Psychiatry - H.T. Sonnyk 2003

General psychopathology and symptomatology of mental illnesses
Syndromes dominated by emotional and effecter-volitional disorders

Neurotic syndromes refer to psychopathological presentations characterized by disorders typically seen in neuroses, such as neurasthenia, obsessive-compulsive disorder, or hysteria.

Asthenic syndrome is a condition marked by increased fatigue, irritability, and mood instability, accompanied by autonomic symptoms and Sleep disturbances.

Increased fatigue in asthenia is invariably accompanied by decreased work productivity, which is especially noticeable during intellectual strain. Patients complain of difficulty comprehending situations, forgetfulness, and poor attention span. They find it hard to focus on any single task. The generation of ideas diminishes, and their verbal expression becomes impaired: patients struggle to find the right words. Ideas themselves lose their clarity. Patients complain of feelings of personal inadequacy. They take work breaks, but short-term rest fails to improve their well-being. Work begins to seem insurmountable and overwhelming. A sense of tension, anxiety, and a conviction of intellectual failure emerge. Mood shifts frequently, and both unpleasant and joyful events often lead to crying. A certain degree of hyperesthesia is constantly present, particularly to loud sounds and bright light. Asthenia is invariably accompanied by autonomic dysfunctions. Cardiovascular symptoms are the most common: Blood pressure fluctuations, tachycardia and pulse lability, various unpleasant sensations or actual pain in the cardiac region, easily provoked dermographic reactions, feelings of warmth despite a normal body Temperature, or conversely, heightened sensitivity to cold, and sweating that is either localized or relatively generalized. Dyspeptic disorders are frequently observed, including decreased appetite, abdominal pain, and spastic constipation. In men, diminished potency often occurs. Many patients complain of headaches varying in character and localization.

Sleep disorders manifest as difficulty falling asleep, superficial sleep with numerous anxious dreams, nighttime awakenings, difficulty returning to sleep, and early morning waking. Patients do not feel sufficiently rested upon waking and experience daytime drowsiness.

Hysterical syndrome is a symptom complex comprising mental, autonomic, motor, and sensory disorders that occur either in isolation or in various combinations. It typically arises following psychological trauma. The Clinical presentation of hysterical syndrome will be discussed in greater detail in the chapter dedicated to neuroses.

Obsessive syndrome (obsessive-compulsive) is a psychopathological state characterized by the predominance of obsessive phenomena. Obsessive syndrome is frequently accompanied by a subdepressive mood, asthenia, and autonomic disorders. Obsessions in obsessive syndrome may be limited to a specific type, such as obsessive counting, doubts, ruminations, monophobia, etc. In other cases, obsessive manifestations of the most diverse nature coexist simultaneously. Their onset and duration vary; they may develop gradually and persist continuously for a long period, or arise suddenly for a short time. In moderate obsessive phenomena, the subdepressive Background is limited to dejection with feelings of inadequacy and insecurity, while asthenia is marked by symptoms of irritability or irritable weakness. Obsessive syndrome, in which obsessive phenomena occur in the form of distinct attacks, is frequently accompanied by prominent autonomic symptoms: dermographic lability, cold sweat, tachycardia or bradycardia, a feeling of air hunger, increased bowel peristalsis, polyuria, etc.

Psychopathic syndrome is a congenital (psychopathy) or acquired (psychopath-like state) disharmony of personality, manifesting primarily in Disorders of the emotional and volitional sphere, with inadequate reactions to external influences and Changes in the body's internal state.

The clinical manifestations of various psychopathic syndromes will be examined in detail in the chapter dedicated to personality disorders (psychopathies).

Hebephrenic syndrome is a combination of motor and verbal excitation with playfulness and labile affect. Motor excitation is accompanied by clowning, grimacing, and mimicking the actions and words of those around them in a buffoonish manner. Using hospital clothing, newspapers, and other items, patients invent bizarre outfits for themselves. They pester others with inappropriate or cynical questions, seek to interfere by throwing themselves underfoot, grabbing people by their clothes, etc. The excitation may be accompanied by elements of behavioral regression. For instance, patients refuse to sit at the dining table, eat standing up without using forks or spoons, grab food with their hands, smack their Lips, spit, etc.

Patients fluctuate between being cheerful—laughing inappropriately loud—and whimpering, squealing, sobbing, or howling, or becoming tense, malicious, and aggressive. Speech is often incoherent to varying degrees, and may be accompanied by neologisms, The Use of rarely used words and bizarrely constructed sentences, or echolalia. In other cases, patients sing songs of a cynical nature or use profanity. Unstable hallucinatory and delusional disorders arise within The Structure of hebephrenic syndrome. Catatonic symptoms are frequently noted; when persistent, the condition is referred to as hebephreno-catatonic syndrome.

Catatonic syndrome is a symptom complex of mental disorders dominated by motor disturbances in the form of akinesia (catatonic stupor) or hyperkinesia (catatonic excitation).

In catatonic stupor, there is increased Muscle tone (catatonia), which in some cases is accompanied by the patient's ability to maintain a forced posture imposed on their limbs (waxy flexibility, catalepsy). One manifestation of waxy flexibility is the air pillow symptom (Dupré's syndrome): if the HEAD of a patient lying on their back is raised, their head, and in some cases their shoulders, remain elevated in that position for some time. A frequent symptom of catatonic stupor is passive obedience: the patient exhibits no resistance to changes in THE POSITION OF their limbs, posture, and other manipulations directed at them. Along with this phenomenon, the opposite disorder—negativism—may also be observed during stupor, manifesting as unmotivated resistance by the patient to the words and, especially, the actions of anyone attempting to communicate with them.

In passive negativism, the patient fails to obey requests addressed to them, and when external interventions are attempted—such as feeding, changing clothes, or examining them—they resist, accompanied by a sharp increase in muscle tone. Active negativism involves performing actions opposite to those requested.

Speech disorders in catatonic stupor may be expressed as mutism—the absence of verbal communication with others despite an intact speech apparatus. Patients in catatonic stupor frequently assume characteristic postures: lying on their side in a fetal position, standing with a bowed head and arms extended along the torso. Some patients pull a robe or blanket over their head while leaving the face uncovered, known as the hood symptom. Occasionally, stupor is accompanied by muscular rigidity, where tone is sharply elevated; patients lie on their side in a fetal position with knees bent and drawn up to the abdomen, arms pressed to the chest, fingers clenched into fists, head inclined toward the chest, eyes closed, jaws clenched, and lips pursed forward (snout reflex / prolabium sign).

Catatonic excitation lacks internal unity and purposeful direction. The patients' actions are unnatural, inconsistent, often unmotivated, and sudden (impulsivity); they feature a high degree of monotony (stereotypy), along with the repetition of gestures, movements, and postures of those around them (echopraxia). The patients' facial expressions do not correspond to their actions and mood (paramimia). Speech is most often incoherent, accompanied by symbolic utterances, neologisms, the repetition of monotonous sentences and words (verbigeration); the words and statements of others are also echoed (echolalia). Rhymed speech may be observed. To questions, patients give Answers unrelated to the content of the question (vorbereden / tangential answers). Continuous, incoherent verbal excitation suddenly alternates for short periods with complete silence. Catatonic excitation is accompanied by various affective disturbances—pathos, ecstasy, anger, rage, and at times emotional flattening and indifference.

Seizures (paroxysms) are suddenly occurring, short-term states characterized by altered levels of consciousness ranging up to its complete loss, accompanied by motor disorders, primarily in the form of convulsions. In addition to a critical termination, seizures are characterized by recurrence and a stereotyped clinical presentation—developing according to a "cliché" pattern. The symptomatology of seizures will be examined in the chapter dedicated to Epilepsy.

Epileptiform syndrome comprises paroxysmal disorders arising from various exogenous-organic Brain lesions, resembling the paroxysms characteristic of epilepsy. Focal seizures predominate in epileptiform syndrome, whereas major convulsive seizures occur less frequently.

Paroxysmal disorders in epileptiform syndrome may manifest exclusively as psychopathological symptoms—derealization, depersonalization, psychic auras, twilight and dream-like states, dysphoria, etc. Psychic paroxysms may be combined with focal and generalized seizures. Typically, epileptiform syndrome arises in the presence of a psycho-organic syndrome—ranging from mild and fluctuating to pronounced and persistent.

Psycho-organic syndrome may develop progressively and reach the stage of organic dementia. Personality changes in epileptiform syndrome invariably reflect the Specific features of the underlying disease.