintaining attention for a more or less significant period of time. Nonetheless, it remains true that in preschool age, and sometimes in early school age, a child still has very weak control over their attention. The development of voluntary attention is one of the most crucial subsequent achievements, closely linked to the formation of a child's volitional qualities.

An essential aspect of the development of attention in a child is its intellectualization, which initially relies on sensory content and then begins to shift toward mental connections. As a result, the span of the child's attention expands.

A rapid increase in the stability of a child's attention is already observed in the fourth year of life. In particular, a relatively high level of it is formed around the age of 6, on the threshold of school age. This is an essential condition for "school readiness."

Distraction of attention in a 2-4-year-old child is 2-3 times greater than at 4-6 years of age. In school age, attention—both involuntary and voluntary—continues to develop. However, in the early grades of school, children may still exhibit significant distraction.

At 10-12 years of age, that is, during the period when most children show a noticeable, often leaps-and-bounds increase in mental development, accompanied by the development of Abstract thinking, logical memory, etc., there is also a noticeable increase in the span of attention, its concentration, and stability.

Various disorders can lead to impaired attention. For instance, damage to the occipital cortex leads to visual attention deficits, whereas damage to the temporal cortex impairs auditory attention, and so forth.

The following forms of attentional activity disorders are distinguished.

Distractibility of attention is characterized by excessive lability and the shifting of focus from one object to another, which is particularly typical of the manic phase of Affective Disorders. The opposite phenomenon is attentional sluggishness (inertia), observed in the depressive phase of affective disorders, chronic epidemic encephalitis, and other organic brain lesions.

Insufficient ability to switch attention (torpidity), associated with mental rigidity and a tendency toward excessive detail, is characteristic of patients with Epilepsy and organic brain lesions. A decline in attentional level and impaired distribution of attention are observed in vascular brain disorders, particularly cerebral atherosclerosis.

Fatigability of attention is typical of asthenized patients with severe chronic somatic illnesses, individuals with neurasthenia, and those with organic brain damage.

Aprosexia is the complete loss of attention.

Pronounced dementia is accompanied by the complete disintegration of active attention. Passive attention persists longer, whereby a patient may still turn toward a source of intense light or sound.

A peculiar distortion of attention is observed in Schizophrenia. The patient becomes absorbed in their own pathological experiences (hallucinations, obsessive states, delusions). In some cases, schizophrenia is also accompanied by a general weakening of attention, its distractibility, and sluggishness.

Changes in the state of attention can be identified through simple observation; however, more precise data are provided by experimental psychological Research Methods.

Memory

Memory is a mental process that performs the function of accumulating, retaining, and reproducing the experience of an individual's cognition of the environment and of themselves, thereby ensuring their differentiated adaptation.

Memory is one of the most critical components of Higher Nervous Activity. No current action is possible without memory processes, because the course of any mental act, even the simplest, necessarily presupposes the retention of each of its elements in order to "link" it with the next. Without the capacity for such linkage, development becomes impossible. Memory ensures the accumulation of impressions about the external environment and serves as the basis for acquiring knowledge, habits, and skills for subsequent application. The preservation of experience makes human learning and the development of mental Functions (perception, speech, etc.) possible. As a paramount characteristic of all mental processes, memory ensures the unity and integrity of the personality.

A leading tenet of the psychological theory of memory is The Doctrine of the active Nature of the processes underlying mnemonic activity. Thus, memorization is a process directed by attention, purpose, and interest toward a given event. In The process of forgetting, however, the primary role is played by Interference—the distracting effect of other information.

The Physiological Basis of memory is the formation of temporary neural connections capable of being reproduced and actualized later under METABOLISM/18.html">The Influence of various stimuli.

Recent neurophysiological and biochemical studies make it possible to distinguish two phases in the formation of such connections. In the first (labile) phase, the trace is maintained through the reverberation of nerve impulses. During the second (stable) phase, trace preservation is achieved through structural changes originating from the changes in The first phase. According to various data, these include either the growth of protoplasmic nerve terminals, changes in synaptic endings, alterations in Cell membrane properties, or modifications in The Cell's ribonucleic acid composition. The acquired biochemical changes endow the nerve cell with the ability to resonate upon repeated exposure to "familiar" stimuli. The Formation of the trace is facilitated, and its fading slowed, by Peptides (vasopressin, ACTH and its fragments, etc.). These also include Neuropeptides (endo-exogenous neurohumoral regulators) that possess the potential to stimulate Learning and Memory processes, enhance concentration, and regulate the level of arousal.

An important role in the consolidation of memory is played by the period following the perception of information—specifically, the period of its consolidation in memory. Without this period, incoming information cannot be transformed into a stable memory trace. Deep brain structures, and above all the structures of the hippocampal circuit (Papez circuit), participate in ensuring this process. In addition to the hippocampal formations, it consists of the anterior thalamic nuclei and the mammillary bodies. The hippocampus and associated PARTS OF THE reticular formation provide the necessary Background activity and select new, relevant information. The mammillary bodies, anterior thalamic nuclei, and parts of the limbic cortex execute the coding of the perceived information.

According to the duration of material consolidation and retention, sensory, short-term, and long-term memory are distinguished.

Sensory memory is a peripheral, modality-specific, instantaneous memory (lasting no more than 2 s) with a large capacity for storing information. This system retains a fairly accurate and complete picture of the world as perceived by the Senses. It is assumed that sensory memory reflects the physical characteristics of stimuli. This type of memory ensures the ability to perceive the environment continuously during Eye Movements and blinking.

Short-term memory is characterized by a brief retention period (no more than 30 s) following a single, brief perception, with immediate reproduction of the material. In this case, the retained information is not a complete reflection of the events that occurred at the sensory level, but rather an immediate interpretation of those events. The capacity of short-term memory is limited. Typically, only the last 5–9 units of information from the presented material are memorized.

By making a conscious effort and repeatedly rehearsing the material held in short-term memory, it can be retained for a longer period of time.

A special type of short-term memory is working memory, which refers to the mnemonic processes that serve a person's immediate execution of ongoing actions and operations. Working memory differs from long-term memory in that it forms a "working mixture" of Materials derived from both short-term and long-term memory. As long as this working material is functional, it remains under the jurisdiction of working memory.

Long-term memory is characterized by the prolonged retention of material following repeated rehearsal and reproduction. Long-term memory is the most important and complex system within the memory architecture. Its capacity is practically unlimited, and information can be stored indefinitely.

According to the character of mental activity predominating in human action, memory is divided into motor, emotional, figurative (iconic/perceptual), and verbal-logical. This sequence reflects the evolutionary stages of memory development: from motor to emotional, figurative, and finally verbal-logical memory as the highest form of human memory.

Motor memory is the memorization, retention, and reproduction of various movements and systems of movements. This type of memory serves as the basis for forming various practical and work-related skills, walking, writing, and other activities. Naturally, an indicator of good motor memory is physical dexterity and skill in labor.

Emotional memory is memory for feelings. Emotions signal the degree to which an individual's needs and interests are being met. Therefore, feelings experienced and retained in memory act as signals or motivational factors driving action.

Imaginative memory (or sensory memory) is the memory for mental representations, images, smells, and sounds. Depending on which analyzer played the most active role in perceiving the material, we distinguish visual, auditory, tactile, and Other types of memory. While visual and auditory memory are typically well-developed and play a leading role in spatial orientation for all normally developing individuals, tactile, olfactory, and gustatory memory are, to some extent, "professional" forms of memory. Like their corresponding sensations, they develop with particular intensity in connection with specific working or living conditions. These types of memory can reach exceptionally high levels of development when they must compensate for or Supplement missing forms of memory, such as in blind or deaf individuals.

Verbal-logical memory is based on verbalized mental operations and is uniquely human. Motor, emotional, and imaginative memories, in their simplest forms, are also characteristic of animals.

Each person's memory is individual and unique, as it reflects the distinct pattern of a particular individual's activity. Individual characteristics of memory are rooted in the predominant development of a specific type of memory, which stands out according to The Nature and means of perceiving the memorized material. Many people exhibit a more pronounced development of one of the following types: verbal-logical, imaginative, emotional, or motor.

Information is better retained when the dominant type of memory is engaged. These primary memory types are further divided into specific subtypes (e.g., memory for faces, numbers, etc.). Widely recognized are the individual peculiarities of memory conditioned by the sensory modality of information intake: visual, auditory, tactile, etc. For instance, individuals with more developed visual memory easily retain non-verbal visually perceived material, whereas those with better auditory memory more readily recall the same text if presented orally.

One of the factors determining individual differences in memory is the functional characteristic of The Nervous system. Individuals with a predominantly imaginative type of memory rely on the dominance of the first signaling system, whereas those with a verbal-logical type rely on the second signaling system. However, first and foremost, individual variations in memory are the result of the diverse activities pursued by people. Consequently, the most highly developed forms of memory are those most frequently used by the individual: a mathematician finds it significantly easier to remember abstract symbols, while an artist recalls images.

Alongside the types of memory, we distinguish memory processes—the functions that memory performs in life and activity. These processes include memorization, reproduction, as well as the retention and forgetting of material.

The primary among these processes is memorization. It determines the completeness and accuracy of material reproduction, as well as the durability of its retention. The key conditions for effective memorization depend on the form it takes: involuntary or voluntary. Voluntary memorization is the product of purposeful mnemonic actions—that is, actions whose main goal is to commit something to memory. The efficiency of such memorization is determined by The Nature of its goals, motives, and execution methods. The stages of semantic memorization include: realizing the goal of memorization, understanding the essence, analyzing the material, identifying the most essential ideas, generalizing, and memorizing this generalization.

Involuntary memorization is both a product and a condition of cognitive and practical activities, where memorization itself is not the primary objective. Material is better remembered involuntarily when it constitutes an integral part of the main activity's goal rather than merely serving as a condition or means to achieve that goal. In such cases, the material prompts more active mental engagement and, consequently, a greater interest in the content of the task at hand.

The utilization of acquired experience is made possible by retrieving previously mastered knowledge, abilities, and skills. Its simplest form is recognition, which occurs during the repeated perception of objects previously fixed in memory. A more complex process is the reproduction in consciousness of past experiences that are not currently perceived by us. Both recognition and reproduction can be either voluntary or involuntary.

Reproduction accompanied by an active search for the required material is called recall. The completeness and quality of recall depend on the strategies employed. Among the most important are: creating a written or oral outline of the material to be recalled, actively evoking mental images of the relevant objects, and consciously triggering associations that indirectly lead to the retrieval of what we need. Recall is not a mere playback of past impressions. During recall, associative links are established between new and previously mastered material, and the entire informational array is re-analyzed from a fresh perspective in the appropriate direction.

Remembrance is the individual's reproduction of past images localized in time and space. It is a complex process involving the retrieval of past objects and placing them within a specific period and Location of life, accompanied by corresponding emotional reactions.

Occasional errors in recall and recognition—ranging up to the complete inability to either recall or even recognize previously perceived stimuli—are various manifestations of forgetting. Forgetting can be persistent, prolonged, or temporary. This process is viewed as the result of inhibition, specifically proactive (stemming from prior excitation), retroactive (stemming from subsequent excitation), and inhibition caused by interfering (extraneous) influences.

In the developmental aspect of various memory manifestations, recognition appears first, associated with the repetition of perceived impressions.

The capacity to recognize real-world objects grows progressively and consolidates. While in a three-month-old infant it lasts for a few minutes after contact with an object, by 12 months it increases to several weeks, at 24 months to several months, and from the age of 4 it persists for a year. Memory for categories of space and time is formed only after basic orientation in them becomes accessible and concepts of space and time develop. In turn, mastering these categories is impossible without the involvement of memory. Therefore, it is no coincidence that memory for the days of the week emerges around 5–6 years of age—coinciding with the onset of orientation in these temporal categories—while memory for months and years appears around 9–10 years of age. Memorization in preschool age is primarily mechanical. This is due both to an insufficient capacity for material comprehension and a limited stock of knowledge, which restricts The Use of associations, as well as a lack of experience and familiarity with memorization techniques. Mechanical memory becomes fully formed only by ages 10–14. In adolescence, memory for forms and images is established, whereas verbal-logical memory continues to develop well into adulthood.

Memory as an integrative function reaches its peak development between the ages of 20 and 25. Subsequently, a stabilization period begins, lasting until ages 45–50, after which memory gradually declines. In old age, The structure of memory changes: the mechanical component fades first, followed by a weakening of direct reproduction, the fixation of current experience, and sensory memory. Thus, the functions that formed earliest are the first to deteriorate. In advanced old age, associative links also weaken. During this life stage, memory functions are adversely affected by factors such as reduced emotionality, lower alertness and attention, a narrowing of interests, and the disruption of numerous life ties. Alongside these factors, memory decline in the elderly is promoted by impaired cerebral Blood Circulation. In such cases, the brain structures responsible for fixing new experiences find themselves under the most unfavorable conditions. This explains the predominant impairment of memory for recent events. At the same time, memory for events of the distant past is largely preserved (the law of regression, or Ribot's law).

At the same time, skills of logical-semantic memorization and professional memory may persist for a long time, thereby compensating for deficiencies in other mnemonic functions.

Mnemonic functions fluctuate within certain limits under the influence of various everyday factors—fatigue, Sleep deprivation, emotional stress, and somatic illnesses. Among the earliest manifestations of memory decline are the weakening of fixation and selective reproduction—manifesting as difficulty in retrieving currently needed memory material. The weakness of selective reproduction is sometimes accompanied by an ease of imaginative recollections that arise involuntarily in the form of vivid, sensory-concrete representations.

Memory disorders include the impairment or loss of the ability to memorize, retain, and reproduce information. The following types of memory disorders are distinguished: hypermnesia—enhancement or sharpening of memory; hypomnesia, or dysmnesia—weakening of mnemonic functions; amnesias—absence of memory; paramnesias—memory illusions and distortions.

Hypermnesia manifests as an intensification of memories from past life, often fragmentary, or a temporary enhancement of current event memorization. Hypermnesia arises from a facilitated, sometimes chaotic flow of associations, mostly simple ones based on similarity and contiguity, which drives an enhancement of mechanical rather than verbal-logical memory. Hypermnesia is observed in states of excitation, particularly in manic and hypomanic states, and occasionally in syndromes of altered consciousness. In depressive syndrome, patients sometimes complain of intrusive floods of memories from the distant past. Similar phenomena are occasionally encountered during fever in infectious diseases.

Hypomnesia is characterized by a distinct dynamic of memory deterioration. Initially, a decline in voluntary reproduction is observed: the patient cannot recall a necessary word or name. Focusing attention only worsens the search for the forgotten word, but after some time, once the word or name loses its urgency for the patient, it seemingly resurfaces from memory on its own. The next stage of hypomnesia is the weakening of information retention in memory, followed by a progressively worsening impairment of memorization. The state of memory may stabilize at any of these stages. Hypomnesia can be general (affecting both memorization and reproduction) or partial (affecting either memorization or reproduction). Hypomnesia is also characterized by an early decline in mechanical memory and a more prolonged preservation of verbal-logical and associative memory. Hypomnesia is frequently observed in asthenic syndromes, cerebral Vascular Diseases, and epilepsy.

Amnesia refers to gaps in reproduction—the dropping out of memory of events from a specific time period. According to their clinical dynamics, amnesias are classified into retrograde (absence of memories regarding the period preceding the loss or disintegration of consciousness); anterograde (absence of memories concerning the period following emergence from a state of clouded consciousness); anterogretrograde (a combination of anterograde and retrograde amnesia); partial reproductive (difficulty in reproducing or recalling individual events) and general reproductive (absence of memories for all events of a past time period); fixation amnesia (Impairment of the ability to memorize); progressive amnesia (gradual forgetting starting with one's own mental processes and operations, followed by the temporal arrangement of events and facts, the events and facts themselves, emotional attitudes, and life skills and habits).

Amnesias may result from a preceding state of altered consciousness of various origins or from gross organic brain damage. Occasionally, amnesia arises psychogenically (affectogenic amnesia). In amnesia, the patient experiences difficulties in spatial and situational orientation and adjustment (amnestic disorientation).

Paramnesias belong to the Clinical forms of memory distortion. These include disturbances in the temporal and spatial distribution of recalled events (e.g., shifting past events into the present, or from one context to another); distortion of previously experienced events, substituting them or filling in memory gaps during amnesia with fantasies (fantastic pseudorecollections); and the alienation of recalled experiences from one's own life experience, and vice versa. Paramnesias encompass pseudoreminiscences, confabulations, and cryptomnesias.

In pseudoreminiscences, an event genuinely experienced in the past is recalled as having occurred recently. For instance, a patient who has been hospitalized for a long time insists that they have just arrived here from the railway station, that this morning they were still on the train, and that yesterday evening they left on a business trip.

In confabulations, memory gaps are filled with fabricated and sometimes fantastic pseudorecollections. With extraordinary vividness and rich detail, patients recount incredible events that supposedly happened to them in the past. The content may feature major discoveries, found treasures, or marvelous adventures, all tied to a specific period of past life. The intensive emergence of numerous confabulations, accompanied by false recognitions of surrounding circumstances and persons, inconsistent behavior, and disordered thinking, is termed confabulatory confusion. In such a state, the patient perceives surrounding people as close relatives, acquaintances, or long-deceased family members, and the hospital as their workplace or home. The misidentification of individuals and surrounding circumstances changes constantly, and the patients' statements are extremely inconsistent, sometimes incoherent.

In cases of cryptomnesia, previously experienced events are recalled as something that was heard, seen, or read (through The Mechanism of alienation), or conversely, things that were read, seen in a dream, or in a movie are recalled as personally experienced (through the mechanism of appropriation).

One of the most frequent syndromes involving significant impairments in mnemonic activity is Korsakoff's syndrome. It consists of memory impairments for current events (fixation amnesia) and false memories—pseudoreminiscences and confabulations. Significant memory pathology affects the functions of orientation in time and space, particularly in time, since this type of orientation requires memorizing The sequence of events and their correlation with temporal parameters. The patient cannot remember the doctor's full name, cannot find their ward, and does not remember where the dining room is or whether they have eaten today. At the same time, memory for events preceding the illness is preserved. Intellectual functions such as wit, resourcefulness, and critical abilities are also unimpaired. Gaps resulting from fixation amnesia are filled with pseudoreminiscences and confabulations. Confabulations are more common—purely fantastic fabrications that typically arise in these patients not spontaneously, but when they need to answer a question, especially regarding recent, current events. Korsakoff's syndrome is observed in infectious and traumatic Diseases of the Central nervous system with predominant damage to the limbic-reticular structures of the brain.

The most frequent and significant memory impairments are observed in acute exogenous psychoses (e.g., infectious and traumatic), as well as in endogenous-organic brain diseases. Various memory disorders are also detected following HEAD injuries, poisonings, and suicide attempts (hanging).

To a large extent, the nature of memory impairment is influenced by the localization of brain lesions. Damage to the cortical areas of analyzers leads to partial memory impairments, which are limited to defects in the storage and retrieval of traces belonging to a specific modality (visual, auditory, tactile, etc.). Thus, disorders of acoustic, audio-verbal, visual, and motor memory, known as modality-specific memory disorders, are distinguished. Damage to the associative zones between the cortical parts of analyzers leads to impairments in complex memorization and recall. Damage to the frontal lobes results in impaired voluntary, selective mnemonic activity. A decrease in Cerebral Cortex tone and damage to subcortical-Brainstem structures manifest as a diffuse deterioration of all mnemonic processes—fixation, retention, and reproduction.

In right-handed individuals, damage to the right hemisphere is marked by a deterioration of non-verbal, imaginal memory. Damage to the left hemisphere results in a weakness of verbal-logical memory.

To assess the state of memory, experimental psychological methods are used, ranging from the simplest techniques to complex ones that require professional experience and application skills. Simple techniques include tests for memorizing words and numbers; repeating growing series of numbers in forward and reverse order after the interviewer, etc. Complex methods include the Wechsler Memory Scale, among others.

The capacity for retention is determined by assessing the preservation of the subject's anamnestic information, school knowledge, practical information, and everyday knowledge.

To identify retrograde amnesia, it is necessary to thoroughly question the patient about their past up to the moment of the onset of the illness. To establish the presence of confabulations, it is advisable to compare the Answers given multiple times to the same questions with each other and with objective data.

One of the memory testing methods that most clearly reflects the changes occurring in it under pathological conditions is the word-list learning method (A. R. Luria). It involves reading a series of 10 unrelated words (e.g., cat, house, forest, table, Nose, needle, etc.) to the patient at equal intervals. After listening to the entire series, the patient must repeat the words they retained in memory, without worrying about the order of the words. The number of retained words is expressed by a specific figure (4, 5, 6). After that, the same series of words is repeated again (including those reproduced previously). This test is conducted with the same series of words three times consecutively, and a fourth time after an hour. With normal memory, the patient typically reproduces the entire series of words after the 3rd repetition and retains almost all the words in memory for an hour. Patients with various types of memory impairment usually experience great difficulties in retaining the series of words and, even after repeated trials, fail to reproduce all 10 words. Patients who are passive and inert usually reproduce no more than 3-4 words. Patients with pronounced exhaustion quickly memorize words at first, but subsequently grow tired, and with further repetitions, the number of remembered words decreases significantly, dropping practically to 1-2 during the control recall after 1 hour.

Intellect

Intellect is a person's ability to utilize thinking operations (analysis, synthesis, comparison, abstraction, generalization, concretization), the ability to apply acquired knowledge and experience in practical activity, to penetrate into The Essence of things and phenomena of the surrounding world, to single out the main link in a complex chain of cause-and-effect relationships, and to accumulate new knowledge and experience.

Impairments of intellectual activity in mental disorders are quite diverse. States characterized by intellectual deficiency are termed dementia. It can be acquired (dementia) and congenital (oligophrenia).

Dementia is an acquired intellectual deficiency, The breakdown of previously established intellect due to mental illnesses, characterized by a persistent decline in a person's cognitive activity, a progressive course, behavioral disorders, and an impoverishment of the moral and ethical core of the personality. Lacunar, total, concentric, and transitory dementias are distinguished.

Lacunar dementia (partial, focal) manifests as partial defects of intellect, primarily resulting from memory decline. The person becomes less capable of thinking operations. In this case, associative connections are restricted, leading to insufficient resourcefulness. Lacunar dementia is accompanied by emotional instability and reduced work capacity, while professional skills are preserved to a certain extent. At the onset of lacunar dementia, the patient's personality and critical attitude toward their own mental state remain intact. Lacunar dementia occurs in focal brain lesions (vascular diseases, TRAUMATIC BRAIN INJURIES, syphilitic brain lesions, etc.).

Total dementia (global, paralytic, diffuse) is manifested by a decline in all forms of cognitive activity. The patient gradually loses the ability to use thinking operations, critically evaluate their condition, actions, and the surrounding world. There is a general (global) decline in mental activity accompanied by the disintegration of the core of the personality. Memory for current and past events is profoundly impaired. Euphoria is frequently observed. The patient is incapable of purposeful activity and requires care and supervision. Total dementia develops in senile dementia, progressive paralysis, Alzheimer's disease, Pick's disease, etc.

Concentric (epileptic) dementia is characterized by a gradual mental degradation of the personality with a loss of thinking flexibility due to a reduced capacity for thinking operations. Viscosity, mental rigidity, and fixation of thoughts are observed. The patient cannot switch from one conversational topic to another. They become overly meticulous, petty, and egoistic. Attention is focused on their own person and needs, predominantly biological ones, which contributes to the development of extreme egocentrism. Mood is depressed. Patients are irritable, vindictive, complaining that they are wronged by other patients and that the medical staff is inattentive, etc. As the illness progresses, concentric dementia deepens, and patients become helpless, apathetic, and marantic. Their interests narrow down exclusively to satisfying their own instincts. Concentric dementia is observed in epilepsy.

Transitory (schizophrenic) dementia is characterized by a weakness of cognitive processes, develops gradually, and tends to progress. The patient is unable to utilize thinking operations not due to memory impairment or the loss of knowledge and skills, but as a result of the disintegration (dissociation) of mental processes. This type of dementia develops against the background of reduced energetic potential. Despite a sufficient level of formal knowledge, the patients' activity is unproductive, making them socially maladjusted. From time to time, such a patient may surprise others with an apt remark, a witty joke, etc. After Treatment, the patients' condition improves, but following the next exacerbation, the illness deepens. Transitory dementia is observed in schizophrenia.

Oligophrenia (congenital mental deficiency, intellectual underdevelopment) is a collective group of non-progressive pathological states diverse in Etiology, Pathogenesis, and clinical manifestations. Their common feature is the presence of congenital or early childhood-acquired general and mental underdevelopment with a predominance of intellectual deficiency.

The Selection/11.html">General features of oligophrenia are as follows:

1. The psychopathological structure of dementia featuring the totality of mental underdevelopment and the predominance of abstract thinking weakness.

2. The non-progressive nature of intellectual deficiency.

3. A slowed pace of the individual's mental development.

Based on the degree of mental underdevelopment and the clinical picture of dementia, the following forms of oligophrenia are distinguished: debility, imbecility, and idiocy.

Debility is a mild degree of mental underdevelopment. Patients are incapable of abstract thinking, making generalizations, or forming complex concepts. They are dominated by a concrete-descriptive type of thinking. They fail to understand the situation as a whole. Perception is inaccurate, and attention is unstable. They are unable to master the general education school curriculum, especially in mathematics. They frequently have to repeat a grade. Learning is significantly easier in a special remedial school. They cannot cope with complex work and require assistance from older individuals. They are easily suggestible, which leads to them falling under the influence of others. The intelligence quotient ranges from 50 to 69.

Imbecility is a moderate degree of mental developmental delay. Cognitive function is impaired to a greater extent than in debility. Patients cannot form concepts or think abstractly. They acquire self-care skills (dressing, elementary neatness, etc.). They understand simple speech and acquire a small vocabulary themselves. They use very short sentences (noun, adjective, verb). They assimilate new material only at the level of concrete representations. Full independent thinking is beyond their capability due to the inability to generalize. Therefore, adaptation is possible only in familiar situations. Patients understand other people's speech, facial expressions, and gestures within the limits of everyday life. They require supervision. Interests are quite primitive and relate exclusively to the satisfaction of physiological needs. Behavior depends on the affective state and the strength of drives. The intelligence quotient ranges from 20 to 49.

Idiotia is the most severe degree of congenital intellectual disability, characterized by an inability to engage in cognitive activity. Such individuals have severely limited perception and are incapable of thinking or speaking, producing only isolated sounds. They do not understand other people, fail to recognize even close relatives, and cannot distinguish between edible and inedible items. Their facial expression is vacant. They begin walking very late, sometimes moving only by crawling. They fail to acquire self-care skills and are untidy. Episodes of angry outbursts (biting, spitting) sometimes occur. They frequently exhibit congenital physical abnormalities. Their intelligence quotient (IQ) is up to 20.

To diagnose intellectual disability, particularly mild and moderate degrees, it is necessary to apply school, social, and psychometric criteria in addition to describing the clinical picture.

School criterion. Children with mild intellectual disability can attend school or lag behind their peers by two years up to the age of nine, and by three years after the age of nine.

Social criterion. It is necessary to assess the ability to exist independently and provide for one's livelihood. Individuals with mild intellectual disability can work independently, while those with moderate disability can perform simple tasks under supervision. They require care and guardianship.

Psychometric criterion. The intelligence quotient is determined using pathopsychological tests (the Wechsler scale).

Children with intellectual disability show no interest in learning and lack a sense of responsibility or duty. In some cases, children are unsociable, passive, and their emotional manifestations are blunted. In other cases, the lower emotions of children with intellectual disability may be sufficiently developed, with their emotions depending on the specific situation. The degree of emotional underdevelopment corresponds to the depth of the intellectual defect.

These manifestations are illustrated by the following clinical case. A 14-year-old boy, intellectually disabled, sluggish, and passive. He most often has a placid smile on his face, and his attitude toward people around him is poorly differentiated: he is equally affectionate and kind to everyone, eagerly helps adults, and loves to be praised. Deep attachments do not form, and his emotions are superficial. Higher emotions and aesthetic feelings are underdeveloped. He has little critical judgment regarding his actions and is unconcerned if he breaks something or harms someone.

Needs

Every human being requires certain conditions for their continued existence and development. The necessity for these conditions shapes the Organism's needs. The specific nature of these needs depends on the social and natural activity of the person, primarily labor. For analyzing human needs, the starting point is society as a concrete historical system that determines the formation and development of needs, as well as the content, means, and forms of their satisfaction.

Needs can be divided into biological, social, and ideal.

Biological needs ensure the individual and species existence of a human being. Biological needs also include The Need for energy conservation, which prompts a person to seek the shortest, easiest, and simplest way to achieve their goals.

Social needs are the need to belong to a social group and occupy a specific place within it, to enjoy the affection and respect of others, and to be the object of their respect and love. Social needs, which boil down to the desire to defend one's rights (needs "for oneself"), are opposite yet interconnected with the need to fulfill one's duties (needs "for others"). The strength of a given need is controlled by social norms regarding its satisfaction. These norms are formed as a result of the complex interaction of historical, economic, national, and other factors.

Ideal needs are the needs for cognizing the surrounding world as a whole and in its individual parts, one's place within it, and understanding the meaning and purpose of one's existence.

Each of these needs prompts corresponding types of activity: material, social, and spiritual.

Needs are The basis of human activity. The psychological form of individual activity that reflects needs is the motivation of behavior. In humans, the process of satisfying needs acts as purposeful activity. However, for such a need to become a driving force for purposeful behavior, it must acquire certainty regarding external objects appropriate for its (the need's) satisfaction—that is, it must become defined and thereby delegate the function of organizing activity to the object capable of satisfying it, namely, the motive. By subjectively realizing the goal as a need, a person becomes convinced that its satisfaction is possible only by achieving the goal. The dynamics of needs are manifested in the transition from the realization of the goal (as a prerequisite for activity) to the mobilization of the means by which it is achieved. Thus, needs manifest themselves in motives that prompt activity and become the form in which needs are expressed.

While human need for activity in itself does not depend on object-social content, in motives this dependence manifests as the individual's personal activity. Therefore, The system of motives, which is leading for individual behavior, is richer in attributes than the needs that constitute its essence.

The primary form of existence of a motive is material objects that correspond to a person's simplest needs. Subsequently, ideal motives emerge, acting in the form of various motivational representations or conscious goals.

Some motives, while prompting activity, simultaneously impart personal meaning: these motives are called meaning-forming. Others, coexisting with them and acting as motivating factors (positive or negative), sometimes acutely emotional, lack the meaning-forming function and are called stimulating motives (incentives).

Human activity is usually prompted simultaneously by several motives, one of which is the main or leading one, while the rest are subordinate, sometimes serving only auxiliary stimulating functions. The peculiarity of leading motives is that, in addition to the functions of prompting and directing activity, they impart a specific subjective meaning to its objects and conditions. The evolution of motives is reflected not only in their enrichment but also in the establishment of a certain hierarchy of motives—whereby motives corresponding to elementary needs are subordinated to higher social and spiritual motives; thus, under certain circumstances, a person is capable of sacrificing material goods and even life itself in the name of ideal aspirations.

Drives

Drives play a significant role in human vital activity. They are understood as mental states that express undifferentiated, unconscious, or insufficiently conscious needs of the subject. Drives are aspirations in which only the dissatisfaction with a certain state is realized, but neither its change as a goal nor the Ways and means of achieving it are conscious. When an awareness of the connection between the drive expressing the need and the object capable of satisfying that need arises, the drive transforms into a desire; it becomes, so to speak, "objectified" and acquires its motive. Such "objectification" is already a prerequisite for The Emergence of a personal volitional process, revealing the possibilities for organizing action.

Instinctive mechanisms lie at the base of drives. Instincts are genetically fixed forms of human behavior and mental activity. The adaptive significance of instincts (self-preservation, alimentary, sexual) lies in ensuring the execution of vital functions most essential for human existence.

Disorders of various types of drives: impulsive drives and actions, drive disorders at the instinctive level, etc.

Impulsive actions are carried out without control by thought and consciousness. They are characterized by the absence of motives and lack of critical judgment. The patient suddenly begins to shout loudly, break furniture, throw themselves out of a window, break window panes, attack passersby, etc.

Impulsive drives are insufficiently motivated or completely unmotivated. They seize the patient's consciousness and subordinate their behavior. These drives are aimed at achieving objectively unnecessary goals and are carried out without an internal struggle of motives and resistance.

There are several types of impulsive drives: pyromania, an unmotivated impulse to start fires; kleptomania, a periodic urge to commit motiveless, petty thefts; coprolalia, an unmotivated compulsion to utter obscene or vulgar words; and dromomania, a recurrent urge to change one's place of residence or engage in aimless wandering.

Disorders of alimentary drive include the following conditions.

Bulimia is an enhanced appetite accompanied by an intense feeling of hunger. It manifests in various psychiatric disorders, including catatonic conditions, general paresis, and dementia. It can also be linked to psychogenic factors, where food becomes a means to satisfy non-nutritional needs—for instance, to cope with emotional stress or low mood, boost self-confidence, or demonstrate superiority.

Anorexia is the loss of appetite that occurs in certain mental states, depression, and catatonia. During Puberty, girls are more commonly affected by anorexia nervosa than boys. The initial stages involve psychogenic food refusal, followed by the complete loss of appetite and the development of an aversion to food.

Polyphagia is a condition characterized by the ingestion of various non-food items and objects. Physiologically, polyphagia may occur in pregnant women and young children.

Polydipsia is most frequently observed in endocrine disorders and Pathologies of the diencephalic region of the brain.

Parorexia refers to dietary overcomplications driven by overvalued or delusional ideas about food. Patients devise bizarre diets (e.g., "I only eat calcium and magnesium salts with a tiny amount of protein").

Coprophagia is a condition where a patient exhibits perverse nutritional drives (seen in schizophrenia and dementia), consuming not only inedible objects but also feces.

Pathological alterations of the self-preservation drive manifest in several forms:

— an intensification of the drive, manifested in heightened anxiety, a readiness for rapid (sometimes panic) reactions, and extreme sensitivity to pain or other stimuli;

— a reduction of this drive, evidenced by the absence of protective or defensive reactions during an unexpected threat to the patient;

— suicidal behavior is likewise rooted in a significant weakening of the self-preservation instinct.

The sex drive undergoes pathological changes in many Mental Illnesses and endocrine disorders. A diminished sexual drive (impotence, frigidity) can occur in severe psychoses, depression, or during prolonged treatment with psychotropic medications. In neurasthenia and psychasthenia, weak erections and premature ejaculation may also be observed. An intensified sex drive (hypersexuality) is normally typical of adolescents and is also noted in certain pathological states (manic syndrome, general paresis).

Perverted forms of sexual drive (Sexual Perversions) include the following.

Sadism is the desire to inflict physical pain or emotional suffering on a sexual partner for the purpose of personal sexual arousal or gratification.

Masochism is the need to experience physical pain or emotional suffering inflicted by a sexual partner.

Fetishism is the redirection of sexual desire toward articles of clothing or specific parts of the body.

Pygmalionism is the manifestation of sexual arousal and gratification derived from viewing paintings and touching sculptures.

Other sexual disorders (paraphilias) are also observed: transvestism, the desire to wear clothing of the opposite sex; pedophilia, sexual attraction to children; gerontophilia, sexual attraction to elderly individuals; sodomy, sexual attraction to animals; necrophilia, attraction to corpses; and exhibitionism, the urge to expose one's genitals and engage in masturbation in the presence of non-consenting persons of the other sex.

Class="center">Will and Its Disorders

Human activity as a whole is inherently willful in character.

Will is the capacity of an individual to strive toward a consciously set goal while overcoming external and internal obstacles. Such obstacles arise when a person is forced to act under the influence of two opposing tendencies: one driven by an immediate impulse, and the other by a personally significant yet non-impulsive goal. In other words, will lies in the ability to act in accordance with a goal while disregarding immediate desires and urges.

The essence of will is that it constitutes striving through the overcoming of obstacles. Practically, this manifests as an inclination toward achieving distant goals and mastering difficult-to-attain objects of desire. Thanks to will, these appear especially alluring to the resolute individual, unlike the irresolute person who is drawn to whatever is easiest and most accessible. For example, a weak-willed person prefers to succumb to the need to conserve energy, yield to laziness, and instantly obtain the positive emotions brought by the accessibility of what they want. A resolute individual does not shy away from activity, repeatedly experiencing the joy of overcoming obstacles, even when that "obstacle" on the path to their goal is themselves.

Willful behavior is grounded in a complex psychophysiological mechanism. It includes components that are both specific and common to any goal-directed activity. The common components include the mediation of behavior (in contrast to impulsive, situational drives) by an internal intellectual plan that functions to consciously regulate activity. In this process, the internal intellectual plan is directed toward finding those actions that, under specific conditions, will lead to the achievement of the set goal.

The starting point of a volitional act is its goal and task, which generate the driving force for its execution.

Goals and Objectives usually do not coincide. A person may set a goal that requires the gradual execution of a wide range of actions and the resolution of many tasks over a prolonged period.

Goals and objectives can be achieved under two conditions: a realistic assessment of objective prerequisites and accurate self-assessment. An intended goal or set task prompts action through the formulation of a relatively clear plan and the selection of means for its Implementation.

This planning or programming constitutes a crucial stage of volitional action. The capacity for action planning, as well as its level and individual capabilities, depends on personality typology, the level of intellectual development, and other factors.

Thus, the volitional process consists of 4 main stages:

Stage 1 — the emergence of a drive for activity and the awareness of a goal (motive formation).

Stage 2 — the struggle of motives, comparing newly emerged needs with other traits inherent to the personality.

Stage 3 — making the decision to act.

At the final 4th stage, an action plan is outlined, which is subsequently manifested in behavior.

Disturbances in volitional activity can occur at all of its stages. The MAIN TYPES OF volitional pathology include: abulia, hypobulia, hyperbulia, parabulia, and motor-volitional disorders.

Abulia is observed in various psychopathological processes. It occurs in schizophrenia (“loss of energy potential,” “dynamic depletion”) and is most pronounced in its simple form and in states of profound psychic defect.

Hypobulia is a weakening of drives. It is characteristic of depression and in some cases determines the mental status of patients (“anergic depression”). At the same time, a critical attitude toward the decline in activity is preserved, experienced as a distressing phenomenon. The patient strives to overcome this state.

Hyperbulia is a state of excessive, heightened activity with a multitude of diverse impulses to action, a drive for their immediate realization, and disinhibition of drives. Overall, activity proves to be low-productivity due to the rapid shifting from one impulse to another, a lack of systematic planning, loss of purpose, and the dominance of intuitive reactions.

Parabulia is a perversion of volitional activity. It is caused by pathological motivation of behavior associated with perceptual distortions, delusions, affective disorders, and alterations of consciousness. Inappropriate behavior is expressed through various actions that contradict the situation (flight, refusal to eat, acts of aggression, and suicidal tendencies).

Motor-Volitional Disorders

Motor-volitional disorders include the following conditions: akinesia — immobility resulting from the cessation of independent actions, though movements remain possible upon external prompting; hypokinesia — motor inhibition accompanied by a reduction and slowing of movement; stupor — complete immobility; hyperkinesia (motor agitation) — an excessive drive for activity, generalized motor restlessness; parakinesia — mannerisms, bizarre actions and movements, and pointless grimacing.

Hyperkineses

The most pronounced form of motor-volitional agitation is raptus. This state is characterized by extreme agitation, suddenness, and explosiveness. Patients fuss, shout, howl, beat their heads against walls, and inflict self-harm. This condition frequently arises against the background of a depressed mood (melancholic raptus).

Catatonic excitement is accompanied by stereotypy and automatic movements that are purposeless, chaotic, and bizarre. Alongside this, unmotivated impulsive actions may suddenly occur. Catatonic excitement is characterized by ambivalence of drives (ambitendency); automatic repetition of speech (echolalia) and movements (echopraxia) of others, negativism, and verbigeration.

Manic excitement is characterized by an excessive drive for activity with unfinished tasks and unmotivated transitions from one type of activity to another, combined with an elevated mood, accelerated thinking, and rapid speech. In this state, patients sing, laugh, strive to engage in any activity, and bustle about.

Psychomotor agitation is an excessively expressed, inadequate motor and psychic activity, pathological in form and intensity, which creates abnormal conditions and even danger for those around the patient and the patient themselves. The most common types of agitation encountered in clinical practice include: hallucinatory-paranoid, manic, depressive, catatonic, hebephrenic, epileptic, amentive, choreatic, hysterical, psychopathic, panic, and erotic.

Hallucinatory-paranoid agitation is the result of hallucinations (auditory, visual, olfactory, etc.) that threaten the patient, as well as delusions of persecution, physical and mental manipulation, poisoning, and the like. The agitation is accompanied by the affect of fear, anxiety, emotional tension, and rage. Patients are suspicious of their surroundings, interpreting every movement in a delusional light. Psychomotor agitation directed at “enemies” may be accompanied by aggressive actions (eliminating “foes”). Sometimes patients “rescue” themselves by performing actions dangerous to their lives—for instance, jumping out a window without considering the building's floor, self-inflicting injuries, or executing suicidal intentions (“it is better to die an easier death”), etc. Hallucinatory-paranoid agitation is observed in schizophrenia and other mental disorders manifested by hallucinations and delusions.

Manic excitement is accompanied by unmotivated gaiety, an elevated mood, an accelerated train of thought (“flight of ideas”), and speech that becomes incoherent (manic derailment of speech). Patients constantly strive to act. They unmotivatedly shift from one direction of activity to another without finishing their work. They are restless, fidgety, and sexually disinhibited. They sleep little, eat little, and lose weight. Sometimes they become irritable and aggressive (angry mania). Manic excitement is characteristic of the manic phase of affective psychosis (bipolar affective disorder) and manic states of other origins.

Depressive (melancholic) agitation, or agitated depression. The classical depressive syndrome manifests as depressed mood, anguish, boredom, slowed thinking, and generalized inhibition. Agitated depression arises suddenly, like a flash, interrupting inhibition or stupor. Patients become frantic, unable to sit in one place, shouting, pacing, beating their heads against the wall, tearing at their clothes, pulling their Hair, wringing their hands, and attempting suicide. All of this combines with despair, unbearable anxiety, anguish, and boredom. Such patients express delusions of self-abasement and self-blame. Agitated depression is observed in the depressive phase of affective psychosis, involutional depression, and depression of vascular origin.

Catatonic excitement is accompanied by motor restlessness with senseless stereotypies — both verbal and motor. Characteristic Features of this state include grimacing, mannerisms, caricature-like (“pseudo-sophisticated”) movements, unusual bizarre body postures, and paramimia (incongruity of facial expression with emotion). In catatonic excitement, impulsive actions, aggression, and destructive behaviors are possible; it is characterized by negativism, ambitendency, echolalia, echopraxia, and so forth. It frequently combines with or transitions into isolated symptoms of catatonic stupor. This type of agitation is observed in the catatonic form of schizophrenia.

Hebephrenic excitement manifests as motor and verbal agitation with silly, foolish behavior. Patients become restless, and against the background of an elevated, absurd mood, stereotyped movements appear (silly euphoria): inappropriate laughter and grimacing. They mimic others, acting the clown and copying their actions. They jump, clap their hands, and undress. Their postures change kaleidoscopically and repeat. Impulsive antisocial actions are possible.

Hebephrenic excitement most commonly occurs in adolescent patients with hebephrenic schizophrenia.

Epileptic excitement often arises during altered states of consciousness, immediately before or after convulsive seizures, and typically manifests as dysphoria (marked by intense affects of anger, fear, and outbursts of rage or aggression). During such episodes, patients can be brutal, posing a risk of severe injury or even homicide. The excitement develops abruptly, without a clear motive, as a result of a narrowed field of vision. It is observed in Various Forms of epilepsy and epileptiform syndromes.

Amential excitement is characterized by disorganized behavior. Patients are restless and bewildered; their movements are repetitive and chaotic. Disoriented to their surroundings, they fail to grasp what is happening around them, repeatedly looking about and peering into people's faces. They constantly ask questions such as «Where am I?», «Who are they?», and «What is happening?» Their utterances are incoherent and fragmentary (amential speech clutter). Occasionally, this chaotic stream of phrases is interrupted by somber laughter or sobbing. Their facial expressions convey a mix of astonishment, anxiety, fear, and helplessness. Amential excitement is seen in infectious psychoses and exhaustion psychoses.

Choreic excitement has an acute onset, most commonly in the evening or at night, and is characterized by profound confusion and disorientation. Movements are disordered, amorphous, and confined to the bed (jactitation). The patient flails their arms, throws the bedding onto the floor, twists it, and lets their legs hang down. Speech is poorly modulated, consisting of shouted isolated words, fragments of phrases, syllables, and sounds (choreic speech clutter). The somatic condition is severe. The Skin and mucous membranes are dry and pale; the face is hyperemic, and the sclerae are injected. The Lips are cracked, often with herpes labialis. The Tongue is dry and coated with a gray-brown fur. Petechiae and bruises are visible on the body. Hyperhidrosis and physical exhaustion are present, with body Temperature reaching 40–41 °C. Choreic excitement is observed in acute delirious infectious psychosis and febrile schizophrenia.

Hysterical excitement manifests as affective disturbances (heightened affectivity, irritability, emotional lability). Against a backdrop of depressed mood, patients may throw demonstrative tantrums over minor triggers: crying, wailing, pounding their fists on the table, stamping their feet, breaking dishes, and tearing their clothes. Sometimes, depressed moods alternate with bouts of euphoria, during which the patients laugh inappropriately. At the peak of excitement («motor storm»), they scream, tremble, and thrash about, potentially leading to convulsions. They make demonstrative threats of suicide and occasionally attempt it. Hysterical excitement may be accompanied by hysterical twilight states and hysterical seizures. The patient's behavior is invariably driven by a specific psychotraumatic situation. In some cases, hysterical excitement presents as puerilism, pseudodementia, or Ganser syndrome. It can accompany hysterical personality disorder, hysterical forms of reactive psychoses, and neurotic hysteria.

Psychopathic excitement is most often psychogenically determined, purposeful, and quite diverse in its manifestations (depending on the type of personality disorder). Individuals with psychopathic traits create a tense atmosphere, drawing others into conflict. If restrained, their excitement tends to escalate. The content of their speech (shouts, demands, insults, threats, profanity) shifts in response to the actions of those around them and the changing situation. This condition is observed in personality disorders and in patients with psychopathy-like symptoms.

Panic excitement is characterized by chaotic, senseless motor agitation that occurs suddenly as a result of natural disasters, catastrophes, or life-threatening situations. The individual scurries about, makes erratic movements, waves their arms, screams, and pleads for help while failing to notice realistic avenues of escape. Sometimes they suddenly dash off aimlessly, frequently running straight into danger (fugue reaction). Panic excitement may be accompanied by altered consciousness with subsequent amnesia. It is typically marked by autonomic symptoms: elevated blood pressure, tachycardia, skin pallor, diaphoresis, and diarrhea.

When several individuals are gripped by this state, mass panic ensues. This phenomenon can occasionally take on the character of mass induced psychosis, particularly when the «inducer» is a highly suggestible personality.

Erotic excitement is observed in intellectual disability (oligophrenia) and manifests as senseless motor agitation, occasionally involving destructive actions, screaming, and sometimes self-harm.

Hypokinesia and stupor

The main types of psychomotor inhibition are hypokinesia and stupor.

The various types of stupor include catatonic, depressive, reactive (psychogenic), and exogenous stupor, among others.

Catatonic stupor is characterized by immobility, mutism (refusal to speak), increased Muscle tone, and waxy flexibility (catalepsy, where the patient freezes for long periods in spontaneously assumed or passively molded, often uncomfortable postures). Dupre's symptoms may also be observed (when the patient's pillow is removed, their head remains suspended in mid-air for an extended period). Negativism manifests as groundless resistance to situational demands: in active negativism, the patient performs actions directly opposite to those requested, whereas in passive negativism, they refuse to carry out requested actions or comply with automatic obedience. Depressive stupor is characterized by the development of profound motor inhibition, progressing to complete immobility at the height of depression.

Catatonic stupor is a manifestation of catatonic syndrome. It is characterized by immobility, prolonged maintenance of a rigid posture (frequently embryonic), and Dupre's air-pillow sign (when lying supine, the head, neck, and shoulder girdle remain elevated), as well as the hood sign (patients sit or lie with a blanket or robe pulled over their head, leaving only the face exposed), among others. Individuals do not react to wet bedding, room temperature changes, hunger, thirst, pinpricks, thermal stimuli, or even danger (such as a fire). Muscle hypertonia or waxy flexibility (maintaining postures imposed by others) and mutism (silence) are also characteristic. It may be accompanied by negativism — active (senseless, active resistance to instructions) or passive (failure to respond to any external interventions). Memories of this period are usually preserved. A substuporous state refers to partial stupor, varying degrees of mutism, unnatural posture, and partial refusal to eat.

Depressive stupor involves complete or near-complete immobility, a sorrowful posture, and a suffering facial expression. Verbal contact is difficult, and responses are monosyllabic. Patients are sometimes untidy. The stupor can suddenly give way to acute agitation, during which the patient is capable of inflicting severe self-harm. It is observed in severe endogenous depressions.

Psychogenic (hysterical) stupor arises as a result of psychological trauma — experiencing a catastrophe, fear, terror, the sudden death of loved ones, etc. It most commonly occurs in hysteroid personalities. It is characterized by generalized inhibition, up to and including a state of petrification. Sometimes it is accompanied by mutism and muscle relaxation. It is also known as «apparent death».

Apathetic stupor is characterized by total indifference, inactivity, disorientation, profound asthenia, insomnia, anorexia, decreased muscle tone, and untidiness. It develops against a background of severe physical exhaustion and cachexia in protracted symptomatic psychoses or encephalopathies. It is also referred to as adynamic, aspontaneous, or abulic stupor.

Exogenous stupor refers to hypo- or akinesia observed in severe toxic or infectious brain lesions.

The Study of volition and the drive sphere requires, first and foremost, a thorough anamnestic interview based on accounts from the patient as well as relatives and close contacts, which often yields far more insight. The medical history must be examined with particular care when hypobulia is combined with a depressed mood, which may be accompanied by suicidal ideation. Direct observation of the patient (the expressiveness, precision, and speed of movements, level of activity on the ward, attitude toward food, etc.) and a detailed review of their Complaints can provide a wealth of information. Necessary data regarding the patient's behavior can also be obtained from the shift notes of nursing staff in specialized medical logs.

Finally, special mention should be made of the so-called akinetic-abulic (apathetico-abulic) syndrome, which comprises apathy and abulia and holds significant clinical importance in schizophrenia and other severe mental disorders.