Psychiatry - O. K. Napryeyenko 2001

General Psychiatry
Disorders of Emotion

Emotions are a person's subjective experience of their attitude toward themselves and the surrounding world. The perception of the external environment, coupled with bodily sensations, is accompanied by specific feelings that reflect our attitude toward these impressions. Emotions play a vital role in all manifestations of human life—fulfilling instinctive needs, professional endeavors, communicative activities, and more. They mobilize the Organism for proper adaptation, reflect a person's state, and mirror their perspective on what they are doing or feeling.

The mechanism behind The Emergence of emotions is explained by several theories. According to one of them—the James-Lange theory—emotions arise As a result of visceral and muscular reactions. A person does not cry because they are sad; rather, they are sad because they cry. The Cannon-Bard theory posits that emotional experience results from impulses originating in the Hypothalamus and traveling to the Brainstem, rather than from the periphery. In the framework of I. Pavlov's school, the Physiological Basis of emotions lies in the subcortex, while the Cerebral Cortex acts as the supreme regulator of emotional life. The central nervous apparatus of emotion is a complex of structures that includes the hypothalamus, often referred to as the visceral Brain. The cerebral cortex plays a key role in interpreting emotional sensations.

The broad spectrum of human feelings encompasses both lower emotions tied to the gratification of biological drives and higher, social forms of emotional activity. Lower emotions (such as hunger, sexual instinct, and danger avoidance) stem from instinctive needs. Higher emotions include aesthetic, intellectual, and moral feelings. While higher feelings incorporate a cognitive element, aesthetic emotions arise from the contemplation of beauty (nature, works of art, or beautiful people).

Intellectual feelings accompany the cognitive process, and their ultimate goal is truth. Moral feelings include a sense of justice, friendship, duty, shame, and remorse. In a mature individual, higher feelings are dominant, modifying and guiding lower instinctive impulses. Depending on a person's evaluation and attitude toward internal and external phenomena, emotions can be categorized as positive or negative. Positive emotions indicate that a particular event or phenomenon is pleasing to us, whereas negative ones arise from dissatisfaction. Some authors also distinguish neutral emotions, such as curiosity or passive contemplation. Furthermore, emotions are divided into sthenic and asthenic. Sthenic emotions (such as joy and hope) boost the body's vitality, activate life processes, and make a person stronger, whereas asthenic emotions (such as fear and sorrow) reduce Muscle tone, weaken willpower, slow down mental processes, and diminish overall vitality.

Depending on the duration and intensity of the experience, emotional states are categorized as moods, passions, or affects. A relatively prolonged, stable emotional Background—either positive or negative—is called a mood. An intense and enduring feeling is termed a passion. An affect is a short-lived, intensely turbulent emotion accompanied by prominent motor and autonomic manifestations. A distinction is made between physiological and pathological affects. A physiological affect is an emotional explosion triggered by acute excitement (anger, despair, fear, etc.). During a physiological affect, regardless of its intensity, an individual remains capable of controlling their actions, is aware of them, and bears responsibility for everything done in that state.

Healthy individuals typically experience normal emotional fluctuations, which reflect The ability to respond to impressions and life experiences. However, mood swings and affects become pathological when they are so pronounced that they disrupt the goal-directedness of mental activity and lead to a loss of working capacity.

Classification OF EMOTIONAL DISORDERS

1. Pathological Amplification of emotions (mania, depression).

2. Pathological attenuation of emotions (emotional flattening, paralysis of emotions, emotional dullness, apathy).

3. Pathology of emotional mobility (lability, incontinence, inertia).

4. Disorders of emotional appropriateness (inappropriateness, ambivalence, dysphoria, pathological affect, motiveless fear).

Mania (hyperthymia, manic affect) is a persistent elevation of mood accompanied by heightened drives, increased activity, and accelerated speech and thought. Manic affect is characterized by feelings of gaiety, optimism, and happiness, along with distractibility, talkativeness, sharpening of memory, and self-overestimation. Mania is a core symptom of the manic phase of manic-depressive psychosis (now conceptualized as bipolar affective disorder). A moderately expressed form of mania is termed hypomania.

Pathological elevation of mood can progress into euphoria—a state of causeless happiness tinged with carelessness, passivity, and bliss, combined with a sense of physical well-being and a lack of activity. Euphoria is most commonly observed in alcohol and drug intoxication, under METABOLISM/18.html">The Influence of chronic intoxications, and in organic psychoses. Unlike mania, it lacks accelerated thinking and increased motor activity. When the frontal lobes of the brain are damaged, euphoria is combined with motor disinhibition, silly behavior, foolishness, and cognitive decline (moria).

Elevated mood can also take the form of ecstasy—an experience of extraordinary happiness, unaccompanied by an accelerated flow of mental processes or motor hyperactivity. Such patients are prone to high-flown, pathetic expressions. Ecstasy can reach the highest degree of rapture and adoration, combined with motor stiffness and stupor. This state is observed in Epilepsy, Schizophrenia, and hysteria.

Depression (hypothymia, depressive affect) is a state characterized by a depressed mood and sadness, accompanied by reduced physical activity, slowed thinking, feelings of personal inadequacy, forebodings of disaster, a sense of heavy chest discomfort, and suicidal ideation or attempts. Nothing brings joy; the past, present, and future are perceived in dark, often tragic tones. Self-esteem is extremely low, typically dominated by feelings of worthlessness, sinfulness, and a loss of faith in one's own strength. The slowing of mental processes is combined with weakened drives, loss of appetite, and insomnia. This state is characteristic of the depressive phase of manic-depressive psychosis. Mild forms of these deviations are referred to as subdepression.

Depressive affect is sometimes accompanied by motor agitation (agitated depression), lethargy (adinamics/adinamical depression), severe exhaustion (asthenic depression), irritability and anger (angry depression), or a feeling of agonizing pain due to the loss of emotional responsiveness (anesthetic depression). In the latter case, patients react with extreme distress to their condition, acutely aware of their complete indifference to everything, and frequently resort to suicide. A complete loss of feelings may also occur (psychic anesthesia — *anaesthesia psychica dolorosa*).

Pathological attenuation of emotions includes emotional flattening, emotional dullness, paralysis of emotions, and apathy.

Emotional flattening and emotional dullness refer to an irreversible, progressive loss of the vividness of emotional expression, a decline in subjective experiences, coldness, indifference, and emotional impoverishment. These states may be accompanied by disinhibited drives, brutality, and aggressiveness, and are often observed in schizophrenia (simple form) and organic brain lesions.

Apathy is a state of profound emotional dullness, indifference, and emptiness. Nothing evokes interest or emotion in the patient, including their own future life Prospects. Apathy can result from severe pathology, such as schizophrenia, Brain Tumors, cerebral atrophy, Pick's disease, or Alzheimer's disease.

Extremely traumatic psychological events (news of a loved one's death, a natural disaster with fatalities, a severe earthquake) can trigger a paralysis of emotions—a sudden, acute loss of feelings. The clinical picture of this state also involves the complete disappearance of interests, motor inhibition, inactivity, and emptiness, but unlike apathy, emotional paralysis is short-lived and reversible.

Disorders of emotional mobility can manifest as excessive lability or inertia.

Emotional lability is characterized by easy, rapid shifts from an elevated mood to a depressed one and vice versa, without any apparent cause. In childhood, emotional lability is considered a physiological norm; as a pathology, it is most frequently observed in hysterical personalities and following brain injuries. Minor triggers can provoke a turbulent, affective reaction accompanied by autonomic symptoms and motor agitation. Recognizing the unnaturalness of their outburst, such patients calm down relatively quickly and acknowledge their inability to restrain themselves.

Emotional incontinence (affective incontinence) occurs when a person bursts into tears or laughter over the most trivial triggers, sometimes prompted merely by a memory. This condition is characteristic of patients with cerebral vascular lesions, particularly atherosclerosis.

Emotional inertia is the prolonged preoccupation with unpleasant emotions, guilt, resentment, or anger. It is commonly encountered in epilepsy and personality disorders.

Emotional inappropriateness (parathymia) is a symptom expressed as an emotional response that does not correspond quantitatively or qualitatively to the triggering event. A classic example is a patient showing a cheerful mood upon receiving news of a close relative's death. Parathymia is also a hallmark of schizophrenia.

In emotional ambivalence, a patient experiences two opposing feelings simultaneously, such as love and hate, or pity and cruelty. According to E. Bleuler, who made a significant contribution to The Study of schizophrenia, ambivalence is one of the four core symptoms of this disorder.

Dysphoria is also among disorders of emotional appropriateness. The patient becomes depressed, malicious, and sullen, as well as hypersensitive to external stimuli, tense, and wrathful, often complaining of a sense of fear. Any minor detail can trigger aggressive actions, cruelty, and violence. Dysphoric states are characteristic of epilepsy and organic brain lesions; they occur suddenly and last from several hours to several days.

Pathological affect takes the form of a time-delimited attack. It is a short-term impairment of mental activity manifested as a violent emotional reaction with clouded consciousness. Pathological affect occurs in epilepsy, traumatic brain injury, psychopathy, and under the influence of various adverse factors (alcohol intoxication, psychological trauma, overfatigue). A stimulus of minor intensity provokes an emotional reaction so severe that the patient becomes capable of destructive and aggressive actions. Pathological affect arises suddenly, lasts from several seconds to several minutes (less commonly hours), and ends in deep Sleep followed by complete or partial amnesia.

Psychiatric literature frequently discusses the symptoms of anxiety and fear. Fear is expressed as a feeling of tension accompanied by the expectation of danger or misfortune, and it is associated with the urge to avoid danger or flee. The patient is focused on a consciously recognized threat and danger. In anxiety, the sense of danger lacks specific content. Fear and anxiety often dominate the clinical picture of many mental illnesses.

CONTROL QUESTIONS

1. Definition and classification of emotions.

2. Hypothymia and depressive syndrome.

3. Hyperthymia, euphoria, and manic syndrome.

4. Anxiety and fear.

5. Physiological and pathological affects.

6. Define dysphoria.

7. Define apathy.

8. Pathological emotional lability, affect lability, and irritable emotional weakness.

9. Anaesthesia psychica dolorosa.