Psychiatry - G.T. Sonnyk 2003

General psychopathology and symptomatology of mental illnesses
Attentional disorders

Attention is The ability to focus on an external or internal stimulus. It is a mental function characterized by a selective attitude toward objects of mental activity, whereby consciousness singles out one or more stimuli from a vast array of inputs.

Active attention refers to conscious, conditioned-reflex-based, purposeful concentration of mental activity on specific phenomena.

Passive, or involuntary, attention is the elicitation of focus by any of the numerous external stimuli acting upon a person. Such insufficiently concentrated and excessively labile attention suddenly shifts from one object to another. This phenomenon is underpinned by the unconditioned orienting reflex (the "What is it?" reflex).

Attentional disturbances may manifest in the following forms.

Difficulty in switching focus (inertness of nervous processes) is observed in Epilepsy, atherosclerosis, and residual organic Brain lesions.

Weakness of active attention is characterized by the inability to sustain focused attention on a single object over time and difficulties in concentration.

Hyper-fixation of attention (prothetic concentration) involves heightened concentration and stability of attention. It is characteristic of depressed patients, individuals with hypochondriacal symptoms, and patients with delusions.

Distractibility of attention is an impairment characterized by diminished concentration and stability.

Sluggishness of attention is a disturbance in The Mechanism of shifting focus from one object or phenomenon to another, caused by the inertia of primary cortical processes.

Aprosexia is the complete loss of attention.

Intellectual impairments.

Intellect is the sum of an individual's current knowledge and their capacity to subsequently acquire and successfully apply it. Intellect encompasses a combination of cognitive processes such as memory, mental performance, The Nature of thinking, its situational adequacy, realism, and the accuracy of judgments and inferences.

Three Structural components of intellect are distinguished:

- prerequisites of intellect—attention, memory, mental performance, and speech apparatus features;

- intellectual inventory—knowledge acquired through upbringing, education, self-education, as well as personal experience, or erudition;

- intellect proper—the ability to generate a particular quality of judgments and inferences.

The mere stock of knowledge cannot fully indicate the presence or absence of dementia in a given patient. A low stock of knowledge is generally a sign of intellectual decline, whereas a high stock of knowledge does not yet guarantee high intellect. It is from this perspective that the presence of isolated abilities (such as musical talent or advanced memory) in individuals with low intellect should be viewed.

A distinction is made between congenital intellectual disability (oligophrenia) and acquired intellectual disability (dementia).

Congenital intellectual disability (oligophrenia) is characterized by delayed intellectual development resulting from factors operating intrauterinely or in early childhood (up to the age of three). Depending on the severity of cognitive impairment, it is subdivided into debility (mild intellectual disability), imbecility (moderate intellectual disability), and idiocy (profound intellectual disability).

Acquired intellectual disability (dementia) is the consequence of brain diseases or mental disorders, manifesting as a persistent decline in cognitive activity. It can be total (diffuse, global), lacunar, concentric, or transitory.

Total dementia is characterized by an across-the-board decline in all forms of cognitive activity, manifested by weaknesses in intellect, memory, and attention, as well as a blunting of emotions (especially higher feelings) and will. This type of dementia is observed in senile dementia, progressive paralysis, and other conditions. Its consequences include degraded judgment, impaired critical insight, behavioral alterations, and the disintegration of the core personality.

Lacunar dementia is characterized by a decline in cognitive activity with a predominance of Memory and Attention impairments, resulting in compromised judgment. The core personality, critical insight, and behavior remain intact for a long time. This type of dementia is most commonly observed in focal brain diseases.

Based on the course of progression, dementia is classified into:

1) prodredient;

2) stationary (traumatic, encephalitic);

3) regredient (in Vascular Diseases).

According to its dynamics, dementia progresses through three phases (Bleuler):

a) predominance of functional disorders over organic ones. Clinically, wide fluctuations in intellectual activity are observed.

b) crystallization of dementia — organic symptoms become clearly prominent.

c) terminal phase — dementia reaches its extreme degree and takes the form of marasmus.

Clinical and nosological Classification of intellectual disorders.

I. Vascular dementia. This is the most frequently encountered type. Depending on the stage, the following forms are distinguished: simple arteriosclerotic, acute post-apoplectic (resulting from a stroke), pseudoparalytic, pseudo-Alzheimer's, and hallucinatory-paranoid dementia, as well as dementia associated with Korsakoff's syndrome.

II. Senile dementia. It begins with personality changes, an accentuation of premorbid features and character traits (such as egoism, egocentrism, and suspicion), a loss of warmth toward family members, and heightened stubbornness. Regression of the personality core begins, primarily affecting intellect. Global dementia ensues.

III. Dementia in Schizophrenia (transitory dementia) is characterized by a weakening of cognitive activity, which develops slowly due to the progression of a destructive process in the motivational-volitional sphere. The dementia develops against a Background of diminished mental energy. Despite the absence of memory disorders and a sufficient level of formal knowledge, the patient is completely socially maladjusted and incapable of practical activity.

IV. Epileptic dementia (concentric dementia) is a type of dementia characterized by a gradual narrowing of the patient's interests toward their own person and bodily Functions. Thinking becomes sluggish, viscid, detailed, and concrete. Thoughts fixate on trivialities, and the ability to distinguish the essential from the secondary is impaired. Memory deteriorates, and individual words are omitted, resulting in restricted and monotonous speech. Social and professional interests are lost. All interests progressively narrow and center upon the patient's somatic existence. This constriction develops gradually and concentrically.

V. Presenile dementias.

a) Alzheimer's disease — a primary atrophic process of a lacunar nature.

b) Pick's disease — an intellectual disorder that immediately assumes a global character with Impairment of the personality core.

VI. Traumatic dementia is characterized by a decline in the quality of judgment and reasoning, asthenia, affective instability, yet accompanied by orderly behavior and adequate adaptive capabilities.

VII. Intellectual disorders in psychogenic conditions have a complex genesis depending on personality traits and the psychotraumatic situation. This gives rise to phenomena of pseudodementia (reversible, not associated with organic lesions), which are described in detail in the chapter "Disorders of Consciousness".

Review Questions:

1. Define METABOLISM/2.html">THE CONCEPT OF "memory".

2. Functions of memory and their significance in human mental activity.

3. What are the Main Properties of memory that you know?

4. Classification of memory disorders.

5. Definition of hypermnesia.

6. Definition of hypomnesia and various types of amnesia.

7. Definition and varieties of paramnesia.

8. Characterize the main attention disorders.

9. What is oligophrenia? Its types.

10. Dementia: definition and clinical signs of its various types.

11. Characteristics of dementia in vascular diseases.

12. Dementia in schizophrenia and epilepsy.