Psychiatry - O. K. Napreyenko 2001

General Psychiatry
Introduction to General Psychiatry

Perhaps in no other clinical discipline is such a vast nomenclature used to describe pathological conditions as in psychiatry. This is due to the fact that The Development of this science proceeded largely not along general medical criteria—whereby each nosological entity possesses its own unique Etiology, Pathogenesis, and pathomorphology—but rather through the empirical description of various psychological syndromes.

Judging by the dictionary of eponymic terms, among the prominent psychiatrists of the 19th and early 20th centuries—especially French and German ones—there is hardly a single figure who did not secure a place in the History of Psychiatry by attaching their name to one phenomenon or another.

In search of a universal theory capable of unifying the numerous symptoms and syndromes that define the clinical picture of mental disorders, specialists turned to the works of 18th-century French materialists, who linked mental activity and its impairments to Specific features of Brain function. Explanations for individual manifestations and the specific nature of psychopathology were also sought in C. Darwin's evolutionary theory, the pathomorphological studies of Virchow's school, the discoveries of I. M. Sechenov and I. P. Pavlov, and so forth.

A notable role in shaping concepts regarding the causes behind specific symptoms and syndromes in mental illness was played by J. H. Jackson's (1864) Concept of the Localization of Functions within The Nervous system.

J. H. Jackson divided the symptoms arising from brain lesions into negative (unproductive), or deficit symptoms, and positive (productive) ones, which stem from lower brain centers escaping the control of higher centers. Negative symptoms are those characterized by a deficit in mental function. For instance, amnesia involves a loss of memory. Positive symptoms of illness consist of mental functions being supplemented by phenomena that do not occur in mentally healthy individuals—such as hallucinations, where patients see or hear things that do not actually exist.

J. H. Jackson's concept significantly influenced E. Kraepelin's (1920) research on the registers of Psychopathological Syndromes.

E. Kraepelin hypothesized specific syndromes, suggesting that when the brain is affected, primitive mechanisms of mental activity, released from cortical control, begin to operate. This generates the clinical picture of mental deviations. In other words, to use the author's terminology, these are registers of psychopathological syndromes that follow one another and depend on the depth of Central Nervous System impairment. These can manifest as either functional or organic disorders.

E. Kraepelin included neurotic, affective, hallucinatory, delusional, dyskinetic, and encephalopathic disorders in this spectrum.

Based on the depth of psychic impairment, French researchers H. Ey and J. Rouart (1936) developed a scale comprising eight main syndrome groups: neurotic, paranoid, oneiric, cenestopathic, manic-melancholic, confusional-stuporous, schizophrenic, and demented.

J. H. Jackson's ideas were transformed and extended into clinical syndromology by A. V. Snezhnevsky (1960, 1983). The author formulated THE PRINCIPLE OF the nosological Specificity of psychopathological syndromes, according to which, as a pathological process progresses, syndromes evolve from simple to complex, and from minor to major, while taking into account the developmental stereotype characteristic of each specific disease.

The researcher pointed out a close correlation between general pathological (positive and negative) syndromes and nosological entities, suggesting that any single clinical symptom or syndrome represents "one period in the continuous development of a disease, one link in a chain process."

A. V. Snezhnevsky identified 9 groups of positive and 10 groups of negative syndromes, succeeding one another in accordance with the degree of severity and the increasing nosological specificity.

Positive syndromes include: emotional-hyperesthetic, affective, and neurotic disorders; verbal hallucinosis and paranoid states (catatonic, hallucinatory-paranoid, and paraphrenic syndromes); disturbances of consciousness; paramnesias; and convulsive and psychoorganic syndromes.

Negative syndromes are considered to be: exhaustion of mental activity; subjectively perceived personality change; objectively determined personality change; personality disharmony (including schizoid development); reduction of energetic potential; decline in personality level; personality regression; amnestic disorders; total dementia; and psychic marasmus.

Any Classification of mental symptoms—regardless of whether it is based on specific medical tasks, psychological principles, or physiological foundations—cannot fully encompass the multitude of concepts existing in psychiatry; it merely provides a General Overview of them.

Mental illnesses manifest primarily through pathological alterations in such mental processes as sensation, perception, memory, thinking, intellect, emotion, volition, drives, and attention. Such deviations are frequently accompanied by motor (psychomotor) disorders and disturbances of consciousness. During the investigation and classification of individual symptoms of mental illness, the Specific characteristics of these alterations are revealed. For example, symptoms of mental illness such as hallucinations are classified as perceptual disorders; delusions as Pathology of Thinking; false memories as memory impairments, and so on.

However, this psychological principle of classifying psychopathological symptoms is applied for a single purpose: to describe their clinical expression. Ultimately, symptoms should be classified according to their pathogenesis.

A symptom of mental illness is, first and foremost, a medical concept specific to psychiatry. Symptoms serve as clinical Criteria for the pathological state of the Organism. Depending on the specific objectives of clinical analysis, they are classified in various ways. When examining the clinical picture of a disease, general and local symptoms are distinguished; by pathogenesis, functional and organic; for prognostic purposes, favorable and unfavorable, and so forth.

Every symptom of an illness is polysemous. This applies to all diseases, including mental ones. It must be emphasized that when describing symptoms, the psychological principle of classification is applied conventionally. When interpreting a particular symptom of mental illness resulting from an impairment of a corresponding mental process (perception, memory, thinking, etc.), one is guided by the predominant rather than the exhaustive alterations of that process. For instance, the features of a delusion are not exhausted solely by a disorder of thinking; they also encompass a pathologically altered affect, behavioral disturbances, and frequently memory impairments and other psychic changes.

In various mental illnesses, The process of reflecting reality in the consciousness of the ill person is disrupted in specific ways. During Diagnosis, the physician isolates specific symptoms of perceptual, memory, or thinking impairments from the complex clinical picture of the pathological process, and systematizes them into symptom complexes (syndromes).

Thus, the section on General Psychiatry describes the characteristics of mental disorders, their nature, and regularities of progression, while examining the symptomatology of disorders across various aspects of mental activity.

It is important to emphasize that isolating certain symptoms from the overall picture of a mental illness is somewhat conditional, because behind the impairment of any single mental process lies the disruption of nearly all spheres of mental activity.

CONTROL QUESTIONS

1. Basic mental processes and their characteristics.

2. Principles of classification of psychopathological symptoms.

3. Gradation of psychopathological syndromes according to N. I. Laskzop, E. Kraepelin, H. Ey, and Z. Kopari.

4. The principle of nosological specificity and the classification of psychopathological syndromes according to A. V. Snezhnevsky.