Psychiatry - G.T. Sonnyk 2003

General psychopathology and symptomatology of mental illnesses
Disorders of emotion

In addition to cognitive processes, human beings also possess an emotional life. Their Anatomical and physiological basis is primarily the thalamohypothalamic region. Cortical dysfunction does not lead to gross emotional disturbances, with the exception of lesions in the frontal lobes (moria). Conversely, damage to specific subcortical structures results in severe emotional disorders.

Emotions belong to one of the phylogenetically oldest mental processes and also exist in animals. Emotions existed even before The formation of conditioned Reflexes. They play a vital role in human mental life. Thanks to the emotional charge — tone — bodily Functions are maintained at an optimal level.

All emotional stresses and anxieties are accompanied by autonomic changes. Emotions connect mental life with physical existence. Feelings (emotions) reflect the satisfaction or dissatisfaction of the needs of a human or an animal.

All symptoms of emotional disorders can manifest either as features of affective response to a specific situation or as pathological mood disorders.

I. Enhancement of Emotions.

Pathological affect is a state of extreme emotional tension, a violent emotional reaction of anger that arises suddenly in response to trivial (though sometimes significant) triggers. It is characterized by a sudden onset, impairment of consciousness followed by complete or partial amnesia, and a loss of the psychologically understandable link between the intensity and CHARACTERISTICS OF THE emotion and The Nature of the triggering factor. A person in a state of pathological affect may commit a serious offense.

Pathological affect should be differentiated from physiological affect, which occurs after severe agitation, but is not accompanied by clouding of consciousness, and maintains a psychologically understandable connection between mental experiences and the factor that caused them.

Ecstasy is the highest degree of rapture and delight, which may be combined with restricted movement (stupor).

Emotional hyperesthesia consists of intense emotions triggered by minor causes that overpower the individual and overshadow primary Social and biological interests.

II. Diminution of Emotions.

Emotional blunting is an impoverishment of feelings manifested by a patient's complete indifference to themselves, their health status, and The Fate of relatives and loved ones. Social emotions and the capacity for empathy are typically lost first. This is a characteristic disorder in Schizophrenia.

Emotional impoverishment is a progressive weakening of higher emotions coupled with the reinforcement and dominance of lower ones. It occurs in organic pathology accompanied by the loss of a portion of the Cerebral Cortex.

Apathy is unresponsiveness, a lack of emotional reactions to the environment and future life Prospects. When this state arises as a reaction to psychological trauma, it is termed emotional paralysis.

Painful psychic anesthesia (anaesthesia psychica dolorosa) is an exceptionally distressing sensation of emotional emptiness for the patient, a painful numbness of feelings.

III. Disorders of Emotional Mobility.

Emotional lability is the easy elicitation, by minor causes, of shallow and unstable emotions that change rapidly (sometimes into their opposites) even without any change in the acting stimulus. It is characteristic of neuroses.

Emotional incontinence is the easy triggering and shifting of emotions of normal intensity, their lack of control, and the inability to conceal one's feelings. It is frequently encountered in cerebrovascular pathology.

Emotional inertia is an excessive persistence of emotions that seem to get stuck in a person's consciousness and persist independently of changing situations.

IV. Disorders of Emotional Adequacy.

Dysphoria is a tense, depressed-irritable mood with elements of irritability, occasionally mixed with fear. Any minor factor that elicits negative emotions can provoke aggressive agitation.

Phobias are obsessive fears accompanied by a critical attitude toward them. Fear may be caused by mental disorders, acting as a consequence of hallucinatory-delusional experiences or experiences associated with various manifestations of altered states of consciousness; occasionally, it is triggered by somatic disorders (predominantly of the cardiovascular and respiratory systems).

The intensity of fear ranges from timidity to terror, which leads to clouding of consciousness. As a rule, fear is combined with a sense of anxiety that can escalate into tension.

Parathymias are emotions inappropriate to the stimulus. A patient recounting the death of a loved one may laugh, or suddenly display aggression toward someone they previously held in high regard.

Ambivalence of feelings is a dual, and sometimes simultaneously contradictory, emotional experience of the same event or object by a person (e.g., pleasure and displeasure, sympathy and antipathy, love and hate, etc.). This is related not to the peculiarities of the stimulus, but to the pathological state of mental activity. Opposing emotions coexist rather than replace one another.

Euphoria is a pathologically elevated, yet non-tense Background mood tinged with cloudless joy and complacency. Emotions are inadequate to either the surrounding reality or the patient's physical condition.

Moria is a state of euphoria tinged with clownishness and affectation. It is characterized by a tendency toward nonsensical jokes, and may be accompanied by pronounced motor agitation. Occasionally, moria is observed against the background of mild clouding of consciousness.

Mania and depression are distinguished as primary mood disorders and prolonged psychopathological states.

Mania is a persistent, intensely elevated mood that is impervious to negative affects. Its main manifestations are euphoria, accelerated thinking driven by superficial associations, and motor agitation. It is accompanied by a sensation of boundless energy, strength, and vigor. Patients feel capable of any achievement and overestimate their capabilities to the point of delusions of grandeur. In manic states, active attention is impaired and distractibility is increased.

If these traits are expressed to a mild degree, it is referred to as hypomania.

Several types of manic states are distinguished:

1) Joyful (sunny) mania — patients exhibit a cheerful mood, tending toward posturing and jocularity. Insight into the illness is absent. Hypersexuality is observed.

2) Expansive mania — characterized by an elevated mood combined with an overestimation of one's own capabilities and grandiose delusions, though these are not absurd and patients can be reasoned with.

3) Mania with flight of ideas (fuga idearum) — mania featuring accelerated associative thinking. Clinically, it resembles formal thought disorder.

4) Dysphoric (angry) mania — mania accompanied by symptoms of irritability, wrathfulness, and aggression. Patients are universally dissatisfied and prone to conflict.

5) Confused mania — an elevated mood combined with elements of altered consciousness. This serves as an indicator of an exogenous-organic disorder.

Depression is a lowering of mood characterized by despondency, intellectual and motor retardation, physically burdensome sensations, diminished drives, and a profound subjective sense of distress that leads to a morbidly negative appraisal of reality.

Kielholz's Classification of depressions:

I. Endogenous (vital):

a) in schizophrenia;

b) in manic-depressive psychosis;

c) involutional.

II. Psychogenic:

a) neurotic;

b) reactive;

c) exhaustion depressions.

III. Somatogenic:

a) symptomatic;

b) associated with organic CNS lesions.

Endogenous depression is linked to an endogenous psychiatric disorder. It is characterized by unprovoked onset, diffuseness, and the absence of a gnostic component (the patient does not understand the cause of their suffering). Such a state reflects Autonomic Nervous system dysfunction. Patients experience vague, agonizing distress that is acutely felt. Precordial anguish frequently occurs—a distressing feeling of tension and constriction in the chest. Its intensity fluctuates throughout the day, with improvement typically observed in the evening. Melancholic agitation (raptus) may occur, accompanied by sudden intense anxiety, agitation, and uncontrollable suicidal tendencies. It frequently arises during the recovery period.

In so-called vital depression, a sensation of painful anesthesia (loss of feeling) arises; the patient can neither feel joy nor grieve ("My Heart is like stone; I feel no love for my loved ones or children"). It is characterized by distinct somatic signs, primarily manifesting as Protopopov's triad: tachycardia, mydriasis, and constipation.

Psychogenic depression is a lowering of mood associated with an existing psychotraumatic situation. Ideas of self-blame stemming from the specific situation are frequent. Ideas of persecution related to psychotraumatic factors are also observed. In prolonged conflict situations, reactive depressions may acquire a vital character.

Somatogenic depression is associated with painful sensations due to a somatic illness.

Depressive syndromes:

1) Anxious-depressive syndrome - depression accompanied by anxiety, fear, and agitation. It is frequently observed in involutional melancholia.

2) Depressive hypochondriacal syndrome - depression with a hypochondriacal component. It occurs within the framework of schizophrenia. The severity of hypochondria ranges from mild to Cotard's syndrome (see below).

3) Astheno-depressive syndrome - asthenia, increased fatigue, and exhaustion. It is observed in exogenous psychoses.

4) Depressive-paranoid syndrome - depression accompanied by ideas of persecution, poisoning, and other delusional manifestations. Most commonly observed within the framework of schizophrenia.

5) Depressive-depersonalization syndrome - depression combined with phenomena of depersonalization and derealization. It occurs within the framework of bipolar affective disorder, schizophrenia, and cyclothymia.

6) Obsessive-depressive syndrome - a combination of depression with obsessive phenomena.

Based on accompanying signs, grumbling, whining, and tearful depressions are traditionally distinguished. Depression of self-torture, insecurity, poverty, and fate are also differentiated. Furthermore, agitated depression, depression of liberation, and exhaustion depression have been described. Masked, or larvated, depressions are of great importance.

CONTROL QUESTIONS.

1. Definition of emotions and their physiological characteristics.

2. What are sthenic and asthenic emotions?

3. Pathological elevation of mood. Define mania and euphoria. Varieties of mania.

4. Low mood. Clinical signs of depression.

5. Classification of depressions.

6. What are endogenous and vital depressions? Their Clinical Features.

7. Clinical characteristics of psychogenic depressions.

8. What syndromes with a depressive component do you know?

9. What is dysphoria?

10. Phobias, definition, and association with other disorders.

11. What is pathological emotional lability?

12. Define emotional ambivalence.

13. Definition and clinical features of parathymia.

14. Define emotional inertia and emotional weakness (astasia).