MINISTRY OF HEALTH OF UZBEKISTAN
CENTRE FOR MEDICAL EDUCATION
TASHKENT MEDICAL ACADEMY
"Approved"
Head of main department of personnel
and institutions of higher education
of Uzbekistan Ministry of Health
prof. ______Sh.E.Atahanov
«____»______2011 yil
Department: Psychiatry and Addiction
Name of discipline: PSYCHIATRY
3 Tema: The basic psychopathological syndromes. Levels and registers of mental frustration.
(For teachers and students of higher medical educational institutions)
Training manuals
For Higher Medical Nurse Business faculty 3 courses
Tashkent 2011
Department of Psychiatry and Addiction
"Approved"
Vice-rector for academic,
Professor OP Teshaev
«___»______2011.
3 Tema: The basic psychopathological syndromes. Levels and registers of mental frustration.
For Higher Medical Nurse Business faculty 3 courses
Higher Medical Nurse Businessfaculty ММК yes
checked and approved
The report № ______
«___» ______2011 __
TASHKENT 2011
3 Tema: THE BASIC PSYCHOPATHOLOGICAL SYNDROMES. LEVELS AND REGISTERS OF MENTAL FRUSTRATION.
Venuelessons,equipment
- Department ofPsychiatry atthe medicalpsychologyatthe baseTashkentСity ClinicalPsychiatryHospital
- Tables
- Slides
- Tables, charts, educational developmentin electronic format,computer
- Demonstratedonpatientsand volunteers
2. Duration of study topics:
Number of hours
3. The purpose of training.
- Provide insight into the concepts of "symptom," "syndrome", "nosology";
- To form a representation of the principle diagnosis of mental illness: a symptom of a syndrome, the syndrome of nosology;
- Form an idea of neurotic and psychotic syndromes, the levels of positive and negative
syndromes;
- Objectives
The student should know:
-The differences between neurotic and psychotic syndromes levels;
-The difference between positive and negative syndromes;
-Syndromes that are characteristic for exogenous mental illness;
-The student should be able to:
-Find an approach to a patient suffering from any mental illness, to differentiate various types of violations in the areas of mental activity, to collect complaints, history, or Follow-up data set pre-syndromic diagnosis.
4. Motivation.
The physician in any specialty, including general practitioner in his medical activities in patients receiving stream must learn to recognize mental disorders, their well-qualified in order to subsequently determine the correct and timely organizational and treatment policy (statement of syndromic diagnosis, definition social danger, the depth and complexity of the state, if necessary, seek the ability to see a specialist for consultation, urgent measures to cure, to write competently in mental status and medical history in the area, if necessary, call an ambulance and specialist to determine the indications for hospitalization).
5. Interdisciplinary communication and vnutripredmetnye.
Teaching this topic is based on the knowledge bases of students of physiology, psychology, internal medicine propaedeutics .. The knowledge gained will be useful during the passage of all the disciplines of therapeutic and surgical (cardiology, neurology, gynecology, urology, general surgery, etc.) as well as interaction with people is unavoidable for any medical specialty that is in contact with patients
6. The content of lessons.
6.1 The theoretical part.
Syndromes of mental disorders. In the study of individual psychopathology is noteworthy that they occur in the clinic disease is not isolated, but in certain typical combinations. Symptom - a separate sign of mental illness, and symptoms - symptom, combined single mechanism for the development, pathogenesis. Syndromes express varying degrees of mental disorder and is characterized by a separate stage of the disease, have their own characteristics. As in any section of clinical medicine, psychiatry can be simple or complex, large and small, specific and nonspecific, typical and atypical, functional and organic, positive and negative, neurotic and psychotic. For the general practitioner should be able to identify the leading psychopathological syndrome for competent performances Allative, prior, syndromic diagnosis, based on the structure of the mental status of the patient.
Syndromes can be positive or negative, neurotic and psychotic.
The positive include abnormal formation of productive ("plus" syndrome), introduced into the state of the organism painful process.
Negative syndromes ("minus"-syndrome, deficient disorder) - maloobratimye, trudnokurabelnye, without absolute specificity nosological violation of a temporary or persistent depletion of mental activity.
Negative disturbances depend on the severity and progression of positive symptoms at the same time modifying and simplifying the structure of the positive syndrome.
In the group of syndromes neurotic level include:
1. asthenic (neurasthenic) syndrome - a condition of irritable weakness, irritability and exhaustion;
2. obsessive-compulsive syndrome - a combination of obsessive thoughts, doubts, fears, fears, desires, actions against the rigidity of mental activity, thoroughness of thinking, depressed mood;
3. hypochondriac or senestopaticheski-hypochondriasis - overvalued related to the condition of his health, combined with the haunting fears of possible severe illness;
4. hysterical state - expressed in the rapid ostentatious external display of emotional response to the situation (hysterics, psychomotor agitation, etc.) along with the possible different functional, vegetative, motor-sensory impairments: paresis, paralysis, astasia-abasia, blepharospasm, mutism, stuttering, hiccupping, aphonia, blindness, deafness, hysterical "lump in the throat", anorexia, flatulence, vaginismus, impotence, etc.;
5. psychopathic syndrome - a violation of mental activity, an individual's behavior in connection with disharmony, disproportion reaction force of impact and irritation, which results in maladjustment of the individual in society.
Neurotic disorder level, ie absence of mental symptoms and the most peculiar anosognosia different types of neuroses - neurasthenia psychasthenic, hypochondriacal, hysterical. However, there may be and in many other diseases ..
Asthenic syndrome - a condition of fatigue, irritability, unstable moods, combined with vegetative symptoms and sleep disturbances.
Fatigue at fatigue leads to reduced productivity at work, intolerant of previous loads. Attention is concentrated ill, reducing the number of submissions, hampered their verbal expression, a feeling of forgetfulness, poor intelligence. No short rest, no willpower does not increase productivity. A sense of their own inadequacy and emotional stress. Varies the mood, more to the downside, the pessimistic assessment. This is accompanied by autonomic disorders: fluctuation of blood pressure, heart rate lability, tachycardia, chills or hot flashes, discomfort in the internal organs, dyspepsia.
Fatigue - the most common and the most common mental disorder. It can be found for any mental and physical illness, it is often combined with other neurotic syndromes. Asthenia must be differentiated from depression, sometimes referred to as asthenic-depressive syndrome.
2. Obsessive-compulsive syndrome - obsessive syndrome - a psychopathological state dominated by the phenomena obsessions. Obsessive Syndrome is often accompanied by subdepressivnye mood, fatigue, vegetative-vascular disorders. Compulsion may be limited to some one species (monofobiya, the phenomenon of mental chewing gum, etc.) or a combination of various forms of obsessions.
Obsessional syndrome usually determines the clinical picture of obsessive-compulsive neurosis, psychopathy is at psychasthenic circle, with the depressed state of neurotic level. Obsessional syndrome occurs in schizophrenia and clinical maloprogredientnoy within psychoorganic disorders.
3. Hypochondriacal state - characterized by unrealistic or exaggerated interpretation of physical signs and sensations, that is overvalued related to the condition of his health, concern about the possibility of contracting severe physical illness. The degree of belief in the presence of physical illness can vary from overvalued to delusional conviction. Other major structural component of the syndrome are senestopatii.
The following types of hypochondriacal symptoms:
"Hypochondria health" - personality traits of persons "living interests of the body";
"Senestoipohondriya" - with a predominance of senestopaty;
"Ideoipohondriya" - dominated the intellectual processing of hypochondriacal complaints;
"Hysterical hypochondria" - a pathological fixation, "conventionally profitable" disease care, dramatized Easter hypochondriacal complaints;
obsessive hypochondria - an alarming hypochondria, obsessive fears of contracting;
hypochondriac depression - overvalued or delusional hypochondriacal ideas on the background
of depressive affect;
hypochondriacal personality - personality traits with a tendency toward rigidity, masochistic
tendencies, egocentrism;
paranoiac hypochondria - a strong belief in an incurable disease with a system of evidence - this is the level of psychotic disorders, and all subsequent forms of hypochondriacal symptoms:
delusional hypochondria - abundant senestopatii senestopatichesky or automaticity with delusions of influence, corruption, witchcraft, possession;
paraphrenic hypochondriac - in the structure of the syndrome Kotara or hypochondriacal delusions parafrenicheskih experiences;
hypochondriacal psychosis monosimpatichesky - Ekboma syndrome - dermatozoyny delirium, tactile hallucinations, paratsitofobiya.
4. Hysterical state - isteronevrotichesky syndrome, which outlined the sequence of symptoms of
autonomic, affective sensorimotor to ideatornoy. Characteristic of hysterical seizures, hyperkinesis, tremor, sensory disturbances, disruption of the senses, speech, pronounced mood swings. Hysterical manifestations of psychogenic caused, are functional and reflect the reversible nature of the specific mechanisms of hysterical personality responses: the desire to attract attention, the state of "conditional pleasantness, desirability," a symptom of mechanisms "flight into illness" to help you find a "solution" of a difficult situation.
Affective disorders are characterized by lability of emotions, a tendency to violent emotional reactions. Intellectual activity takes on the features of emotional logic, demonstrative behavior. When the trauma of continuing a transition to a hysterical neurotic development.
5. Psychopathic syndrome - psihopatizatsii personality - a process by which the form psychopathic condition that can occur at any age due to severe or prolonged stress, severe mental, physical illness and cranial trauma. Disharmony of personality traits in these cases is secondary psychopathy without intrinsic dynamics (compensation, decompensation, development, etc.) and depends in its manifestations of the underlying disease.
The group of psychotic syndromes level include:
Affective (emotional) syndromes:
- depressive syndrome - a triad in the structure of symptoms and required an additional: depressed mood (gipotimiya), slow thinking, motor retardation, sometimes in combination with delusions of self-blame, self-deprecation;
- mania - is characterized by a joyful mood (hyperthymia), accelerated thinking, physical activity, with a thirst for action and sometimes with delusions of grandeur;
- dysphoric syndrome - characterized by a melancholy mood, angry with a tendency toward aggression.
II. Hallucinatory-delusional syndrome:
- hallucinosis - is characterized by massive true or false, hallucinations, delusional interpretation of the low, not accompanied by disturbances of consciousness (verbal, visual, tactile);
- paranoiac syndrome - limited to primary, systematic, monothematic delusions combined with thoroughness of thinking;
- paranoid syndrome - is made up of multidisciplinary delirium, sometimes in combination with hallucinations;
- hallucinatory-paranoid syndrome (syndrome Kandinsky Clerambault) is a set of delusions or mental or physical coercion, delusions of various other subjects, pseudohallucinations,
III. Complex motor-volitional disorders:
- catatonic excitement - is characterized by stereotyped, impulsivity, inexpedient, pretentiousness movements in combination with inkogerentsiey thought echo-symptoms (echolalia, echomotism) and negativism;
- catatonic stupor - combines in its structure symptoms of partial or complete immobility, negativism, catalepsy, mutism, refusal to eat, raunch feces and urine, due to muscular hypertonicity may elaborate special postures (embryonic, guard dogs), symptoms of "proboscis", "Air pillow, "" hood ", etc.;
IV. Syndromes of impaired consciousness:
Syndromes Shutdown of consciousness (not related to psychotic syndromes):
- Stunning - characterized by increasing the sensitivity and perception, inhibition of all kinds of mental processes, but with the ability to mobilize mental activity with external stimulation;
- Sopor - more profound disturbance of consciousness with complete loss of comprehension of the situation and orientation, followed by amnesia;
-Coma - even more profound disturbance of consciousness with loss of all types of orientation, the conditioned and unconditioned reflex reactions to any external stimulation and dysfunction of internal organs.
Syndromes of confusion:
- Delirium - a syndrome characterized by the structure of an illusory perception of,, visual, real, frightening hallucinations stsenopodobnye, there may be verbal and tactile hallucinatory experiences, combined with figurative sense delusions (often of persecution), psychomotor agitation, intense emotion of fear, dissociation of thinking, disorientation in place time and partial amnesia of the real events of the output from the state (and possible mussitiruyuschy professional delirium);
- Oneiric - is characterized by the influx of fantastic grezopodobnyh representations pseudohallucinations - twilight of consciousness disorder - paroxysmally comes with a deep disorientation in time, place, self, bright, colorful, true hallucinations, delusions sensual, intense emotion of anger and sadness and a tendency to aggressive actions , followed by complete delayed amnesia (option in an orderly and disorderly conduct);
- V. Syndromes of impaired memory and intelligence:
1. Korsakoff amnestic syndrome - has in its structure fixation amnesia retro-and anterograde amnesia, confabulation and psevdoreministsentsii, disorientation in time and place;
2. psychoorganic syndrome - characterized by a triad of Walter Byuelya: memory loss,
weakening of the intellect, passion incontinence;
3. dementia (dementia) - persistent, maloobratimoe depletion of mental activity, its simplification and decline, and total release lacunary dementia;
In the group of negative disorders distinguished:
1. personality changes;
2. asthenic syndrome;
3. apatiko-abulichesky syndrome (falling energy potential, reducing the individual, the individual regression);
4. amnestic Korsakov's syndrome;
5. total dementia;
Negative mental disorders, as well as positive, reflect:
- existing at that time the level of disturbances of mental activity that gives an indication of the severity of mental illness;
- nosology of disease;
- trend of development, therefore, established prognosis as a result of dynamic monitoring and research.
CLASSIFICATION OF MENTAL ILLNESS.
Single, universally accepted classification of mental illness does not exist.
Devised by the World Health Organization International Classification of Diseases (currently 10 revision) is modified and adapted to the existing national classification.
Classification of mental illnesses.
- Endogenous mental illness:
- schizophrenia.
- manic-depressive psychosis.
- functional psychoses of old age (involutional psychosis).
II. Endogenous organic disease:
- epilepsy.
- atrophic processes in the brain:
- Senile dementia;
- Alzheimer's disease;
- Pick's disease - Parkinson's disease;
- Gentingyuna chorea.
- organic hereditary disease.
III. Exogenous-organic diseases:
- disease of the brain;
- mental disorders in traumatic brain injury;
- mental disorders in brain tumors;
- mental disorders in infectious and organic diseases of the brain:
- Encephalitis;
- Syphilis of the brain, paralysis;
- Brain abscesses.
- Acute psychosis - hallucinosis.
IV. Exogenous mental disorders:
- Symptomatic psychoses:
- In somatic non-communicable diseases;
- With somatic infections;
- With intoxication.
- Substance Abuse:
- Alcoholism - non-alcoholic substance abuse - drug addiction.
- Psychogenic illness:
- Neurosis - reactive psychoses.
- The pathology of mental development:
- Psychopathology - mental retardation.
Used in this lesson, new educational technologies:
Methodology and technology for business game "swarm."
Total playing time - 45 minutes. All students are divided into groups by drawing lots 3 groups of 4 students each. Each subgroup sits at a separate table, preparing a sheet of paper and a pen. In the worksheet, write the date, group number, department, name Student participants in this subgroup and the name of the business game. One of the members of each subgroup of the envelope option takes the job, which is used for all subgroups. One of the students in each subgroup rewrites job list. All of the students together to discuss sub-task, then one of them writes a solution. On the solution set is given 15 minutes. The teacher monitors the progress of the game. At the expiration time of the surrender prepodavatelya.Vse the players discuss the results, choose the best solutions for which the maximum score is placed.
Complex issues for the business game "swarm" on a practical lesson on the topic: "The main psychopathological syndromes."
1. What syndromes are negative?
2. What is negative syndromes?
3. What are the positive syndrome?
4. What syndromes are disorders of thinking?
5. What is paranoyalny syndrome?
6. What is characteristic of the paranoid syndrome?
7. The structure of the hallucinatory-paranoid syndrome.
8. What are symptoms of neurotic level?
9. What syndromes are disorders of memory and mind?
10. The structure of the Korsakov syndrome.
11. What is characteristic of a depressive syndrome?
12. What is characteristic of mania?
13. Criteria stupefaction by Jaspers.
14. The main components of aneroid syndrome.
15. Features amential impairment of consciousness and its components.
6.2 Analytical part.
Situational problems.
1. Patient X., 42, inv. Group II. Ill for 15 years. The Department holds self-confidence, feels samodovolstva, cheerfulness. Calls himself a "superman", "a man from another world", "an astronaut on Mars." He hears "voices inoplaetyan" and talking with them, gives orders to other pianism. Believes that with the help of special devices, "the aliens are studying the earth, a person familiar with the achievements of science and technicks." With a special technique they look through my eyes, Chimelt, listen, convey ideas. "Declares that the Martians at night may transfer it to other cities of the country, taught him 'chuzhomu language "," convey to him the knowledge to decide the fate of four-lovechestva. " The department is active enough, read newspapers, books ("they need it"), eagerly talking to patients.
Determine the syndrome.
A: The syndrome Kandinsky Clerambault.
- Patient G., aged 23, a disabled 2 groups. Immobilized in flowtion of 3 months., Lying in bed, the conversation does not come, mutichna. Fixed gaze, facial expression is monotonous. Oily skin face, lips stretched tube (proboscis symptom), the mouth and nose discharge. Hands and feet are cyanotic. Inspect yourself does not give everyone resists impact, grits chelyu STI, zazhmurivaet eyes. After inspecting the freezes in the form attached. Limb muscle tone was increased, a symptom of "gear to forest", a raised area above the head for hours does not fall. Feeding after release barbamilovogo, eating with hands per ¬ son, gluttonous. Rarely eats alone, planted with other patients, lack of food in them. Untidy, defecates in bed. Requires constant care.
Determine the syndrome.
Answer: The catatonic stupor.
3. Patient B, aged 37, a mechanic. Three days ago there was anxiety, restlessness. It seemed that his room is full of people, some people behind a wall of screaming, threatening to kill, are invited to "go-to drink." Did not sleep at night, seen from under the bed crawling monster with horns and glowing eyes, saw the room running the gray mouse polusobaki, polukoshki, heard a knock at the window, screaming for help. In extreme fear, ran out of the house and ran to the police station to escape the "persecution". From there taken to a psychiatric hospital. The department: WHObuzhden, especially at night, tears to the door to the window. During the conversation - conversation on the topic of attention focuses with labor house, trembling, looking anxiously around. Suddenly begins to shake off something that says that shakes him by crawling insects, sees a "grimace faces," shows at Vaeth. them with his finger, laughing loudly. Determine the syndrome.