Methods and research in clinical psychology. Methods of experimental pathopsychology. The concept of pathopsychology. Tasks of pathopsychological research
Clinical psychology is a branch of psychological science. Her findings are of theoretical and practical importance for both psychology and medicine.
In some countries, the concept of medical psychology is common, but in most countries the concept of "clinical psychology" is more commonly used.
In recent decades, the question of the convergence of domestic and world psychology has increasingly arisen in Russia, which required a revision of such concepts as medical and clinical psychology.
The change in the name of medical psychology to clinical psychology is due to the fact that in recent decades it has been integrating into world psychology.
Clinical psychology as an organization of researchers and practitioners has been represented by the American Association of Clinical Psychology since 1917, and in German-speaking countries since mid-nineteenth V.
In the International Guide to Clinical Psychology, under general edition M. Perret and W. Baumann give the following definition: “Clinical psychology is a private psychological discipline, the subject of which is mental disorders and mental aspects of somatic disorders (diseases). It includes the following sections: etiology (analysis of the conditions for the occurrence of disorders), classification, diagnosis, epidemiology, intervention (prevention, psychotherapy, rehabilitation), health care, evaluation of results. IN English speaking countries in addition to the term "clinical psychology", the concept of "pathological psychology" - Abnormal Psychology - is used as a synonym. In addition to clinical psychology, many universities, mostly Western ones, also teach medical psychology. The content of this discipline may be different. It includes:
1) the application of the achievements of psychology in medical practice (first of all, this concerns solving the problem of interaction between a doctor and a patient);
2) disease prevention (prophylaxis) and health protection;
3) mental aspects of somatic disorders, etc. In accordance with the state educational
standard clinical psychology - specialty general profile aimed at solving a set of problems in the healthcare and education system. It is also noted that clinical psychology is intersectoral in nature.
Experts give different definitions of clinical psychology. But they all agree on one thing: clinical psychology considers the area that borders between medicine and psychology. This is a science that studies the problems of medicine from the point of view of psychology.
The leading Soviet psychiatrist A. V. Snezhnevsky believes that medical psychology is a branch of general psychology that studies the state and role of the psyche in the occurrence of human diseases, the features of their manifestations, course, as well as outcome and recovery. In its research, medical psychology uses descriptive and experimental methods accepted in psychology.
2. Subject and object of research in clinical psychology
According to the direction, psychological research is divided into general (aimed at identifying general patterns) and private (aimed at studying the characteristics of a particular patient). In accordance with this, one can distinguish between general and particular clinical psychology.
The subject of general clinical psychology are:
1) the main patterns of the psychology of the patient, the psychology of a medical worker, psychological features communication between the patient and the doctor, as well as the influence of the psychological atmosphere of medical institutions on the human condition;
2) psychosomatic and somatopsychic mutual influences;
3) individuality (personality, character and temperament), the evolution of a person, the passage of successive stages of development in the process of ontogenesis (childhood, adolescence, youth, maturity and late age), as well as emotional and volitional processes;
4) issues of medical duty, ethics, medical secrecy;
5) mental hygiene (psychology of medical consultations, family), including mental hygiene of persons in crisis periods of their lives (puberty, menopause), psychology of sexual life;
6) general psychotherapy.
Private clinical psychology studies a specific patient, namely:
1) features of mental processes in mental patients;
2) the psyche of patients during the period of preparation for surgical interventions and in the postoperative period;
3) features of the psyche of patients suffering from various diseases (cardiovascular, infectious, oncological, gynecological, skin, etc.);
4) the psyche of patients with defects in the organs of hearing, vision, etc.;
5) features of the psyche of patients during labor, military and forensic examinations;
6) the psyche of patients with alcoholism and drug addiction;
7) private psychotherapy.
B. D. Karvasarsky, as a subject of clinical psychology, singled out the features of the mental activity of the patient in their significance for the pathogenetic and differential diagnosis of the disease, the optimization of its treatment, as well as the prevention and promotion of health.
What is the object of clinical psychology? B.D. Karvasarsky believes that the object of clinical psychology is a person with difficulties in adaptation and self-realization, which are associated with his physical, social and spiritual state.
3. Goals and structure of clinical psychology. Main sections and areas of their research
Clinical psychology as an independent science faces certain goals. In the 60s-70s. 20th century the specific goals of clinical psychology were formulated as follows (M. S. Lebedinsky, V. N. Myasishchev, 1966; M. M. Kabanov, B. D. Karvasarsky, 1978):
1) the study of mental factors affecting the development of diseases, their prevention and treatment;
2) study of the influence of certain diseases on the psyche;
3) the study of mental manifestations of various diseases in their dynamics;
4) the study of developmental disorders of the psyche; study of the nature of the relationship of a sick person with medical personnel and the surrounding microenvironment;
5) development of principles and methods of psychological research in the clinic;
6) creation and study of psychological methods of influencing the human psyche for therapeutic and prophylactic purposes.
Such a formulation of the goals of clinical psychology corresponded to the growing tendency to use the ideas and methods of this science to improve the quality of the diagnostic and therapeutic process in various fields of medicine, with all the difficulties that are inevitable at this stage, due to the unequal degree of development of one or another of its sections.
It is possible to single out specific sections of medical psychology that find practical application of knowledge in the relevant clinics: in a psychiatric clinic - pathopsychology; in neurological - neuropsychology; in the somatic - psychosomatics.
According to B. V. Zeigarnik, pathopsychology studies disorders of mental activity, patterns of disintegration of the psyche in comparison with the norm. She notes that pathopsychology operates with the concepts of general and clinical psychology and uses psychological methods. Pathopsychology works both on the problems of general clinical psychology (when changes in the personality of mental patients and the patterns of mental decay are studied), and private (when mental disorders of a particular patient are studied to clarify the diagnosis, conduct a labor, judicial or military examination).
The object of study of neuropsychology are diseases of the central nervous system (central nervous system), predominantly local-focal lesions of the brain.
Psychosomatics studies how changes in the psyche affect the occurrence of somatic diseases.
Pathopsychology should be distinguished from psychopathology (which will be discussed later). Now it is only worth noting that pathopsychology is a part of psychiatry and studies the symptoms of a mental illness by clinical methods, using medical concepts: diagnosis, etiology, pathogenesis, symptom, syndrome, etc. The main method of psychopathology is clinical and descriptive.
4. The relationship of clinical psychology with other sciences
The basic sciences for clinical psychology are general psychology and psychiatry. The development of clinical psychology is also influenced by big influence neurology and neurosurgery.
Psychiatry - medical science, but it is closely related to clinical psychology. These sciences have common subject scientific research- mental disorders. But besides this, clinical psychology deals with such disorders, which in their significance are not equivalent to diseases (for example, problems of matrimony), as well as the mental aspects of somatic disorders. However, psychiatry, as a private field of medicine, takes more into account the somatic plane of mental disorders. Clinical psychology focuses on psychological aspects.
Clinical psychology is related to psychopharmacology: both study psychopathological disorders and their treatment. In addition, the use of drugs always has a positive or negative psychological effect on the patient.
Medical pedagogy is successfully developing - an area adjacent to medicine, psychology and pedagogy, whose tasks include the education, upbringing and treatment of sick children.
Psychotherapy as an independent medical specialty is closely related to clinical psychology. Theoretical and practical problems of psychotherapy are developed based on the achievements of medical psychology.
In the West, psychotherapy is considered to be a special area of clinical psychology, and thus emphasizes the special affinity between psychology and psychotherapy.
However, the position on the special proximity of psychotherapy and clinical psychology is often disputed. Many scientists believe that from a scientific point of view, psychotherapy is closer to medicine. This gives the following arguments:
1) the treatment of patients is the task of medicine;
2) psychotherapy is the treatment of patients. It follows that psychotherapy is the task of medicine. This provision is based on the fact that in many countries only physicians are eligible to practice it.
Clinical psychology is close to a number of other psychological and pedagogical sciences - experimental psychology, occupational therapy, oligophrenopedagogy, tiflopsychology, deaf psychology, etc.
Thus, it is obvious that in the process of work, a clinical psychologist needs to apply an integrated approach.
5. Origin and development of clinical psychology
The formation of clinical psychology as one of the main applied branches of psychological science is associated with the development of both psychology itself and medicine, biology, physiology, and anthropology.
The origin of clinical psychology dates back to ancient times, when psychological knowledge was born in the depths of philosophy and natural science.
The emergence of the first scientific ideas about the psyche, the separation of the science of the soul, the formation of empirical knowledge about mental processes and their disorders is associated with the development of ancient philosophy and the achievements of ancient doctors. So, Alkemon of Croton (VI century BC) for the first time in history put forward a position on the localization of thoughts in the brain. Hippocrates also attached great importance to the study of the brain as an organ of the psyche. He developed the doctrine of temperament and the first classification of human types. The Alexandrian physicians Herophilus and Erasistratus described the brain in detail; they drew attention to the cortex with its convolutions, which distinguished man in mental abilities from animals.
The next stage in the development of clinical psychology was the Middle Ages. It was a rather long period, riddled with unbridled mysticism and religious dogmatism, persecution of natural scientists and the fires of the Inquisition. Initially, education was built on the basis of ancient philosophy and the natural science achievements of Hippocrates, Galen, Aristotle. Then knowledge declines, alchemy flourishes, and until the 13th century. the dark years continue. Psychology in the Middle Ages is based on philosophy
Thomas Aquinas. The development of ideas about the psyche at this stage slowed down sharply. An important role in the development of domestic clinical psychology was played by A. F. Lazursky, the organizer of his own psychological school.
Thanks to A.F. Lazursky, the natural experiment was introduced into clinical practice, although he had originally developed it for educational psychology.
Most developed in the 60s. 20th century were the following sections of clinical psychology:
1) pathopsychology, which arose at the intersection of psychology, psychopathology and psychiatry (B. V. Zeigarnik, Yu. F. Polyakov, etc.);
2) neuropsychology, formed on the border of psychology, neurology and neurosurgery (A. R. Luriya, E. D. Khomskaya and others).
There is an independent area of psychological knowledge, which has its own subject, its own research methods, its own theoretical and practical tasks - clinical psychology.
Currently, clinical psychology is one of the most popular applied branches of psychology and has great prospects for development both abroad and in Russia.
6. Practical tasks and functions of a clinical psychologist
A clinical psychologist in healthcare institutions is a specialist whose duties include both participation in psychodiagnostic and psychocorrective activities, and in the treatment process as a whole. Medical assistance is provided by a team of specialists. This "brigade" model of medical care originally arose in the psychotherapeutic and psychiatric services. The center of the team is the attending physician, working in conjunction with a psychotherapist, a clinical psychologist and a specialist in social work. Each of them carries out their own diagnostic, treatment and rehabilitation plan under the guidance of the attending physician and in close cooperation with other specialists. But such a "team" model in health care is not yet widespread enough, and the speed of its spread depends on the availability of psychological personnel. But so far, unfortunately, the domestic healthcare system is ready for this moon.
The activities of a psychologist medical institution aimed at:
1) increasing the mental resources and adaptive capabilities of a person;
2) harmonization of mental development;
3) health protection;
4) prevention and psychological rehabilitation. The subject of the activity of a clinical psychologist
Therefore, it is important to emphasize that a clinical psychologist is a specialist who can work not only in clinics, but also in institutions of a different profile: education, social protection, etc. These are institutions that require an in-depth study of a person’s personality and the provision of psychological assistance to him.
In the above areas, a clinical psychologist performs the following activities:
1) diagnostic;
2) expert;
3) correctional;
4) preventive;
5) rehabilitation;
6) advisory;
7) research, etc.
7. Features and objectives of pathopsychological research
The main areas of work of the pathopsychologist are as follows.
1. Solving problems of differential diagnostics.
Most often, such tasks arise when it is necessary to distinguish the initial manifestations of sluggish forms of schizophrenia from neurosis, psychopathy, and organic diseases of the brain. Also, the need for a pathopsychological study may arise when recognizing erased or “masked” depressions, dissimulating delusional experiences and some forms of pathology of late age.
2. Assessment of the structure and degree of neuropsychiatric disorders.
With the help of a pathopsychological study, a psychologist can determine the severity and nature of violations of individual mental processes, the possibility of compensating for these violations, taking into account the psychological characteristics of a particular activity.
3. Diagnostics of mental development and the choice of ways of training and retraining.
In children's institutions, the pathopsychologist plays an important role in solving diagnostic problems. An important task here is to determine the anomalies of mental development, to identify the degree and structure of various forms of mental development disorders. Pathopsychological research contributes to a better understanding of the nature of mental development anomalies, and also serves as the basis for the development of psycho-corrective programs for further work with the child.
4. Study of the personality and social environment of the patient.
In this case, the psychological experiment is based on the principle of modeling a certain objective activity. At the same time, the features of the psyche of patients, mental processes and personality traits that play important role in social and professional adaptation. The pathopsychologist must determine which functions are affected and which are preserved, and determine the ways of compensation in various activities.
5. Assessment of the dynamics of mental disorders. Psychological methods are effective
to identify changes in the system of relations and in the social position of the patient in connection with the ongoing psycho-corrective work. It is important to note that when assessing the dynamics of the patient's condition, a repeated psychological examination is always carried out.
6. Expert work.
Pathopsychological research is an important element of medical-labor, military-medical, medical-pedagogical and forensic-psychiatric examinations. In addition, in judicial practice, psychological examination can act as independent evidence. The tasks of the study are determined by the type of examination, as well as the questions that the psychologist must answer during the experiment.
8. Methods of pathopsychological research
The methods used for pathopsychological research can be divided into standardized and non-standardized.
Non-standardized methods are aimed at determining specific disorders of mental activity and are compiled individually for each patient.
Non-standardized methods of pathopsychological research include:
1) the method of "formation of artificial concepts" by L. S. Vygotsky, which is used to identify the features of conceptual thinking in various mental illnesses, primarily in schizophrenia and some organic brain lesions;
2) the method of "classification of objects" by Goldstein, which is used to analyze various violations of the processes of abstraction and generalization;
3) methods "classification", "subject pictures", "exclusion of objects", "exclusion of concepts", "interpretation of proverbs" and other methods of studying thinking;
4) Anfimov-Bourdon's "correction tests" method and Schulte-Gorbov's "black-and-red digital tables" method (to study attention and memory), as well as the methods of typing syllables and words, the Kraepelin and Ebbinghaus methods are used to study short-term memory;
5) the method of "unfinished sentences";
6) the method of "paired profiles";
7) thematic apperception test (TAT) and other methods for the study of personality.
The main principle when using non-standardized research methods is the principle of modeling certain situations in which certain types of mental activity of the patient are manifested. The conclusion of the pathopsychologist is based on an assessment of the end result of the patient's activity, as well as on an analysis of the characteristics of the process of performing tasks, which allows not only to identify violations, but also to compare the disturbed and intact aspects of mental activity.
Standardized methods are widely used in diagnostic work. In this case, specially selected tasks are presented in the same form to each subject. Thus, it becomes possible to compare the methods and levels of task performance by the subjects and other persons.
Almost all non-standardized methods can be standardized. It should be noted that for a qualitative analysis of the characteristics of mental activity, most of the subtests included in the standardized methods can be used in a non-standardized version.
B. V. Zeigarnik believes that the pathopsychological experiment is aimed at:
1) to study the real activity of a person;
2) a qualitative analysis of various forms of the disintegration of the psyche;
3) to reveal the mechanisms of disturbed activity and the possibility of its restoration.
9. The procedure for conducting a pathopsychological study
Pathopsychological research includes the following stages.
1. Studying the medical history, talking with a doctor and setting the task of a pathopsychological study.
The attending physician must inform the pathopsychologist of the main clinical data about the patient and set the tasks of pathopsychological research for the psychologist. The psychologist specifies for himself the task of the study, selects the necessary methods and establishes the order of their presentation to the patient. The doctor must explain to the patient the goals of the pathopsychological study and thereby contribute to the development of positive motivation in him.
2. Carrying out a pathopsychological study.
First of all, the psychologist needs to establish contact with the patient. The reliability of the results obtained in the course of the pathopsychological study largely depends on the success of establishing psychological contact between the pathopsychologist and the subject. Before proceeding with the experiment, it is necessary to make sure that contact with patients is established and the patient understands the purpose of the study. The instruction should be formulated clearly and accessible to the patient.
M. M. Kostereva identifies several types of patient's relationship to pathopsychological research:
1) active (patients join the experiment with interest, adequately respond to both success and failure, are interested in the results of the study);
2) wary (at first, patients treat the study with suspicion, irony, or even fear it, but during the experiment, uncertainty disappears, the patient begins to show accuracy and diligence; with this type of attitude, a “delayed form of response” should be noted, when discrepancies are observed between the subjective experiences of the subject and the external expressive component of behavior);
3) formally responsible (patients fulfill the requirements of a psychologist without personal interest, are not interested in the results of the study);
4) passive (the patient needs additional motivation; there is no installation for the examination or is extremely unstable);
5) negative or inadequate (patients refuse to participate in the study, perform tasks inconsistently, do not follow instructions).
In drawing conclusions, the pathopsychologist must take into account all factors, including the education of the patient, his attitude to the study, as well as his condition during the study.
3. Description of the results, drawing up a conclusion based on the results of the study - the limits of the psychologist's competence.
But on the basis of the results of the study, a conclusion is drawn up, in which the conclusions are consistently stated.
10. Violation of mediation and hierarchy of motives
One of the types of personality development disorders are changes in the motivational sphere. A. N. Leontiev argued that the analysis of activity should be carried out through the analysis of changes in motives. Psychological analysis changes in motives is one of the ways to study the personality of a sick person, including the characteristics of his activity. In addition, as B. V. Zeigarnik notes, “in some cases, pathological material makes it possible not only to analyze changes in motives and needs, but also to trace the process of formation of these changes.”
The main characteristics of motives include:
1) indirect nature of motives;
2) hierarchical construction of motives.
In children, the hierarchical construction of motives and their mediation begins to emerge even before school. Then, throughout life, the complication of motives occurs. Some motives are subordinate to others: any one general motive (for example, to master a certain profession) includes a number of private motives (to acquire the necessary knowledge, acquire certain skills, etc.). Thus, human activity is always motivated by several motives and meets not one, but several needs. But in a specific activity, one can always single out one leading motive, which gives a certain meaning to all human behavior. Additional motives are necessary because they directly stimulate human behavior. The content of any activity loses its personal meaning if there are no leading motives that make it possible to mediate motives in their hierarchical structure.
B. S. Bratus points out that changes occur primarily in the motivational sphere (as an example, the narrowing of the circle of interests). In the course of a pathopsychological study, gross changes in cognitive processes are not detected, but when performing certain tasks (especially those that require prolonged concentration of attention, quick orientation in new material), the patient does not always notice the mistakes he has made (uncriticality), does not respond to the experimenter's comments and is not guided by them in the future. The patient also has high self-esteem.
So, we see how, under the influence of alcoholism in this patient, the former hierarchy of motives is destroyed. Sometimes he has some desires (for example, to get a job), and the patient performs some actions, guided by the previous hierarchy of motives. However, these incentives are not sustainable. The main (sense-forming) motive that controls the activity of the patient, as a result, is the satisfaction of the need for alcohol.
So, based on the analysis of changes in mediation and the hierarchy of motives, we can draw the following conclusions:
1) these changes are not derived directly from brain disorders;
2) they go through a complex and long way of formation;
3) in the formation of changes, mechanisms similar to the mechanisms of the normal development of motives operate.
11. Violation of the meaning-forming and incentive functions of the motive
Now consider the pathology of the meaning-forming and motivating functions of motives.
Only by merging these two functions of motive can we speak of consciously regulated activity. Due to the weakening and distortion of these functions, a serious disruption of activity occurs.
These violations were considered by M. M. Kochenov on the example of patients with schizophrenia. They conducted a study, which consisted of a barely blowing one: the subject must complete, of his own choice, three tasks out of nine offered to him by the experimenter, spending no more than 7 minutes on this. The tasks were:
1) draw a hundred crosses;
2) perform twelve lines of the proof test (according to Bourdon);
3) complete eight lines of the account (according to Kraepelin);
4) fold one of the ornaments of the Kos technique;
5) build a “well” from matches;
6) make a chain out of paper clips;
7) Solve three different puzzles.
Thus, the patient had to choose those actions that are most appropriate to achieve the main goal (perform a certain number of tasks in a certain time).
Conducting this study on healthy subjects, M. M. Kochenov came to the conclusion that in order to achieve the goal, an indicative stage (active orientation in the material) is necessary, which was present in all representatives of this group of subjects.
All subjects were guided by the degree of difficulty of the tasks and chose those that would take less time to complete, as they tried to meet the seven minutes allotted to them.
Thus, in healthy subjects in this situation, individual actions are structured into purposeful behavior.
When conducting an experiment among patients with schizophrenia, other results were obtained:
1) patients did not have an indicative stage;
2) they did not choose easy tasks and often took on those tasks that are clearly impossible to complete in the allotted time;
3) sometimes patients performed tasks with great interest and with special care, not noticing that the time had already expired.
Note that all patients also knew that they had to meet the allotted time, but this did not become a regulator of their behavior. During the experiment, they were able to spontaneously repeat “I have to do it in 7 minutes” without changing the way they completed the task.
So, the studies of M. M. Kochenov showed that the disruption in the activity of patients with schizophrenia was due to a change in the motivation of the sphere. Their motive turned into just “knowledge” and thus lost its functions – meaning-forming and motivating.
It was the shift in the meaning-forming function of motives that caused the disturbance in the activity of patients, changes in their behavior and degradation of the personality.
12. Violation of controllability and criticality of behavior
Failure to control behavior is one of the images of personality disorders. It is expressed in the patient's incorrect assessment of his actions, in the absence of criticality to his painful experiences. Investigating violations of criticism in mental patients, I. I. Kozhukhovskaya showed that uncriticality in any form indicates a violation of activity in general. Criticality, according to Kozhukhovskaya, is “the pinnacle of personal qualities person."
As an example of such a violation, consider extracts from the medical history given by B. V. Zeigarnik:
sick M.
Year of birth - 1890.
Diagnosis: progressive paralysis.
Disease history. In childhood, he developed normally. He graduated from the Faculty of Medicine, worked as a surgeon.
At the age of 47, the first signs of mental illness appeared. During the operation, he made a gross mistake, which led to the death of the patient.
Mental state: correctly oriented, verbose. Knows about his disease, but treats it with great ease. Recalling his surgical error, he says with a smile that "everyone has accidents." At the moment, he considers himself healthy, "like a bull." I am convinced that I can work as a surgeon and chief physician of the hospital.
When performing even simple tasks, the patient makes many gross mistakes.
Without listening to the instructions, he tries to approach the task of classifying objects, like a game of dominoes, and asks: “How do you know who won?” When the instructions are read to him a second time, he performs the task correctly.
Performing the task "establishing a sequence of events", trying to simply explain each picture. But when the experimenter interrupts his reasoning and suggests putting the pictures in the right order, the patient performs the task correctly.
When performing the task “correlation of phrases with proverbs”, the patient correctly explains the sayings “Measure seven times - cut once” and “Not all that glitters is gold”. But he incorrectly refers to them the phrase "Gold is heavier than iron."
Using the pictogram technique, the following results were obtained: the patient forms connections of a rather generalized order (to memorize the phrase “jolly holiday”, he draws a flag, “dark night” - shades a square). The patient is often distracted from the task.
When checking, it turns out that the patient remembered only 5 words out of 14. When the experimenter told him that this was very little, the patient replied with a smile that next time he would remember more.
Thus, we see that patients do not have a motive for the sake of which they perform this or that activity, perform this or that task.
Their actions are absolutely unmotivated, patients are not aware of their actions, their statements.
The loss of the opportunity to adequately evaluate one's own behavior and the behavior of others led to the destruction of the activity of these patients and a deep personality disorder.
13. Violation of the operational side of thinking. Methods of its research
Violation of the operational side of thinking occurs in two categories:
1) lowering the level of generalization;
2) distortion of the generalization process.
Generalization refers to the main mental operations.
There are four levels of the generalization process:
2) functional - belonging to a group based on functional characteristics;
3) specific - belonging to a group based on specific characteristics;
4) zero - enumeration of objects or their functions, no attempts to generalize objects.
Before proceeding to consider the types of violations of the operational side of thinking, we list the main methods that are used to diagnose pathology. mental activity.
1. Method "Classification of objects" The task of the subject is to attribute
objects to a particular group (for example, "people", "animals", "clothes", etc.). Then the subject is asked to expand the groups formed by him (for example, "living" and "non-living"). If at the last stage a person identifies two or three groups, we can say that he has a high level of generalization.
2. Method "Exclusion of the superfluous" The subject is presented with four cards. Three of them depict objects that have something in common; the fourth subject should be excluded.
The selection of too generalized features, the inability to exclude an extra subject indicates a distortion of the generalization process.
3. Method "Formation of analogies" The subject is presented with pairs of words, between which there are certain semantic relationships. The subject's task is to highlight a couple of words by analogy.
4. Methodology "Comparison and definition of concepts"
Stimulus material is a homogeneous and heterogeneous concepts. This technique is used to investigate the distortion of the generalization process.
5. Interpretation of the figurative meaning of proverbs and metaphors
There are two versions of this technique. In the first case, the subject is asked to simply explain the figurative meaning of proverbs and metaphors. The second option is that for each proverb you need to find a phrase that corresponds in meaning.
6. Pictogram technique
The subject's task is to memorize 15 words and phrases. To do this, he needs to draw an easy drawing in order to remember all the phrases or words. Then the character of the executed drawings is analyzed. Attention is drawn to the presence of links between the stimulus word and the picture of the subject.
14. Reducing the level of generalization
With a decrease in the level of generalization in patients, direct ideas about objects and phenomena prevail, i.e., instead of highlighting common features, patients establish specific situational relationships between objects and phenomena. They are difficult to abstract from specific details.
B. V. Zeigarnik gives examples of the performance of the “classification of objects” task by patients with a reduced level of generalization: “... one of the described patients refuses to combine a goat with a wolf in one group, “because they are at enmity”; another patient does not combine the cat and the beetle, because "the cat lives in the house, but the beetle flies." Particular signs “lives in the forest”, “flies” determine the judgments of patients more than the general sign “animals”. With a pronounced decrease in the level of generalization, the task of classification is generally inaccessible to patients; for the subjects, the objects turn out to be so different in their specific properties that they cannot be combined. Even a table and a chair cannot be attributed to the same group, since “they sit on the chair, and work and eat on the table ...”.
Let us give examples of responses of patients with a reduced level of generalization in the experiment "exclusion of objects". Patients are presented with pictures “kerosene lamp”, “candle”, “electric light bulb”, “sun” and asked what needs to be removed. The experimenter receives the following responses.
1. “We must remove the candle. She is not needed, there is a light bulb.
2. “You don’t need a candle, it burns out quickly, it is unprofitable, and then you can fall asleep, it can catch fire.”
3. "We don't need a kerosene lamp, now there is electricity everywhere."
4. "If during the day, then you need to remove the sun - and without it it is light." Pictures "scales", "watches", "thermometer", "glasses" are presented:
1) the patient removes the thermometer, explaining that "he is only needed in the hospital";
2) the patient removes the scales, because "they are needed in the store when it is necessary to hang";
3) the patient cannot exclude anything: he says that the watch is needed “for time”, and the thermometer is “to measure the temperature”; he cannot remove his glasses, because “if a person is short-sighted, then he needs them,” and scales “are not always needed, but are also useful in the household.”
So, we see that often patients approach the presented objects from the point of view of their suitability for life. They do not understand the conventions that are hidden in the task assigned to them.
15. Distortion of the generalization process. Violation of the dynamics of thinking
Patients with a distortion of the generalization process, as a rule, are guided by overly generalized signs. In such patients, random associations predominate.
For example: the patient puts shoes and a pencil in the same group because "they leave marks."
Distortion of the generalization process occurs in patients with schizophrenia.
The main difference between the distortion of the generalization process and the decrease in its level was most clearly described by B. V. Zeigarnik. She noted that if for patients with a reduced level of generalization, the compilation of pictograms is difficult due to the fact that they are not able to distract from some specific meanings of the word, then patients with a distortion of the generalization process easily perform this task, since they can form any association that is not related to the task assigned to them.
For example: a patient draws two circles and two triangles, respectively, to memorize the phrases “merry holiday” and “warm wind”, and a bow to memorize the word “separation”.
Let us consider how a patient with a distortion of the generalization process performs the task “classification of objects” (in schizophrenia):
1) combines a cupboard and a saucepan into one group, since “both objects have a hole”;
2) identifies a group of objects "pig, goat, butterfly" because "they are hairy";
3) the car, the spoon and the cart belong to the same group “according to the principle of movement (the spoon is also moved to the mouth)”;
4) combines a clock and a bicycle into one group, because “clocks measure time, and when they ride a bicycle, space is measured”;
5) he refers the shovel and the beetle to the same group, since “they dig the ground with a shovel, the beetle also digs in the ground”;
6) combines a flower, a shovel and a spoon into one group, because "these are objects that are elongated in length."
Violation of the dynamics of thinking is quite common.
There are several types of violation of the dynamics of thinking.
1. Inconsistency of judgments.
2. Lability of thinking.
3. Inertia of thinking.
The study of the dynamics of thinking is carried out using the methods used to study violations of the operational side of thinking. But with this type of violation, it is necessary first of all to pay attention to:
1) features of switching the subject from one type of activity to another;
2) excessive thoroughness of judgments;
3) a tendency to detail;
4) inability to maintain purposefulness of judgments.
16. Inconsistency of judgments
characteristic feature patients with inconsistency of judgments is the instability of the way the task is performed. The level of generalization in such patients is usually reduced. They quite successfully perform tasks for generalization and comparison. However, the correct decisions in such patients alternate with a specific situational association of objects into a group and with decisions based on random connections.
Let us consider the actions of patients with inconsistent judgments when performing the task “classification of objects”. Such patients correctly assimilate the instructions, use an adequate method when performing a task, choose pictures according to a generalized feature. However, after some time, patients change the correct path of decision to the path of incorrect random associations. In this case, several features are noted:
1) alternation of generalized (correct) and specific situational combinations;
2) logical connections are replaced by random combinations (for example, patients assign objects to the same group because the cards are next to each other);
3) the formation of groups of the same name (for example, the patient identifies a group of people "a child, a doctor, a cleaner" and a second group of the same name "sailor, skier").
This violation of the dynamics of thinking is characterized by the alternation of adequate and inadequate solutions. Lability does not lead to gross violations of the structure of thinking, but only for some time distorts the correct course of the patients' judgments. It is a violation of the mental performance of patients.
Sometimes the lability of thinking is persistent. Such a constant, persistent lability occurs in patients with TIR in the manic phase.
Often a word evokes a chain of associations in such patients, they begin to give examples from their own lives. For example, explaining the meaning of the proverb “All that glitters is not gold”, a patient in the manic phase of TIR says: “Gold is a wonderful gold watch my brother gave me, it is very good. My brother was very fond of the theater ... ", etc.
In addition, in patients with manifestations of lability of thinking, “responsibility” is observed: they begin to weave any random stimulus from the external environment into their reasoning. If this happens during the performance of the task, patients are distracted, violate the instructions, lose their focus on actions.
17. Inertia of thinking
The inertia of thinking is characterized by a pronounced difficulty in switching from one type of activity to another. This violation of thinking is the antipode of the lability of mental activity. In this case, patients cannot change the course of their judgments. Such switching difficulties are usually accompanied by a decrease in the level of generalization and distraction. The rigidity of thinking leads to the fact that the subjects cannot cope even with simple tasks that require switching (with tasks for mediation).
Inertia of thinking occurs in patients with:
1) epilepsy (most common);
2) with brain injuries;
3) with mental retardation.
To illustrate the inertia of thinking, let's give an example: " Sick B.(epilepsy). Closet. “This is an object in which something is stored ... But dishes and food are also stored in the sideboard, and a dress is stored in the closet, although food is often stored in the closet. If the room is small and the sideboard does not fit in it, or if there is simply no sideboard, then the dishes are stored in the closet. Here we have a closet; on the right - a large empty space, and on the left - 4 shelves; There are utensils and food. This, of course, is uncivilized, often the bread smells of mothballs - this is moth powder. Again, there are bookcases, they are not so deep. Shelves of them already, a lot of shelves. Now the cupboards are built into the walls, but it's still a cupboard.”
The inertia of mental activity is also revealed in the associative experiment. The instructions say that the subject must answer the experimenter with a word of the opposite meaning.
The obtained data showed that the latent period in such patients averages 6.5 s, and in some patients it reaches 20–30 s.
In subjects with inertia of thinking, a large number of delayed responses were noted. In this case, patients respond to the previously presented word, and not to the one that is presented at the moment. Consider examples of such delayed responses:
1) the patient answers the word "silence" to the word "singing", and the next word "wheel" answers the word "silence";
2) having answered the word “faith” to the word “deceit”, the patient answers the next word “voices” with the word “falsehood”.
Delayed responses of patients are a significant deviation from the course of the associative process in the norm. They show that the trace stimulus for such patients has a much greater signal value than the actual one.
18. Violation of the motivational (personal) side of thinking. Diversity of thinking
Thinking is determined by the goal, the task. When a person loses the purposefulness of mental activity, thinking ceases to be the regulator of human actions.
Violations of the motivational component of thinking include:
1) diversity;
2) reasoning.
Diversity of thinking is characterized by the absence of logical connections between different thoughts. Judgments of patients about this or that phenomenon proceed, as it were, in different planes. They can accurately understand the instructions, generalize the proposed objects based on the essential properties of the objects. However, they cannot complete tasks in the right direction.
Performing the task "classification of objects", patients can combine objects either on the basis of the properties of the objects themselves, or on the basis of their own attitudes and tastes.
Let's look at a few examples of diversity of thinking.
1. The patient singles out a group of objects “wardrobe, table, bookcase, cleaning lady, shovel”, since this is “a group of people who sweep the bad out of life”, and adds that “the shovel is the emblem of labor, and labor is incompatible with cheating”.
2. The patient identifies a group of objects “elephant, skier”, as these are “objects for spectacles. People tend to desire bread and circuses, the ancient Romans knew about this.
3. The patient selects a group of objects "flower, bed, pot, cleaning lady, saw, cherry" because these are "objects painted red and blue."
Let us give examples of the performance of the task "exclusion of objects" by one of the patients with a diversity of thinking:
1) pictures “kerosene lamp”, “sun”, “electric light bulb”, “candle” are presented; the patient excludes the sun, since "this is a natural luminary, the rest is artificial lighting";
2) pictures “scales”, “watches”, “thermometer”, “glasses” are presented; the patient decides to remove the glasses: “I will separate the glasses, I don’t like glasses, I love pince-nez, why don’t they wear them. Chekhov did wear it”;
3) pictures “drum”, “revolver”, “military cap”, “umbrella” are presented; the patient removes the umbrella: "An umbrella is not needed, now they wear raincoats."
As we can see, the patient can make a generalization: she excludes the sun, since it is a natural luminary. But then she allocates glasses based on personal taste (because "she doesn't like them", not because they are not a measuring device). On the same basis, she allocates an umbrella.
19. Reasoning. Classification of thinking disorders in form and content
Reasoning is a tendency to unproductive verbose reasoning, a tendency to the so-called "fruitless sophistication". The judgments of such patients are due not so much to a violation of intellectual activity as to increased affectivity. They strive to bring any phenomenon (even absolutely insignificant) under some concept.
Affectivity is manifested in the very form of the statement (the patient speaks loudly, with inappropriate pathos). Sometimes one intonation of the patient indicates that the statement is “resonant”.
In addition to the considered classification of thought disorders, there is another classification according to which thought disorders are divided into two groups:
1) in form;
Violations of thinking in form, in turn, are divided into:
1) tempo violations:
a) acceleration (a jump of ideas, which is usually observed in the manic phase with MDP; mentism, or mantism, is an influx of thoughts that occurs against the will of the patient with schizophrenia, with MDP);
b) slowing down - lethargy and poverty of associations, which usually occurs during the depressive phase in MDP;
2) violations of harmony:
a) fragmentation - a violation of the logical connections between the members of the sentence (while the grammatical component is preserved);
b) incoherence is a violation in the field of speech, its semantic and syntactic components; c) verbigeration - a stereotypical repetition in speech of individual words and phrases similar in consonance;
3) violations of purposefulness:
a) reasoning;
b) pathological thoroughness of thinking;
c) perseveration.
Content disorders are divided into:
1) obsessive states- various involuntary thoughts that a person cannot get rid of, while maintaining a critical attitude towards them;
2) overvalued ideas - emotionally rich and plausible beliefs and ideas;
3) crazy ideas - false judgments and conclusions:
a) paranoid delusions - systematized and plausible delusions that occur without disturbances of sensations and perception;
b) paranoid delusions - delusions that usually do not have a sufficiently coherent system, flowing most often with impaired sensations and perception;
c) paraphrenic delirium - a systematized delirium with disturbances in the associative process, occurring against the background of elevated mood.
20. Methods that are used to study memory
The following methods are used to study memory.
1. Ten words
The subject is read ten simple words, after which he must repeat them in any order 5 times. The experimenter enters the results in the table. After 20–30 minutes, the subject is again asked to reproduce these words. The results are also entered into a table.
Example: water, forest, table, mountain, clock, cat, mushroom, book, brother, window.
2. Pictogram method
The subject is presented with 15 words to memorize. To facilitate this task, he should make sketches with a pencil. No writing or lettering is allowed. The subject is asked to repeat the words after the end of the work, and then again after 20-30 minutes. When analyzing the features of memorization, attention is paid to how many words are reproduced accurately, close in meaning, incorrectly, and how many are not reproduced at all. A modification of this method can be the test of A. N. Leontiev. This method involves not drawing, but choosing an object from the proposed ready-made pictures. The technique has several series, different in degree of complexity. The test of A. N. Leontiev can be used to study memory in children, as well as in persons with a low level of intelligence.
3. Reproduction of stories The subject is read a story (sometimes a story is given for independent reading). Then he must reproduce the story orally or in writing. When analyzing the results, the experimenter must take into account whether all the semantic links are reproduced by the subject, whether he has confabulations (filling gaps in memory with non-existent events).
Examples of stories for memorization: "Jackdaw and Doves", "Eternal King", "Logic", "Ant and Dove", etc.
4. Study of visual memory (A. L. Benton test).
For this test, five series of drawings are used. At the same time, in three series, 10 cards of the same complexity are offered, in two - 15 cards each. The subject is shown a card for 10 seconds, and then he must reproduce the seen figures on paper. The analysis of the obtained data is carried out using special Benton tables. This test allows you to obtain additional data on the presence of organic diseases of the brain.
When conducting a patho psychological experiment, aimed at the study of memory disorders, the features of direct and indirect memory are usually revealed.
21. Violations of immediate memory
Immediate memory is the ability to recall information immediately after the action of a particular stimulus.
Some of the most common types of memory impairments are:
1) Korsakov's syndrome;
2) progressive amnesia.
Korsakov's syndrome is a violation of memory for current events with a relative preservation of memory for past events. This syndrome was described by the Russian psychiatrist S. S. Korsakov.
Korsakov's syndrome can manifest itself in insufficiently accurate reproduction of what is seen or heard, as well as in inaccurate orientation. Often patients themselves notice defects in their memory and try to fill in the gaps with fictitious versions of events. Real events are sometimes clearly reflected in the mind of the patient, sometimes they are intricately intertwined with events that never existed. The inability to remember current events leads to the impossibility of organizing the future.
With progressive amnesia, memory impairment extends to both current events and past events. Patients confuse the past with the present, distort the sequence of events. With progressive amnesia, the following symptoms are noted:
1. Interfering effect - the imposition of past events on the events of the present, and vice versa.
2. Disorientation in space and time. Example: the patient seems to be living at the beginning of the 20th century; she thinks that the October Revolution has recently begun.
Such memory impairments are often noted in mental illness of late age. First, patients have a reduced ability to remember current events, then the events of recent years are erased from memory. At the same time, the events from the distant past preserved in the memory acquire special relevance in the mind of the patient. The patient does not live in the present, but in fragments of situations and actions that took place in the distant past.
To illustrate such memory impairments, we give examples taken from the results of an experimental study of one of the patients:
1) explaining the meaning of the proverb “Don’t get into your sleigh,” he says: “Don’t be so impudent, impolite, a bully. Don't go where you don't have to";
2) explains the meaning of the proverb “Strike while the iron is hot” as follows: “Work, be hardworking, cultured, polite. Do it fast, good. Love a person. Do everything for him."
Thus, understanding the figurative meaning of the proverb, the patient cannot remember it and is distracted. The patient's judgments are characterized by instability, correct judgments alternate with incorrect ones.
22. Violation of mediated memory
Indirect is memorization using an intermediate (mediating) link in order to improve reproduction.
Violation of mediated memory in various groups of patients was investigated by S. V. Loginova and G. V. Birenbaum. In the works of A. N. Leontiev it is shown that the introduction of the factor of mediation improves the reproduction of words. But despite the fact that the mediating factor normally improves memorization, it turned out that in some patients the introduction of a mediating link often does not improve, but even worsens the possibility of reproduction.
Patients with impaired mediated memory remember words worse when they try to use a mediating link. Mediation does not help those patients who are trying to establish too formal connections (for example, for the word "doubt" the patient drew a catfish fish, because the first syllable coincided, and for the word "friendship" - two triangles).
When analyzing memory disorders, one should take into account the personality-motivational component.
To study the violation of the motivational component of mnestic activity, experimental studies were carried out. The subject was presented with about twenty tasks that he had to complete. This new motive acted as a sense-forming and motivating motive (the subject set himself a specific goal - to reproduce as many actions as possible).
The fact that mnestic activity is motivated can also be seen in the example of pathology.
The same experiments were carried out in patients with various forms of disturbances in the motivational sphere. It turned out that:
1) in patients with schizophrenia, there was no effect of better reproduction of incomplete tasks compared to completed ones;
2) patients with rigidity of emotional attitudes (for example, in epilepsy) reproduced incomplete actions much more often than completed ones.
Summing up, let's compare the results obtained in the study of healthy subjects and subjects with various mental illnesses.
1. In healthy subjects, VL/VZ = 1.9.
2. In patients with schizophrenia (simple form) VL/VZ = 1.1.
3. In patients with epilepsy VL/VZ = 1.8.
4. In patients with asthenic syndrome VL/VZ = 1.2.
So, a comparison of the results of reproducing unfinished actions in patients with various disorders of the motivational sphere indicates the important role of the motivational component in mnestic activity.
23. Methods used to study attention
There are the following methods that are used in the study of attention.
1. Correction test. It is used to study the stability of attention, the ability to concentrate. Forms are used with the image of rows of letters that are arranged randomly. The subject must cross out one or two letters of the experimenter's choice. A stopwatch is required for the study. Sometimes, every 30–60 s, the position of the subject's pencil is noted. The experimenter pays attention to the number of mistakes made, the rate at which the patient completes the task, as well as the distribution of errors during the experiment and their nature (crossing out other letters, omissions of individual letters or lines, etc.).
2. Account according to Kraepelin. This technique was proposed by E. Krepelin in 1895. It is used to study the features of switching attention, to study performance. The subject is presented with forms with columns of numbers located on them. You need to add or subtract these numbers in your mind, and write down the results on the form.
After completing the task, the experimenter draws a conclusion about working capacity (exhaustion, workability) and notes the presence or absence of attention disorders.
3. Finding numbers on Schulte tables. For research, special tables are used, where numbers are randomly arranged (from 1 to 25). The subject must use a pointer to show the numbers in order and call them. The experimenter takes into account the time to complete the task. A study using Schulte tables helps to identify the features of switching attention, exhaustion, workability, as well as concentration or distractibility.
4. Modified Schulte table. To study the switching of attention, a modified Shul-te red-black table is often used, which contains 49 numbers (of which 25 are black and 24 are red). The subject in turn must show the numbers: black - in ascending order, red - in descending order. This table is used to study the dynamics of mental activity and the ability to quickly switch attention from one object to another.
5. Countdown. The subject must count from a hundred a certain number (one and the same). At the same time, the experimenter notes pauses. When processing the results, examine:
1) the nature of the errors;
2) following the instructions;
3) switching;
4) concentration;
5) exhaustion of attention.
24. Feelings. Their classification
Sensation is the simplest mental process, consisting in the reflection of individual properties, objects and phenomena of the external world, as well as the internal states of the body with the direct impact of stimuli on the corresponding receptors.
The main properties of sensations are:
1) modality and quality;
2) intensity;
3) time characteristic (duration);
4) spatial characteristics.
Feelings can be both conscious and unconscious.
An important characteristic of sensations is the threshold of sensation - the magnitude of the stimulus that can cause sensation.
Consider some classifications of sensations.
V. M. Wundt proposed to divide sensations into three groups (depending on what characteristics of the external environment are reflected):
1) spatial;
2) temporary;
3) space-time.
A. A. Ukhtomsky suggested dividing all sensations into 2 groups:
1. Higher (those types of sensations that give the most subtle diverse differentiated analysis, for example, visual and auditory).
2. Lower (those types of sensations that are characterized by less differentiated sensitivity, such as pain and tactile).
Currently, the generally accepted and most common classification is Sherrington, who proposed to divide sensations into three groups depending on the location of the receptor and the location of the source of irritation:
1) exteroreceptors - receptors of the external environment (vision, hearing, smell, taste, tactile, temperature, pain sensations);
2) proprioceptors - receptors that reflect the movement and position of the body in space (muscular-articular, or kinesthetic, vibrational, vestibular);
3) interoreceptors - receptors located in the internal organs (they, in turn, are divided into chemoreceptors, thermoreceptors, pain receptors and mechanoreceptors, reflecting changes in pressure in the internal organs and bloodstream).
25. Methods for the study of sensations and perception. Major sensory disturbances
The study of perception is carried out:
1) clinical methods;
2) experimental psychological methods. The clinical method is usually used in the following cases:
1) studies of tactile and pain sensitivity;
2) study of temperature sensitivity;
3) study of disorders of the organs of hearing and vision.
4) study of the thresholds of auditory sensitivity, speech perception.
Experimental psychological methods are usually used to study more complex auditory and visual functions. So, E.F. Bazhin proposed a set of techniques, which includes:
1) methods for studying the simple aspects of the activity of analyzers;
2) methods for the study of more complex complex activities.
The following methods are also used:
1) the method "Classification of objects" - to identify visual agnosia;
2) Poppelreuter tables, which are images superimposed on each other, and which are needed to detect visual agnosia;
3) Raven tables - for the study of visual perception;
4) tables proposed by M. F. Lukyanova (moving squares, wavy background) - for the study of sensory excitability (with organic disorders of the brain);
5) tachistoscopic method (identification of listened to tape recordings with various sounds: the sound of glass, the murmur of water, whisper, whistle, etc.) - for the study of auditory perception.
1. Anesthesia, or loss of sensation, can capture both individual types of sensitivity (partial anesthesia) and all types of sensitivity (total anesthesia).
2. The so-called hysterical anesthesia is quite common - the disappearance of sensitivity in patients with hysterical neurotic disorders (for example, hysterical deafness).
3. Hyperesthesia usually captures all spheres (the most common are visual and acoustic). For example, such patients cannot tolerate the sound of normal volume or not very bright light.
4. With hypoesthesia, the patient, as it were, does not clearly perceive the world(for example, with visual hypoesthesia, objects for him are devoid of colors, look shapeless and blurry).
5. With paresthesia, patients experience anxiety and fussiness, as well as increased sensitivity to skin contact with bed linen, clothing, etc.
A kind of paresthesia is senestopathia - the appearance of rather ridiculous unpleasant sensations in various parts of the body (for example, a feeling of "transfusion" inside the organs). Such disorders usually occur in schizophrenia.
26. Definition and types of perception
Now consider the main violations of perception. But first, let's define how perception differs from sensations. Perception is based on sensations, arises from them, but has certain characteristics.
What is common to sensations and perceptions is that they begin to function only with the direct action of irritation on the sense organs.
Perception is not reduced to the sum of individual sensations, but is a qualitatively new level of cognition.
The main principles of perception of objects are the following.
1. The principle of proximity (the closer to each other in the visual field are the elements, the more likely they are combined into a single image).
2. The principle of similarity (similar elements tend to unite).
3. The principle of "natural continuation" (elements that act as parts of familiar figures, contours and forms are more likely to be combined into these figures, contours and forms).
4. The principle of isolation (elements of the visual field tend to create a closed integral image).
The above principles determine the main properties of perception:
1) objectivity - the ability to perceive the world in the form of separate objects with certain properties;
2) integrity - the ability to mentally complete the perceived object to a holistic form, if it is represented by an incomplete set of elements;
3) constancy - the ability to perceive objects as constant in shape, color, consistency and size, regardless of the conditions of perception;
The main types of perception are distinguished depending on the sense organ (as well as sensations):
1) visual;
2) auditory;
3) taste;
4) tactile;
5) olfactory.
One of the most significant types of perception in clinical psychology is a person's perception of time (it can change significantly under the influence of various diseases). Great importance is also attached to violations of the perception of one's own body and its parts.
27. Major Perceptual Disorders
The main cognitive impairments include:
1. Illusions are a distorted perception of a real object. For example, illusions can be auditory, visual, olfactory, etc.
There are three types of illusions according to the nature of their occurrence:
1) physical;
2) physiological;
3) mental.
2. Hallucinations - perceptual disturbances that occur without the presence of a real object and are accompanied by confidence that this object is in given time and in this place really exists.
Visual and auditory hallucinations are usually divided into two groups:
1. Simple. These include:
a) photopsia - perception of bright flashes of light, circles, stars;
b) acoasma - perception of sounds, noise, cod, whistle, crying.
2. Complex. These include, for example, auditory hallucinations, which have the form of articulate phrasal speech and are, as a rule, commanding or threatening.
3. Eidetism - a disorder of perception, in which the trace of a just ended excitation in any analyzer remains in the form of a clear and vivid image.
4. Depersonalization is a distorted perception of both one's own personality as a whole and individual qualities and parts of the body. Based on this, there are two types of depersonalization:
1) partial (impaired perception of individual parts of the body); 2) total (impaired perception of the whole body).
5. Derealization is a distorted perception of the world around. An example of derealization is the symptom of "already seen" (de ja vu).
6. Agnosia is a violation of the recognition of objects, as well as parts of one's own body, but at the same time consciousness and self-consciousness are preserved.
There are the following types of agnosia:
1. Visual agnosia - disorders of recognition of objects and their images while maintaining sufficient visual acuity. Are divided into:
a) subject agnosia;
b) agnosia for colors and fonts;
c) optical-spatial agnosia (patients cannot convey in the drawing the spatial features of the object: further - closer, more - less, higher - lower, etc.).
2. Auditory agnosia - impaired ability to distinguish speech sounds in the absence of hearing impairment;
3. Tactile agnosia - disorders characterized by unrecognition of objects by touching them while maintaining tactile sensitivity.
28. Stress. A crisis
The concept of stress was introduced by the Canadian pathophysiologist and endocrinologist G. Selye. Stress is the body's standard response to any factor that affects it from the outside. It is characterized by affects - expressed emotional experiences.
Stress can be of a different nature:
1) distress is negative;
2) eustress is positive and mobilizing.
G. Selye identified two reactions to the harmful effects of the external environment:
1. Specific - a specific disease with specific symptoms.
2. Nonspecific (manifested in the general adaptation syndrome).
The nonspecific reaction consists of three phases:
1) anxiety reaction (under the influence of a stressful situation, the body changes its characteristics; if the stressor is very strong, stress can occur at this stage as well);
2) resistance reaction (if the action of the stressor is compatible with the body's capabilities, the body resists; anxiety almost disappears, the level of body resistance increases significantly);
3) the reaction of exhaustion (if the stressor acts for a long time, the body's forces are gradually depleted; anxiety reappears, but now irreversible; the stage of distress sets in).
The concept of crises originated and developed in the United States. According to this concept, "the risk of mental disorders reaches its highest point and materializes in a certain crisis situation."
“A crisis is a state that occurs when a person encounters an obstacle in life important goals, which for some time is insurmountable using the usual methods of solving problems. There is a period of disorganization, disorder, during which many different abortive attempts at resolution are made. Eventually some form of adaptation is achieved which may or may not best serve the interests of the person and those close to him.” 1 .
There are the following types of crises:
1) developmental crises (for example, the admission of a child to kindergarten, school, marriage, retirement, etc.);
2) random crises (for example, unemployment, natural disaster, etc.);
3) typical crises (for example, death loved one, the appearance of a child in the family, etc.).
29. Frustration. Fear
“Frustration (English frustration -“ frustration, disruption of plans, collapse “) is a specific emotional state that occurs when an obstacle and resistance arises on the way to achieving a goal, which are either really insurmountable or perceived as such.”
Frustration is characterized by the following symptoms:
1) the presence of a motive;
2) the presence of a need;
3) the presence of a goal;
4) the existence of an initial plan of action;
5) the presence of resistance to an obstacle that is frustrating (resistance can be passive and active, external and internal).
In situations of frustration, a person behaves either as an infantile or as a mature person. An infantile personality in the case of frustration is characterized by non-constructive behavior, which expresses itself in aggression or avoiding resolving a difficult situation.
A mature personality, on the contrary, is characterized by constructive behavior, which manifests itself in the fact that a person increases motivation, increases the level of activity to achieve a goal, while maintaining the goal itself.
The most common symptom of emotional disturbance is fear. However, fears can be an adequate mobilizing response to a real threat. Many people are not even aware that they have some kind of fear until they are faced with a corresponding situation.
The following parameters are used to assess the degree of pathological fears.
1. Adequacy (validity) - the correspondence of the intensity of fear to the degree of real danger that comes from a given situation or from people around.
2. Intensity - the degree of disorganization of the activity and well-being of a person seized by a sense of fear.
3. Duration - duration of fear in time.
4. The degree of controllability of the feeling of fear by a person - the ability to overcome own feeling fear.
A phobia is a fear that is experienced frequently, is obsessive, poorly controlled, and to a large extent disrupts the activity and well-being of a person.
The most common types of phobias are:
1) agoraphobia - fear of open spaces;
2) claustrophobia - fear of closed spaces. Social phobias are fairly common. obsessive fears, which are associated with the fear of condemnation of a person by others for any actions.
30. Violations of the volitional sphere
The concept of will is inextricably linked with the concept of motivation. Motivation is a process of purposeful organized sustainable activity (the main goal is to satisfy needs).
Motives and needs are expressed in desires and intentions. Interest, which plays the most important role in acquiring new knowledge, can also be a stimulus for human cognitive activity.
Motivation and activity are closely related to motor processes, therefore the volitional sphere is sometimes referred to as motor-volitional.
Volitional disorders include:
1) violation of the structure of the hierarchy of motives - deviation of the formation of the hierarchy of motives from the natural and age characteristics of a person;
2) parabulia - the formation of pathological needs and motives;
3) hyperbulia - a violation of behavior in the form of motor disinhibition (excitation);
4) hypobulia - a violation of behavior in the form of motor inhibition (stupor).
One of the most striking clinical syndromes of the motor-volitional sphere is the catatonic syndrome, which includes the following symptoms:
1) stereotypy - frequent rhythmic repetition of the same movements;
2) impulsive actions - sudden, senseless and ridiculous motor acts without sufficient critical evaluation;
3) negativism - causeless negative attitude to any external influences in the form of resistance and refusal;
4) echolalia and echopraxia - repetition by the patient of individual words or actions that he hears or sees at the moment; 5) catalepsy (a symptom of "wax flexibility") - the patient freezes in one position and maintains this position for a long time. The following pathological symptoms are special varieties of will disorders:
1) a symptom of autism;
2) a symptom of automatisms.
A symptom of autism is manifested in the fact that patients lose the need to communicate with others. They develop pathological isolation, unsociableness and isolation.
Automatisms are the spontaneous and uncontrolled implementation of a number of functions, regardless of the presence of stimulating impulses from the outside. The following types of automatisms are distinguished.
1. Outpatient (occurs in patients with epilepsy and consists in the fact that the patient performs outwardly ordered and purposeful actions, which he completely forgets about after an epileptic seizure).
2. Somnambulistic (the patient is either in a hypnotic trance, or in a state between sleep and wakefulness).
3. Associative.
4. Senestopathic.
5. Kinesthetic.
The last three varieties of automatisms are observed in the syndrome of mental automatism of Kandinsky-Clerambault.
31. Violations of consciousness and self-consciousness
Before proceeding to the consideration of violations, let's define consciousness.
"Consciousness is the highest form of reflection of reality, a way of relating to objective laws."
To determine the impairment of consciousness, it is important to take into account that the presence of one of the above signs does not indicate clouding of consciousness, so it is necessary to establish the totality of all these signs.
Consciousness disorders are divided into two groups.
1. States of switched off consciousness:
2. States of upset consciousness:
a) delirium;
b) oneiroid;
c) twilight disorder of consciousness. The states of consciousness turned off are characterized by a sharp increase in the threshold for all external stimuli. In patients, movements slow down, they are indifferent to the environment.
Delirium is characterized by a violation of orientation in space and time (not just disorientation, but false orientation occurs) with complete preservation of orientation in one's own personality. This causes scene-like hallucinations, usually of a frightening nature. As a rule, the delirious state occurs in the evening, and intensifies at night.
Oneiroid is characterized by disorientation (or false orientation) in space, in time, and partially in one's own personality. In this case, patients have hallucinations of a fantastic nature.
After leaving the oneiroid state, patients usually cannot remember what really happened in that situation, but only remember the content of their dreams.
The twilight state of consciousness is characterized by disorientation in space, in time and in one's own personality. This state begins suddenly and ends just as suddenly. A characteristic feature of the twilight state of consciousness is the subsequent amnesia - the absence of memories of the period of obscuration. Often in a twilight state of consciousness, patients have hallucinations and delusions.
One of the types of twilight state is “ambulatory automatism” (it proceeds without delirium and hallucinations). Such patients, having left the house for a specific purpose, unexpectedly find themselves at the other end of the city (or even in another city). At the same time, they mechanically cross the streets, ride in transport, etc.
32. Aphasia
Aphasias are called systemic speech disorders that appear with global injuries of the cortex of the left hemisphere (in right-handed people). The term "aphasia" was proposed in 1864 by A. Trousseau.
Consider the classification of speech disorders proposed by A. R. Luria. He identified seven forms of aphasia.
1. Sensory aphasia is characterized by impaired phonemic hearing. At the same time, patients either do not understand the speech addressed to them at all, or (in less severe cases) do not understand speech in complicated conditions (for example, too fast speech), they have a sharp difficulty in writing from dictation, repeating the words they hear, and reading (due to the inability to track the correctness of their speech).
2. Acoustic-mnestic aphasia (violation of auditory-verbal memory) is expressed in the fact that the patient understands the addressed speech, but is not able to remember even a small speech material (while phonemic hearing remains preserved). This impairment of auditory-speech memory leads to a misunderstanding of long phrases and oral speech at all.
3. Optical-mnestic aphasia is expressed in the fact that patients cannot correctly name the object, but try to describe the object and its functional purpose. Patients cannot draw even elementary objects, although their graphic movements remain preserved.
4. Afferent motor aphasia is associated with a violation of the flow of sensations from the articulatory apparatus to the cerebral cortex during speech. Patients have speech disorders.
5. Semantic aphasia is characterized by impaired understanding of prepositions, words and phrases that reflect spatial relationships. In patients with semantic aphasia, there are violations of visual-figurative thinking.
6. Motor efferent aphasia is expressed in the fact that the patient cannot pronounce a single word (only inarticulate sounds) or one word remains in the patient's oral speech, which is used as a substitute for all other words. At the same time, the patient retains the ability to understand the speech addressed to him (to some extent).
7. Dynamic aphasia is manifested in the poverty of speech statements, the absence of independent statements and monosyllabic answers to questions (patients are not able to compose even the simplest phrase can't answer even basic questions in detail).
Note that of the above types of speech disorders, the first five are interconnected with the loss of auditory, visual, kinesthetic links of speech, which are otherwise called afferent links. The remaining two types of aphasia are associated with the loss of the efferent link.
33. Poverty of the vocabulary of speech
The poverty of the vocabulary is usually observed in oligophrenia, as well as in atherosclerosis of the brain. Let us consider the types of mental pathology that can be considered both as derivatives of speech disorders and as a result of disorders of the gnostic brain apparatus.
1. Dyslexia (alexia) is a reading disorder.
In children, dyslexia is manifested in the inability to master the skill of reading (with normal level intellectual and speech development, in optimal learning conditions, in the absence of hearing and vision impairments).
2. Agraphia (dysgraphia) - a violation of the ability to write correctly in form and meaning.
3. Akalkulia - a violation that is characterized by a violation of counting operations.
Let us dwell on the definition of other speech disorders encountered in clinical practice.
Verbal paraphasia - the use instead of some words of others that are not related to the meaning of the speech statement.
Literal paraphasia is when some sounds are replaced by others that are not present in a given word, or certain syllables and sounds are rearranged in a word.
Verbigeration is the repeated repetition of individual words or syllables.
Bradyphasia is slow speech.
Dysarthria - blurry, as if "stumbling" speech.
Dyslalia (tongue-tied tongue) is a speech disorder characterized by mispronunciation individual sounds (for example, skipping sounds or replacing one sound with another).
Stuttering is a violation of the fluency of speech, which manifests itself in the form of a convulsive disorder of speech coordination, the repetition of individual syllables with obvious difficulties in pronouncing them.
Logoclonia is a spasmodic repetition of certain syllables of a spoken word.
Increasing the volume of speech (up to a scream) is a violation that manifests itself in the fact that, as a result of overstrain, the voice of such patients becomes hoarse or completely disappears (noted in patients in a manic state).
Change in the modulation of speech - pomposity, pathos or colorlessness and monotony of speech (loss of speech melody).
Incoherence is a meaningless set of words that are not combined into grammatically correct sentences.
Oligophasia - a significant decrease in the number of words used in speech, impoverishment of the vocabulary.
Schizophasia is a meaningless collection of single words that are combined into grammatically correct sentences.
Symbolic speech - giving words and expressions a special meaning (instead of the generally accepted one), understandable only to the patient himself.
Cryptolalia is the creation of one's own language or a special cipher called cryptography.
34. Violations of arbitrary movements and actions
There are two types of violations arbitrary movements and actions:
1. Violations of voluntary movements and actions that are associated with a violation of efferent (executive) mechanisms.
2. Violations of voluntary movements and actions that are associated with a violation of the afferent mechanisms of motor acts (more complex violations).
Efferent disorders.
1. Paresis - weakening of muscle movements (a person after a brain injury cannot actively act with the opposite limb; while the movements of other parts of the body can remain preserved).
2. Hemiplegia - paralysis (a person completely loses the ability to move; motor function can be restored during treatment).
There are two types of hemiplegia:
1) dynamic hemiplegia (there are no voluntary movements, but there are violent ones);
2) static hemiplegia (no voluntary movements and amimia).
afferent disturbances.
1. Apraxia are disturbances that are characterized by the fact that an action that needs afferent reinforcement and organization of a motor act is not performed, although the efferent sphere remains preserved.
2. Catatonic disorders.
In catatonic disorders, there is an objectless chaotic motor activity of the patient (up to causing injury to himself and others). Currently, this condition is removed pharmacologically. Catatonic disorders are expressed in aimless throwing of the patient.
One form of catatonic disorder is stupor (freezing). There are the following forms of stupor:
1) negativistic (resistance to movements);
2) with numbness (the patient cannot be moved).
3. Violent actions.
This disorder of voluntary movements and actions is manifested in the fact that patients, in addition to their own desire, perform various motor acts (for example, crying, laughing, swearing, etc.).
35. Impaired intelligence
Intelligence is the system of all cognitive abilities of an individual (in particular, the ability to learn and solve problems that determine the success of any activity).
For quantitative analysis of intelligence, the concept of IQ is used - the coefficient of mental development.
There are three types of intelligence:
1) verbal intelligence(vocabulary, erudition, ability to understand what is read);
2) the ability to solve problems;
3) practical intelligence (the ability to adapt to the environment).
The structure of practical intelligence includes:
1. Processes of adequate perception and understanding of ongoing events.
3. The ability to act rationally in a new environment.
The intellectual sphere includes some cognitive processes, but the intellect is not only the sum of these cognitive processes. The prerequisites for intelligence are attention and memory, but the understanding of the essence of intellectual activity is not exhausted by them.
There are three forms of organization of the intellect, which reflect different ways of cognition of objective reality, in particular in the sphere of interpersonal contacts.
1. Common sense is a process of adequate reflection of reality, based on the analysis of the essential motives of the behavior of people around and using a rational way of thinking.
2. Reason is a process of cognition of reality and a way of activity based on the use of formalized knowledge, interpretations of the motives of the activity of communication participants.
3. Reason is the highest form of organization of intellectual activity, in which the thought process contributes to the formation of theoretical knowledge and the creative transformation of reality.
Intellectual cognition can use the following methods:
1) rational (requires the application of formal logic laws, hypotheses and their confirmation);
2) irrational (relies on unconscious factors, does not have a strictly defined sequence, does not require the use of logical laws to prove the truth).
The following concepts are closely related to the concept of intelligence:
1) anticipatory abilities - the ability to anticipate the course of events and plan their activities in such a way as to avoid undesirable consequences and experiences;
2) reflection - the creation of ideas about the true attitude towards the subject on the part of others.
36. The problem of brain localization of mental functions
The problem of localization of mental functions is one of the main researched problems of neuropsychology. Initially, this problem was literally: how various mental processes and morphological zones of the brain are interconnected. But clear matches were not found. There are two points of view on this issue:
1) localizationism;
2) anti-localizationism. Localizationism binds every mental
process with the work of a certain part of the brain. Narrow localizationism considers mental functions as indecomposable into component parts and realized through the work of narrowly localized areas of the cerebral cortex.
The following facts speak against the concept of narrow localizationism:
1) with the defeat of different areas of the brain, a violation of the same mental function occurs;
2) the result of damage to a certain area of the brain may be a violation of several different mental functions;
3) impaired mental functions can be restored after damage without morphological restoration of the injured area of the brain.
According to the concept of anti-localizationism:
1) the brain is a single whole, and its work contributes to the development of the functioning of all mental processes equally;
2) with damage to any part of the brain, a general decrease in mental functions is observed (in this case, the degree of decrease depends on the volume of the affected brain).
According to the concept of equipotentiality of brain regions, all brain regions are equally involved in the implementation of mental functions. Thus, in all cases it is possible to restore the mental process, if only the quantitative characteristics of the damage do not exceed some critical values. However, not always and not all functions can be restored (even if the amount of damage is small).
At present, the main direction in solving this problem is determined by the concept of systemic dynamic localization of mental processes and functions, which was developed by L. S. Vygotsky and A. R. Luria. According to this theory:
1) the mental functions of a person are systemic formations, formed throughout life, are arbitrary and mediated by speech;
2) the physiological basis of mental functions are functional systems that are interconnected with specific brain structures and consist of afferent and efferent interchangeable links.
37. Functional blocks of the brain
A. R. Luria developed a general structural and functional model of the brain, according to which the entire brain can be divided into three main blocks. Each block has its own structure and plays a specific role in mental functioning.
1st block - a block of regulation of the level of general and selective activation of the brain, an energy block, which includes:
1) reticular formation of the brain stem;
2) diencephalic departments;
3) nonspecific midbrain structures;
4) limbic system;
5) mediobasal sections of the cortex of the frontal and temporal lobes.
2nd block - a block for receiving, processing and storing exteroceptive information, includes the central parts of the main analyzer systems, the cortical zones of which are located in the occipital, parietal and temporal lobes of the brain.
The work of the second block is subject to three laws.
1. The law of hierarchical structure (primary zones are phylo- and ontogenetically earlier, from which two principles follow: the “bottom-up” principle - the underdevelopment of primary fields in a child leads to the loss of later functions; the “top-down” principle - in an adult with a fully developed psychological structure, tertiary zones control the work of secondary ones subordinate to them and, if the latter are damaged, have a compensating effect on their work).
2. The law of decreasing specificity (primary zones are the most modally specific, and tertiary zones are generally supramodal).
3. The law of progressive lateralization (as you ascend from the primary to the tertiary zones, the differentiation of the functions of the left and right hemispheres increases).
3rd block - a block of programming, regulation and control over the course of mental activity), consists of motor, premotor and prefrontal sections of the cerebral cortex. With the defeat of this part of the brain, the work of the musculoskeletal system is disrupted.
38. Concepts of neuropsychological factor, symptom and syndrome
“The neuropsychological factor is the principle physiological activity specific brain structure. It is a connecting concept between mental functions and a working brain.
Syndrome analysis is a tool for identifying neuropsychological factors, which includes:
1) qualitative qualification of violations of mental functions with an explanation of the reasons for the changes that have occurred;
2) analysis and comparison of primary and secondary disorders, i.e., the establishment of causal relationships between the direct source of pathology and emerging disorders;
3) study of the composition of preserved higher mental functions.
We list the main neuropsychological factors:
1) modal-non-specific (energy) factor;
2) kinetic factor;
3) modal-specific factor;
4) kinesthetic factor (a special case of modal-specific factor);
5) factor of arbitrary-involuntary regulation of mental activity;
6) the factor of awareness-unconsciousness of mental functions and states;
7) the factor of succession (consistency) in the organization of higher mental functions;
8) the factor of simultaneity (simultaneity) of the organization of higher mental functions;
9) factor of interhemispheric interaction;
10) cerebral factor; 11) the factor of work of deep subcortical structures.
Neuropsychological symptom - a violation of mental functions as a result of local lesions of the brain.
A syndrome is a regular combination of symptoms based on a neuropsychological factor, i.e. certain physiological patterns of the work of brain regions, the violation of which is the cause of neuropsychological symptoms.
Neuropsychological syndrome is a confluence of neuropsychological symptoms associated with the loss of one or more factors.
Syndromic analysis is the analysis of neuropsychological symptoms, the main purpose of which is to find a common factor that fully explains the appearance of various neuropsychological symptoms. The syndromic analysis includes the following stages: first, the signs of the pathology of various mental functions are determined, and then the symptoms are qualified.
39. Methods of neuropsychological research. Restoration of higher mental functions
One of the most common methods for assessing syndromes in neuropsychology is the system proposed by A. R. Luria. It includes:
1) a formal description of the patient, his medical history;
2) a general description of the patient's mental status (state of consciousness, ability to navigate in place and time, level of criticism, etc.);
3) studies of voluntary and involuntary attention;
4) studies of emotional reactions;
5) studies of visual gnosis (based on real objects, contour images, etc.);
6) studies of somatosensory gnosis (recognition of objects by touch, by touch);
7) studies of auditory gnosis (recognition of melodies, repetition of rhythms);
8) studies of movements and actions (evaluation of coordination, results of drawing, objective actions, etc.);
9) speech research;
10) study of writing (letters, words and phrases);
11) reading research;
12) memory research;
13) research of the counting system;
14) research of intellectual processes. One of the important sections of neuropsychology explores the mechanisms and ways of restoring higher mental functions that are impaired as a result of local pathologies of the brain. A position was put forward on the possibility of restoring the affected mental functions by restructuring the functional systems that determine the implementation of higher mental functions.
In the works of A. R. Luria and his students, mechanisms for the restoration of higher mental functions were revealed:
1) transfer of the process to the highest conscious level;
2) replacement of the missing link of the functional system with a new one.
We list the principles of restorative education:
1) neuropsychological qualification of the defect;
2) reliance on preserved forms of activity;
3) external programming of the restored function.
The practice of treating the wounded during the Great Patriotic War proved the effectiveness of these ideas. In the future, neuropsychological methods began to be used in conjunction with medication.
The development of ideas about the functional asymmetry of the human brain in the history of neuropsychology is associated with the name of the French doctor M. Dax, who in 1836, speaking in a medical society, cited the results of the observation of 40 patients. He observed patients with brain damage accompanied by a decrease or loss of speech, and came to the conclusion that the disorders were caused only by defects in the left hemisphere.
40. Schizophrenia
Schizophrenia (from the Greek shiso - “split”, frenio - “soul”) is “a mental illness that occurs with rapidly or slowly developing personality changes of a special type (reduced energy potential, progressive introversion, emotional impoverishment, distortion of mental processes)”.
Often the result of this disease is a break in the patient's previous social relations and a significant maladjustment of patients in society.
Schizophrenia is considered to be practically the most famous mental illness.
There are several forms of schizophrenia:
1) continuously ongoing schizophrenia;
2) paroxysmal-progredient (fur-like);
3) recurrent (periodic flow).
According to the pace of the process, the following types of schizophrenia are distinguished:
1) low-progressive;
2) medium progredient;
3) malignant.
There are various forms of schizophrenia, for example:
1) schizophrenia with obsessions;
2) paranoid schizophrenia (delusions of persecution, jealousy, invention, etc. are noted);
3) schizophrenia with asthenohypochondriac manifestations (mental weakness with a painful fixation on the state of health);
4) simple;
5) hallucinatory-paranoid;
6) hebephrenic (foolish motor and speech excitement, elevated mood, fragmented thinking are noted);
7) catatonic (characterized by the predominance of movement disorders). For patients with schizophrenia, the following features are characteristic.
1. Severe disorders of perception, thinking, emotional-volitional sphere.
2. Decrease in emotionality.
3. Loss of differentiation of emotional reactions.
4. State of apathy.
5. Indifferent attitude towards family members.
6. Loss of interest in the environment.
8. Decreased volitional effort from insignificant to pronounced lack of will (aboulia).
41. Manic-depressive psychosis
Manic-depressive psychosis (MPD) is a disease characterized by the presence of depressive and manic phases. The phases are separated by periods with the complete disappearance of mental disorders - intermissions.
It should be noted that manic-depressive psychosis is much more common in women than in men.
As mentioned earlier, the disease proceeds in the form of phases - manic and depressive. At the same time, depressive phases are several times more common than manic phases.
The depressive phase is characterized by the following symptoms:
1) depressed mood (depressive affect);
2) intellectual inhibition (inhibition of thought processes);
3) psychomotor and speech inhibition.
The manic phase is characterized by the following symptoms.
1. Increased mood (manic affect).
2. Intellectual excitement (accelerated flow of thought processes).
3. Psychomotor and speech stimulation. Sometimes depression can only be identified
through psychological research.
The manifestations of manic-depressive psychosis can occur in childhood, adolescence and adolescence. At each age, with MDP, its own characteristics are noted.
In children under 10 years of age in the depressive phase, the following features are noted:
1) lethargy;
2) slowness;
3) reticence;
4) passivity;
5) confusion;
6) tired and unhealthy look;
7) complaints of weakness, pain in the head, abdomen, legs;
8) low academic performance;
9) difficulties in communication;
10) disorders of appetite and sleep.
Children in the manic phase experience:
1) ease in the appearance of laughter;
2) impudence in communication;
3) increased initiative;
4) no signs of fatigue;
5) mobility.
In adolescence and youth, a depressive state manifests itself in the following features: inhibition of motor skills and speech; decrease in initiative; passivity; loss of vivacity of reactions; feeling of melancholy, apathy, boredom, anxiety; forgetfulness; tendency to self-digging; heightened sensitivity to peers; suicidal thoughts and attempts.
42. Epilepsy
Epilepsy is characterized by the presence in the patient of frequent disturbances of consciousness and mood.
This disease gradually leads to personality changes.
It is believed that the hereditary factor, as well as exogenous factors (for example, intrauterine organic brain damage), play an important role in the origin of epilepsy. One of characteristic features Epilepsy is a seizure that usually begins suddenly.
Sometimes a few days before the seizure, harbingers appear:
1) feeling unwell;
2) irritability;
3) headache.
The seizure usually lasts about three minutes. After it, the patient feels lethargy and drowsiness. Seizures can recur with varying frequency (from daily to several per year).
Patients have atypical seizures.
1. Small seizures (loss of consciousness for several minutes without falling).
2. Twilight state of consciousness.
3. Ambulatory automatisms, including somnambulism (sleepwalking).
Patients have the following symptoms:
1) stiffness, slowness of all mental processes;
2) thoroughness of thinking;
3) tendency to get stuck on details;
4) the inability to distinguish the main from the secondary;
5) dysphoria (tendency to an angry-dreary mood). characteristic features patients with epilepsy are:
1) a combination of affective viscosity and explosiveness (explosiveness);
2) pedantry in relation to clothes, order in the house;
3) infantilism (immaturity of judgments);
4) sweetness, exaggerated courtesy;
5) a combination of hypersensitivity and vulnerability with malice.
The face of patients with epilepsy is inactive, inexpressive, restraint in gestures is noted.
During the study of patients with epilepsy, the psychologist studies primarily thinking, memory and attention.
The following methods are commonly used to study patients with epilepsy.
1. Schulte tables.
2. Exclusion of items.
3. Classification of objects.
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RESEARCH METHODS IN CLINICAL PSYCHOLOGY
The choice of research methods used by a clinical psychologist is determined by the tasks that arise before him in the performance of his professional duties. Diagnostic function dictates the use psychological techniques(batteries of tests, questionnaires, etc.) capable of evaluating both the activity of individual mental functions, individual psychological characteristics, and differentiating psychological phenomena and psychopathological symptoms and syndromes. The psycho-corrective function implies the use of various scales, on the basis of which it is possible to analyze the effectiveness of psycho-corrective and psychotherapeutic methods. The selection of the necessary methods is carried out depending on the goals of the psychological examination; individual characteristics of the mental, as well as the somatic state of the subject; his age; profession and level of education; time and place of the study. All kinds of research methods in clinical psychology can be divided into three groups: 1) clinical interviewing, 2) experimental psychological research methods, 3) evaluation of the effectiveness of psycho-correctional influence. Let's dwell on them in more detail.
Clinical interview
We are aware of how difficult the unification and schematization of the creative process is, and yet interviewing can rightly be called creativity. In this regard, we are aware of the limits of our capabilities and do not pretend to find the ultimate truth. Each psychologist has the right to choose from a variety of existing ones the most suitable for him (his character, interests, preferences, level of sociability, worldview, culture, etc.) method of interviewing a client (patient). Therefore, the proposed text and the thoughts embodied in it should be considered as another possibility, another option that can satisfy the discerning reader and lead to the application of the provisions of this particular guide in practice.
If the information is capable of causing rejection, then it is up to the reader to continue searching for the most appropriate guide to clinical method in clinical psychology.
One of the main goals of clinical interviewing is to assess the individual psychological characteristics of a client or patient, to rank the identified features in terms of quality, strength and severity, to classify them as psychological phenomena or psychopathological symptoms.
The term "interview" has entered the lexicon of clinical psychologists recently. More often they talk about a clinical questioning or conversation, the description of which in scientific works is overwhelmingly descriptive, sententious. Recommendations, as a rule, are given in an imperative tone and are aimed at forming undoubtedly important moral qualities of a diagnostician. In well-known publications and monographs, a clinical method for assessing a person’s mental state and diagnosing mental deviations in him is given without describing the actual methodology (principles and procedures) of questioning, which takes the recommendations given beyond the scope of scientific ones and available for effective reproduction. It turns out a paradoxical situation: it is possible to learn clinical examination and diagnostics only experimentally, participating as an observer-student in conversations with clients of well-known and recognized authorities in the field of diagnostics and interviewing.
Digressing from the main topic, I would like to note that, unfortunately, in the field of diagnostics there is and has a lot of fans even among professionals in diagnosing mental disorders without interviewing. That is, the diagnosis is made in absentia, without a direct meeting of the doctor with the alleged patient. This practice is becoming fashionable in our time. Diagnosis of mental illness based on the analysis of human actions known to the doctor by hearsay or from the lips of non-specialists, psychopathological interpretations of the texts of the "suspects" (letters, poems, prose, once abandoned phrases) only discredit the clinical method.
One more distinctive feature Modern practical psychology has become convinced of the omnipotence in the diagnostic plan of experimental psychological methods. A large army of psychologists is convinced that they are able to identify mental abnormalities and delimit the norm from pathology with the help of various tests. Such a widespread misconception leads to the fact that the psychologist often turns himself into a fortune-teller, into a conjurer, from whom others expect to demonstrate a miracle and solve miracles.
A true diagnosis of both mental deviations and individual psychological characteristics of a person must necessarily combine diagnostics in the narrow sense of the term and a direct examination by a psychologist of a client (patient), i.e. interviewing.
Currently, the diagnostic process is completely at the mercy of psychiatrists. This cannot be considered fair, since the doctor, first of all, is aimed at finding a symptom, and not at the actual differentiation of a symptom and a phenomenon. In addition, due to tradition, the psychiatrist is little aware of the manifestations of healthy mental activity. It is precisely because of these features that it can be considered reasonable to involve a clinical psychologist in the diagnostic process in the form of interviews to assess the mental state of the subjects.
A clinical interview is a method of obtaining information about the individual psychological properties of a person, psychological phenomena and psychopathological symptoms and syndromes, the internal picture of the patient's illness and the structure of the client's problem, as well as a method of psychological impact on a person, produced directly on the basis of personal contact between the psychologist and the client.
The interview differs from the usual questioning in that it is aimed not only at complaints actively presented by a person, but also at revealing the hidden motives of a person’s behavior and helping him to realize the true (internal) grounds for an altered mental state. The psychological support of the client (patient) is also considered essential for the interview.
The functions of the interview in clinical psychology are: diagnostic and therapeutic. They should be carried out in parallel, since only their combination can lead to the desired result for the psychologist - the recovery and rehabilitation of the patient. In this respect, the practice of clinical questioning, ignoring the psychotherapeutic function, turns the doctor or psychologist into an extra, whose role could be successfully performed by a computer.
Clients and patients often cannot accurately describe their condition and formulate complaints and problems. That is why the ability to listen to a presentation of a person's problems is only part of the interview, the second is the ability to tactfully help him formulate his problem, make him understand the origins of psychological discomfort - crystallize the problem. “Speech is given to a person in order to better understand himself,” wrote L. Vygotsky, and this understanding through verbalization in the process of a clinical interview can be considered essential and fundamental.
The principles of a clinical interview are: unambiguity, accuracy and accessibility of wording-questions; adequacy, consistency (algorithmicity); flexibility, impartiality of the survey; verifiability of the received information.
The principle of unambiguity and accuracy in the framework of a clinical interview is understood as the correct, correct and precise formulation of questions. An example of ambiguity is such a question addressed to the patient: “Do you experience a mental impact on yourself?” An affirmative answer to this question does not give the diagnostician practically anything, since it can be interpreted in various ways. The patient could mean by "impact" both ordinary human experiences, events, people around him, and, for example, "energy vampirism", the impact of aliens, etc. This question is inaccurate and ambiguous, therefore uninformative and redundant.
The principle of accessibility is based on several parameters: vocabulary (linguistic), educational, cultural, cultural, linguistic, national, ethnic and other factors. The speech addressed to the patient must be understandable to him, must coincide with his speech practice, based on many traditions. The diagnostician asked: “Do you have hallucinations?” -- may be misunderstood by a person who encounters such a scientific term for the first time. On the other hand, if a patient is asked if he hears voices, then his understanding of the word “voices” may be fundamentally different from the doctor’s understanding of the same term. Availability is based on an accurate assessment by the diagnostician of the patient's status, the level of his knowledge; vocabulary, subcultural features, jargon practice.
One of important parameters the interview is considered algorithmic (sequence) of the questioning, based on the knowledge of the diagnostician in the field of compatibility of psychological phenomena and psychopathological symptoms and syndromes; endogenous, psychogenic and exogenous types of response; psychotic and non-psychotic levels of mental disorders. A clinical psychologist must know hundreds of psychopathological symptoms. But if he asks about the presence of every symptom known to him, then this, on the one hand, will take a lot of time and will be tedious for both the patient and the researcher; on the other hand, it will reflect the incompetence of the diagnostician. The sequence is based on the well-known algorithm of psychogenesis: on the basis of the presentation of the first complaints by patients, the story of his relatives, acquaintances, or on the basis of direct observation of his behavior, the first group of phenomena or symptoms is formed. Further, the survey covers the identification of phenomena, symptoms and syndromes that are traditionally combined with those already identified, then the questions should be aimed at assessing the type of response (endogenous, psychogenic or exogenous), the level of disorders and etiological factors. For example, if the presence of auditory hallucinations is the first to be detected, then further questioning is built according to the following algorithm-algorithm: assessment of the nature of hallucinatory images (the number of "voices", their awareness and criticality, speech features, determining the location of the sound source according to the patient, the time of appearance, etc.) - the degree of emotional involvement - the degree of criticality of the patient to hallucinatory manifestations - the presence of thinking disorders (delusional interpretations of "voices") and Further depending on the qualification of the phenomena described, confirmation of exogenous, endogenous or psychogenic types of response by asking about the presence, for example, of consciousness disorders, psychosensory disorders and other manifestations of a certain range of disorders. In addition to the above, the principle of sequence implies a detailed questioning in a longitudinal section: the order in which mental experiences appear and their connection with real circumstances. At the same time, every detail of the story is important, the context of events, experiences, interpretations is important.
The most significant are the principles of verifiability and adequacy of a psychological interview, when, in order to clarify the congruence of concepts and exclude incorrect interpretation of answers, the diagnostician asks questions like: “What do you understand by the word“ voices ”that you hear?” or “Give an example of the ‘voices’ being tested. If necessary, the patient is asked to specify the description of his own experiences.
The principle of impartiality is the basic principle of a phenomenologically oriented psychologist-diagnostician. The imposition on the patient of his own idea that he has psychopathological symptoms on the basis of a biased or carelessly conducted interview can occur both due to a conscious attitude, and on the basis of ignorance of the principles of the interview or blind adherence to one of the scientific schools.
Considering the burden of responsibility, primarily moral and ethical, lying on the diagnostician in the process of psychological interview, it seems appropriate for us to cite the main ethical provisions of the American Psychological Association regarding counseling and interviewing:
1. Adhere to confidentiality: respect the rights of the client and his privacy. Do not discuss what he said during interviews with other clients. If you cannot comply with the confidentiality requirements, then you must inform the client about this before the conversation; let him decide for himself whether it is possible to go for it. If information is shared with you that contains information about a danger that threatens a client or society, then ethical regulations allow you to violate confidentiality for the sake of safety. However, one must always remember that, be that as it may, the psychologist's responsibility to the client who trusts him is always primary.
2. Realize the limits of your competence. There is a kind of intoxication that occurs after the psychologist has learned the first few techniques. Beginning psychologists immediately try to delve deeply into the souls of their friends and their clients. This is potentially dangerous. A novice psychologist should work under the supervision of a professional; Seek advice and suggestions to improve your work style. The first step to professionalism is knowing your limits.
3. Avoid asking about irrelevant details. The aspiring psychologist is mesmerized by the details and "important stories" of his clients. Sometimes he asks very intimate questions about sex life. It is common for a novice or inept psychologist to place great importance on the details of the client's life and at the same time miss what the client feels and thinks. Consulting is intended primarily for the benefit of the client, and not to increase your volume of information.
4. Treat the client the way you would like to be treated. Put yourself in the client's shoes. Everyone wants to be treated with respect, sparing his self-esteem. A deep relationship and a heart-to-heart conversation begins after the client has understood that his thoughts and experiences are close to you. A relationship of trust develops from the client's and counselor's ability to be honest.
5. Be aware of individual and cultural differences. It is safe to say that the practice of therapy and counseling, regardless of what cultural group you are dealing with, cannot be called an ethical practice at all. Are you prepared enough to work with people who are different from you?
The current situation in society allows us to talk about potentially or clearly existing conflicts in the field of communication. The clinical interview is no exception in this regard. Potential psychological difficulties in conducting interviews are possible on different levels- yesterday they captured one area; today - the second; tomorrow they may spread and a third. Without a trusting atmosphere, therapeutic empathy between a psychologist and a patient, qualified interviewing, diagnosis and psychotherapeutic effect are impossible.
Jacques Lacan's theory suggests that an interview is not just a relationship between two people physically present in a session. It is also the relationship of cultures. That is, at least four people are involved in the counseling process, and what we took for a conversation between a therapist and a client may turn out to be a process of interaction between their cultural and historical roots. The following figure illustrates the point of view of J. Lacan:
Figure 2.
Note that counseling is a more complex subject than simply giving advice to a client. Cultural affiliation must always be considered. In the figure above, the therapist and the client are what we see and hear during the interview. “But no one can get away from their cultural heritage. Some psychological theories tend to be anti-historic and underestimate the impact of cultural identity on the client. They focus mainly on the client-psychologist relationship, omitting more Interesting Facts their interactions” (J. Lacan).
Schneiderman argued that "whoever seeks to erase cultural differences and create a society in which alienness does not exist, is moving towards alienation ... The moral denial of alienness is racism, one can hardly doubt it."
Empathy requires that we understand both the personal uniqueness and the “foreignness” (cultural-historical factor) of our client. Historically, empathy has focused on personal uniqueness, and the second aspect has been forgotten. For example, psychologists in the United States and Canada expect that all clients, regardless of their cultural background, will respond in the same way to the same treatment. Based on the concept of J. Lacan, then such therapy looks like this:
Figure 3
Thus, the cultural-historical influence is reflected in this interview, but the client and the psychologist are not aware of these problems, they are disconnected from them. In this example, the client is aware of the specifics of their cultural identity and takes it into account in their plans for the future. The psychologist, however, proceeds from a theory based on individual empathy and does not pay attention to this important circumstance. In addition, the client sees only a cultural stereotype in the counselor, “This example is by no means an exception to the rule, and many non-white clients who have tried to get counseling from an unqualified white psychotherapist will readily confirm this” (A. Ivey).
Ideally, both - the psychologist and the client - are aware of and use the cultural-historical aspect. Empathy, on the other hand, cannot be considered a necessary and sufficient condition if one does not pay attention to the cultural aspect as well.
J. Lacan's model gives an additional impetus to building a certain level of empathy. Sometimes the client and the psychologist think that they are talking to each other, when in fact they are only passive observers of how two cultural settings interact.
In the course of a clinical interview, as experience shows and confirms the theory of J. Lacan, such components of the historical and cultural bases of a psychologist (doctor) and a client (patient) can collide as: gender, age, religious beliefs and religion, racial characteristics (in modern conditions - nationality); sexual orientation preferences. The effectiveness of the interview in these cases will depend on how the psychologist and the patient with different beliefs and characteristics find mutual language what style of communication the diagnostician will offer to create an atmosphere of trust. Today we face relatively new problems in the field of therapeutic interaction. Patients conceived do not trust doctors, and doctors do not trust patients only on the basis of differences in national, religious, sexual (hetero-, homosexual) characteristics. A doctor (as well as a psychologist) should be guided by the current situation in the field of ethnocultural relations and choose a flexible communication tactic that avoids discussing acute global and non-medical problems, in particular national, religious ones, and even more so not to impose his point of view on these issues.
The described principles of the clinical interview reflect the basic knowledge, the theoretical platform on which the entire interviewing process is built. However, principles not supported by practical procedures will remain unused.
There are various methodological approaches to conducting interviews. It is believed that the duration of the first interview should be about 50 minutes. Subsequent interviews with the same client (patient) are somewhat shorter. The following model (structure) of a clinical interview can be proposed:
Stage I: Establishment of a "confidence distance". Situational support, provision of confidentiality guarantees; determining the dominant motives for conducting an interview.
Stage II: Identification of complaints (passive and active interviews), assessment of the internal picture - the concept of the disease; problem structuring,
Stage III: Evaluation of the desired outcome of the interview and therapy; determination of the patient's subjective model of health and preferred mental status.
Stage IV: Assessment of the patient's anticipatory abilities; discussion of probable outcomes of the disease (if it is detected) and therapy; anticipation training.
The above stages of a clinical psychological interview give an idea of the essential points discussed during the meeting between the psychologist and the patient. This scheme can be used in each conversation, but it should be remembered that the specific weight - the time and effort allocated to one or another stage - varies depending on the order of meetings, the effectiveness of therapy, the level of observed mental disorders, and some other parameters. It is clear that during the first interview, the first three stages should be predominant, and during subsequent interviews, the fourth. Particular attention should be paid to the level of mental disorders of the patient (psychotic - non-psychotic); voluntariness or compulsory interview; criticality of the patient; intellectual features and abilities, as well as the real situation surrounding him.
The first stage of a clinical interview (“establishing a trusting distance”) can be defined as an active interview.” It is the most important and difficult. The first impression of the patient can decide the further course of the interview, his desire to continue the conversation, to reveal intimate details. who has applied to a doctor (especially if to a psychiatric hospital), having felt the drama of the situation, the fear of being recognized as mentally ill or misunderstood or put on record helps him start a conversation.
In addition, at the first stage, the psychologist must identify the dominant motives for contacting him, make a first impression of the level of criticality of the interviewee to himself and psychological manifestations. This goal is achieved with the help of questions like: “Who initiated your appeal to a specialist?”, “Your coming to talk with me is your own desire or did you do it to calm relatives (acquaintances, parents, children, bosses)?”; “Does anyone know that you were going to see a specialist?”
Even when interviewing a patient with a psychotic level of disorder, it is advisable to begin the interview by providing assurances of confidentiality. Often effective for further conversation with such patients are phrases like: “You probably know that you can refuse to talk to me as a psychologist and psychiatrist?” In the vast majority of cases, this phrase does not cause a desire to leave the doctor's office, but rather turns out to be a pleasant revelation for the patient, who begins to feel free to dispose of information about himself and at the same time becomes more open to communication.
The active role of the doctor (psychologist) is interrupted at this point and the stage of the passive interview begins. The patient (client) is given time and opportunity to present complaints in the sequence and with those details and comments that he considers necessary and important. At the same time, the doctor or psychologist plays the role of an attentive listener, only clarifying the features of the manifestations of the patient's disease. Most often, the listening technique includes the following methods (Table 1).
The questions asked by the diagnostician are aimed at assessing the internal picture and concept of the disease, i.e. identifying the patient's ideas about the causes and reasons for the occurrence of certain symptoms in him. At the same time, the problem is structured, which remains frustrating at the time of the interview.
Table 1
The main stages of diagnostic listening (according to A-Ivn)
|
Methodology |
Description |
Function during the interview |
|
|
Open questions |
"What?" - reveals the facts; "How?" -- feelings; "Why?" -- causes; "Is it possible?" - big picture |
Used to clarify basic facts and facilitate conversation |
|
|
Closed questions |
Usually include the particle “li”, they can be answered briefly |
Gives the opportunity to reveal special facts, shorten too long monologues |
|
|
Promotion (support) |
Repetition of several key phrases of the client |
Encourages detailed development of specific words and meanings |
|
|
reflection of feeling |
Draws attention to the emotional content of the interview |
Clarifies the emotional background of key facts, helps to open feelings |
|
|
retelling |
Repetition of the essence of words client and his thoughts, using his keywords |
Activates discussion, shows level of understanding |
|
|
Succinctly repeats key facts* and feelings of the client |
It is useful to repeat periodically during the interview. Required at the end of the meeting. |
Here, the diagnostician asks all sorts of questions regarding analysis and mental state, based on known diagnostic algorithms. In addition to listening, the psychologist should also use elements of influence during the interview.
Methods of influence in the interview process (according to A. Ivey)
table 2
|
Description |
Function during the interview |
||
|
Interpretation |
Sets a new framework in which the client can see the situation |
An attempt to enable the client to see the situation in a new way - an alternative perception of reality, which contributes to a change in attitudes, thoughts, moods and behaviors |
|
|
Directive (indication) |
Tells the client what action to take. It can be just a wish or a technique. |
Clearly shows the client what action the psychologist expects from him. |
|
|
(information) |
Gives wishes, general ideas, homework, advice on how to act, think, behave., |
Moderately used tips provide the client with useful information. |
|
|
Self-disclosure |
Psychologist shares personal experience and experiences, or shares the feelings of the client. |
Closely related to acceptance feedback, built on "I-sentences". Helps build rapport. |
|
|
Feedback |
Gives the client the opportunity to understand how the psychologist perceives him, as well as those around him. |
Gives specific data that helps the client understand how to understand him, how others perceive his behavior and thinking style, which creates the possibility of self-perception. |
|
|
logical subsequence |
Explains to the client the logical consequences of his thinking and behavior. "If...then." |
Gives the client a different point of reference. This method helps people anticipate the results of their actions. |
|
|
Impact Resume |
Often used at the end of a conversation to formulate the psychologist's judgments. Often used in combination with a client's resume. |
Clarifies what the psychologist and client achieved during the conversation. Summarizes what the therapist said. Designed to help the client transfer these generalizations from the interview to real life. |
Essential at this stage of the interview is the collection of the so-called psychological and medical anamnesis - the history of life and illness. The task of the psychological anamnesis is to obtain information from the patient to assess his personality as an established system of attitudes towards himself and, in particular, attitudes towards the disease and assess how much the disease has changed this entire system. Important are the data on the course of the disease and the life path, which are designed to reveal how the disease is reflected in the subjective world of the patient, how it affects his behavior, on the entire system of personal relationships. Outwardly, the medical and psychological history as research methods are very similar - the questioning could go according to a single plan, but their purpose and the use of the data obtained are completely different (V.M. Smirnov, T.N. Reznikova).
The next (III) stage of the clinical interview is aimed at identifying the patient's ideas about the possible and desired results of the interview and therapy. The patient is asked: “Which of what you told me would you like to get rid of first of all? How did you imagine our conversation before coming to me and what do you expect from it? How do you think I could help you?"
The last question aims to identify the patient's preferred mode of therapy. After all, it is not uncommon for a patient, after presenting complaints (often diverse and subjectively severe) to a doctor, to refuse treatment, referring to the fact that he does not take any medications in principle, is skeptical about psychotherapy, or does not trust doctors at all. Such situations indicate the desired psychotherapeutic effect from the interview itself, from the opportunity to speak out, to be heard and understood.
In some cases, this turns out to be sufficient for a certain part of those who seek advice from a doctor or psychologist. Indeed, often a person comes to a doctor (especially a psychiatrist) not for a diagnosis, but in order to get confirmation of his own beliefs about his mental health and balance.
At the fourth and final stage of the clinical interview, the interviewer takes on an active role again. Based on the identified symptoms, having the patient's understanding of the concept of the disease, knowing what the patient expects from treatment, the interviewer-psychologist directs the interview into the mainstream of anticipatory training. As a rule, a neurotic is afraid to think and even discuss with anyone the possible sad outcomes of the existing for him conflict situations that caused the visit to the doctor and the disease.
Anticipatory training, which is based on the anticipatory concept of neurogenesis (V.D. Mendelevich), is aimed, first of all, at the patient's thinking out the most negative consequences of his illness and life. For example, when analyzing a phobic syndrome within the framework of a neurotic register, it is advisable to ask questions in the following sequence: “What exactly are you afraid of? “Something bad is about to happen. - How do you suppose and feel with whom this bad thing should happen: with you or with your loved ones? - I think with me. - What exactly do you think? - I'm afraid to die. What does death mean to you? Why is she terrible? -- Don't know. - I understand that it is an unpleasant occupation to think about death, but I ask you to think about what exactly you are afraid of in death? I will try to help you. For one person, death is non-existence, for another, it is not death itself that is terrible, but the suffering and pain associated with it; for the third, it means that children and loved ones will be helpless in the event of death, etc. What is your opinion about this? -- ...--»
Such a technique within the framework of a clinical interview performs both the function of a more accurate diagnosis of the patient's condition, penetration into the secret secrets of his illness and personality, and a therapeutic function. We call this technique anticipatory training. It can be considered a pathogenetic method for the treatment of neurotic disorders. The use of this method when interviewing patients with psychotic disorders performs one of the functions of the interview - it clarifies the diagnostic horizons to a greater extent, and this has a therapeutic effect.
The clinical interview consists of verbal (described above) and non-verbal methods, especially in the second stage. Along with questioning the patient and analyzing his answers, the doctor can recognize a lot of important information that is not dressed in verbal form.
The language of facial expressions and gestures is the foundation on which counseling and interviewing are based (Harper, Wiens, Matarazzo, A. Ivey). Non-verbal language, according to the last author, functions at three levels:
* Terms of interaction: for example, the time and place of the conversation, the design of the office, clothing and other important details, most of which affect the nature of the relationship between two people;
* Information flow: for example, important information often comes to us in the form non-verbal communication, but much more often non-verbal communication modifies the meaning and rearranges the accents in the verbal context;
* Interpretation: Every individual, belonging to any culture, has completely different ways of interpreting non-verbal communication. What one perceives from non-verbal language may be fundamentally different from what another understands.
Extensive research in Western psychological science in the study of listening skills have shown that the standards of eye contact, torso tilt, average voice timbre may be completely unsuitable in communicating with some clients. When a clinician is working with a depressed patient or someone who is talking about sensitive matters, eye contact during the interaction may be inappropriate. Sometimes it is wise to look away from the speaker.
visual contact. Without forgetting cultural differences, it should still be noted the importance of when and why an individual stops making eye contact with you. “It is the movement of the eyes that is the key to what is happening in the client's head,” says A. Ivey, “Usually, visual contact stops when a person speaks on a sensitive topic. For example, a young woman may not make eye contact when she talks about her partner's impotence, but not when she talks about her solicitousness. This may be a real sign that she would like to maintain a relationship with her lover. However, in order to more accurately calculate the value of the change non-verbal behavior or visual contact, more than one conversation is required, otherwise there is a high risk of drawing erroneous conclusions.
Language of the body. Representatives of different cultures naturally differ in this parameter. Different groups put different content into the same gestures. It is believed that the most informative in body language is the change in torso tilt. The client may sit naturally and then, for no apparent reason, clasp their hands, cross their legs, or sit on the edge of a chair. Often these seemingly minor changes are indicators of conflict in the person.
intonation and tempo of speech. The intonation and pace of a person's speech can say as much about him, especially about his emotional state, how much and verbal information. How loudly or quietly sentences are spoken can serve as an indicator of the strength of feelings. Rapid speech is usually associated with a state of nervousness and hyperactivity; while slow speech may indicate lethargy and depression.
Following AAivy and his colleagues, we note the importance of such parameters as the construction of speech in the interview process. According to these authors, the way people construct sentences is an important key to understanding their perception of the world. For example, it is proposed to answer the question: “What will you tell the controller when he starts checking the availability of tickets, and you find yourself in a difficult situation?”: a) The ticket is torn, b) I torn the ticket, c) The car torn the ticket, or d) Something happened?
Explaining even such an insignificant event can serve as a key to understanding how a person perceives himself and the world around him. Each of the above sentences is true, but each illustrates a different worldview. The first sentence is just a description of what happened; the second - demonstrates a person who takes responsibility and indicates an internal locus of control; the third represents external control, or "I didn't do it," and the fourth indicates a fatalistic, even mystical, outlook.
Analyzing the structure of sentences, we can come to an important conclusion regarding the psychotherapeutic process: the words that a person uses when describing events often give more information about him than the event itself. The grammatical structure of sentences is also an indicator of personal worldview.
The research and observations of Richard Bandler and John Grinder, the founders of neurolinguistic programming, focused the attention of psychologists and psychotherapists on the linguistic aspects of diagnosis and therapy. For the first time, the significance of the words used by the patient (client) and the construction of phrases in the process of understanding the structure of his mental activity, and hence personal characteristics, was noted. Scientists have noticed that people talk differently about similar phenomena. One, for example, will say that he “sees” how his spouse treats him badly; another will use the word "know"; the third is "I feel" or "feel"; the fourth - will say that the spouse does not "listen" to his opinion. Such a speech strategy indicates the predominance of certain representational systems, the presence of which must be taken into account in order to “connect” to the patient and create true mutual understanding within the interview.
According to D. Grinder and R. Bandler, there are three types of mismatches in the structure of the interviewee's speech, which can serve to study the deep structure of a person: deletion, distortion and overgeneralization. Crossing out can appear in sentences such as "I'm afraid." To questions like “Who or what are you afraid of?”, “For what reason?”, “In what situations?”, “Do you feel fear now?”, “Is this fear real or its causes are unreal?” -- usually no responses. The task of the psychologist is to "expand" a brief statement about fear, to develop a complete representative picture of the difficulties. During this "filling in the crossed out" process, new surface structures may appear. Distortion can be defined as an unconstructive or incorrect proposal. These proposals distort the real picture of what is happening. A classic example this can be a sentence like: "He makes me crazy", while the truth is that a person who "makes another crazy" is only responsible for his own behavior. A more correct statement would be: "I get very angry when he does this." In this case, the client takes responsibility for his behavior and begins to control the direction of his actions. Distortions often develop from strikeouts on the surface structure of a sentence. At a deeper level, a close examination of the client's life situation reveals many distortions of reality that exist in his mind. Overgeneralization occurs when the client draws far-reaching conclusions without having sufficient evidence for this. Overgeneralization is often accompanied by distortions. The words accompanying overgeneralizations are usually the following: "all people", "everyone in general", "always", "never", "the same", "always", "forever" and others.
The use of verbal and non-verbal communication contributes to a more accurate understanding of the patient's problems and allows you to create a mutually beneficial situation during the clinical interview.
Experimental-psychological (patho- and neuropsychological) research methods
Pathopsychological research methods.
Under pathopsychological studies (experiments) in modern psychology refers to the use of any diagnostic procedure in order to model an integral system of cognitive processes, motives and "personal relations" (B.V. Zeigarnik).
The main tasks of paraclinical methods in clinical psychology are the detection of changes in the functioning of individual mental functions and the identification of pathopsychological syndromes. The pathopsychological syndrome is understood as a pathogenetically determined commonality of symptoms, signs of mental disorders, internally interdependent and interrelated (V.M. Bleikher). Pathopsychological syndromes include a set of behavioral, motivational and cognitive features of the mental activity of patients, expressed in psychological terms (V.V. Nikolaeva, E.T. Sokolova, A.S. Pivakovskaya). It is believed that the pathopsychological syndrome reflects violations of various levels of functioning of the central nervous system. According to A.Rluriya, Yu.F.Polyakov, in the system of the hierarchy of brain processes, there are such levels as: pathobiological (characterized by violations of the morphological structure of brain tissues, the flow of biochemical processes in them), physiological (consisting in a change in the course of physiological processes), patho- and neuropsychological (which are characterized by a violation of the flow of mental processes and related properties of the psyche), psychopathological (manifested by clinical symptoms and syndromes of mental pathology).
As a result of the identification of pathopsychological syndromes, it becomes possible to assess the features of the structure and course of the mental processes themselves, leading to clinical manifestations - psychopathological syndromes. The pathopsychologist directs his research to the disclosure and analysis of certain components of brain activity, its links and factors, the loss of which is the cause of the formation of symptoms observed in the clinic.
The following pathopsychological register-syndromes are distinguished (I.A. Kudryavtsev):
* schizophrenic
* affective-endogenous
* oligophrenic
* exogenous-organic
* endogenous-organic
* personality-abnormal
* psychogenic-psychotic
* psychogenic-neurotic
The schizophrenic syndrome complex consists of such personality-motivational disorders as: a change in the structure and hierarchy of motives, a disorder of mental activity that violates the purposefulness of thinking and meaning formation (reasoning, slipping, diversity, pathological polysemanticism) while maintaining the operating side, emotional disorders (simplification, dissociation of emotional manifestations, sign paradoxicality), changes in self-esteem and self-awareness nia (autism, sensitivity, alienation and increased reflection).
The psychopathic (personality-abnormal) symptom complex includes: emotional-volitional disorders, violations of the structure and hierarchy of motives, inadequacy of self-esteem and the level of claims, impaired thinking in the form of "relative affective dementia", impaired prediction and reliance on past experience.
The organic (exo- and endogenous) symptom complex is characterized by such signs as: a general decrease in intelligence, the collapse of existing information and knowledge, mnestic disorders affecting both long-term and operative memory, impaired attention and mental performance, impaired operational side and purposeful thinking, changes in the emotional sphere with affective lability, impaired critical abilities and self-control.
The oligophrenic symptom complex includes such manifestations as: inability to learn and form concepts, lack of intelligence, lack of general information and knowledge, primitiveness and concreteness of thinking, inability to abstract, increased suggestibility, emotional disorders.
Identification of pathopsychological register-syndromes allows the clinical psychologist not only to fix disorders in various areas of mental activity, but also to rank them according to the mechanisms of occurrence. In addition, the correct qualification of the pathopsychological syndrome allows the clinician to verify the nosological diagnosis and direct corrective and therapeutic work in the right direction. To a greater extent, register syndromes are significant for pato psychological research in a psychiatric clinic, in a smaller one - in a somatic one.
Paraclinical research methods in clinical psychology represent an extensive set of methods for assessing brain activity. Each of them represents the tools of any field of science. As a result, the development of all paraclinical methods and diagnostic methods is not within the competence of clinical psychologists. But the ability to select paraclinical methods necessary for a specific clinically identified pathology, to justify the need for their use, to correctly interpret the results obtained with their help is considered an integral part of the activity of a clinical psychologist.
Table 3
The main methods of pathopsychological diagnostics for violations of certain areas of mental activity
|
The sphere of mental activity in which violations are noted |
Pathopsychological technique |
|
|
Attention disorders |
Schulte tables correction test Kraepelin account Munsterberg method |
|
|
Memory disorders |
test ten words pictogram |
|
|
Perceptual disorders |
sensory excitability of the Aschaffenburg, Reichardt, Lipman tests |
|
|
Thinking disorders |
tests for classification, exclusion, syllogisms, analogies, generalization associative experiment Everier problem, pictogram test of discrimination of properties of concepts |
|
|
Emotional disorders |
Spielberger test Luscher color selection method |
|
|
Intellectual Disorders |
Raven test Wechsler test |
Pathopsychological diagnostics uses a battery of experimental psychological test methods, with the help of which
it is possible to evaluate the functioning of both individual spheres of mental activity and integrative formations - types of temperament, character traits, personal qualities.
The choice of specific methods and ways of pathopsychological diagnostics in clinical psychology is based on the identification of cardinal psychopathological deviations in various types mental response in certain areas of mental activity. Table 3 presents the indications for the use of certain methods of pathopsychological diagnostics.
Pathopsychological assessment of attention disorders
To confirm the clinically detected attention disorders, the most adequate pathopsychological methods are the assessment of attention according to the Schulte tables, the results of thinning the correction test and the Kraepelin count.
Schulte tables are a set of numbers (from 1 to 25) not placed in random order in the cells. The subject must show and name in a given sequence (as a rule, increasing from one to twenty-five) all the numbers. The subject is offered four or five non-identical Schulte tables in a row, in which the numbers are arranged in a different order. The psychologist records the time spent by the subject on showing and naming the entire series of numbers in each table separately. The following indicators are noted: 1) exceeding the standard (40-50 seconds) time spent on pointing and naming a series of numbers in the tables; 2) the dynamics of temporal indicators during the survey process for all five tables.
Schulte tables. 1.
According to the results of this test, the following conclusions about the characteristics of the attention of the subject are possible:
Attention is concentrated enough - if the subject spends time corresponding to the standard on each of the Schulte tables.
Attention is not concentrated enough - in the event that the subject spends time exceeding the standard on each of the Schulte tables.
Attention is stable - if there are no significant time differences when counting the numbers in each of the four to five tables.
Attention is unstable - if there are significant fluctuations in the results according to the tables without a tendency to increase the time spent on each subsequent table.
Attention depleted - if there is a tendency to increase the time spent by the subject on each next table.
The Kraepelin score technique is used to study fatigue. The subject is asked to add in his mind a series of single-digit numbers written in a column. The results are evaluated by the number of numbers added in a certain period of time and errors made.
When conducting a correction test, special forms are used, on which a series of letters are shown, arranged in a random order. The instruction provides for the test subject to cross out one or two letters at the choice of the researcher. At the same time, every 30 or 60 seconds, the researcher makes marks in the place of the table where the subject's pencil is at that time, and also registers the time spent on the entire task.
The interpretation is the same as when evaluating the results according to the Schulte tables. Normative data for the correction test: 6-8 minutes with 15 errors.
The Munsterberg technique is designed to determine the selectivity of attention. It is a literal text, among which there are words. The task of the subject as quickly as possible reading the text, underline these words. You have two minutes to work. The number of selected words and the number of errors (missing or incorrectly highlighted words) are recorded.
Münsterberg technique
bsopnceevtrgschofionzshchnoeost
sukengshizhwafyuropdbloveavyfrplshd
bkyuradostwufciejdlorrgshrodshljhashshchgiernk
zhdorlvfuyuvfbcompetitionfnguvskaprpersonality
eprppvaniedptyuzbyttrdshschnprkkukom
janvtdmjgftasenplaboratorygsh
Attention disorders are not specific to any mental illness, types of mental response, levels of mental disorders. However, it is possible to note the specifics of their changes in various mental pathologies. So, they are most clearly represented in the structure of the exogenously organic type of mental response, manifesting themselves as impaired concentration and stability of attention, rapid exhaustion, and difficulties in switching attention. Similar disorders are found in neuroses. Within the framework of the endogenous type of mental response, attention disorders are not decisive (as a rule, they are either absent or secondary to other psychopathological phenomena). Despite this, there is evidence (E. Kraepelin) that in schizophrenia, violations of active attention are characteristic, while passive attention is preserved. This distinguishes patients with schizophrenia from patients with exogenous organic and neurotic mental disorders.
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The first pathopsychological studies at the school of V.M. Bekhterev: contribution to the theory and practice of clinical psychology. Categories of mental health. Study of the genesis and structure of psychosomatic phenomena. Psychological correction and therapy, their methods.
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The subject and tasks of clinical psychology of children and adolescents. Childhood autism syndrome. Methods of clinical and psychological research used in diagnostic, correctional, expert, psychotherapeutic activities and restorative education.
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Principles:
Qualitative analysis of the features of the course of mental activity (taking into account not only the results, but also a thorough analysis of the process of activity, errors, compensatory mechanisms, identifying the mechanism of violations).
Modeling of normal mental activity.
Accounting for the personality of the patient, his attitude to the situation of the study.
The complexity of the study, individual selection of methods.
Syndromic analysis of the obtained results.
Accurate and objective registration of symptoms, keeping a study protocol.
Identification of not only disturbed, but also preserved forms of mental activity (positive diagnostics).
The research program depends on the clinical task.
The basic principle of constructing the study is the principle of qualitative analysis of the specifics of the course of mental processes in patients. IN domestic psychology it is believed that due to the fact that mental processes are formed in vivo in the process of appropriating social and historical experience, in the process of activity, communication, the experiment should be directed not to research and measurement of individual mental functions, but to research of a person who performs real activity, to identify the mechanisms of violations of activity and approaches to its restoration.
The analysis of pathopsychological data should be not only qualitative, but also systemic. In pathopsychology, it is necessary to carry out an analysis not so much symptomatic as syndromic (according to Luria). An experimental pathopsychological study should be, as it were, an agent that provokes the manifestation of the originality of the patient's mental activity and his relationship to the environment and himself.
The preparatory stage takes place before the meeting of the psychologist with the future subject. Its purpose is to plan future empirical research. To do this, the psychologist solves two problems: 1) to build a research program (scheme) and 2) to obtain preliminary data about the future subject.
The purpose of the second stage of pathopsychological research is the collection of empirical data. At this stage, the psychologist interacts directly with the subject, an experiment is carried out, a conversation and observation of the patient in the process of communication and performing tasks.
An important requirement for conducting an EPI is careful record keeping. The research protocols should note the behavior of the subject, his understanding of the instructions, as well as everything related to the task.
The final stage of the study is the analysis of the obtained empirical facts, their generalization and interpretation. All empirical data obtained by the psychologist during the study are analyzed: data from the conversation, observations and, of course, the results of all experimental tests. The analysis of experimental data should proceed similarly to clinical analysis - from symptom to syndrome.
As a result of the analysis, the pathopsychologist establishes a psychological diagnosis.
Based on the analysis of the results of the study, a conclusion is drawn up, which in writing reflects and substantiates the characteristics of the identified pathopsychological syndrome.
The conclusion according to the experimental psychological study, according to Zeigarnik, S. Ya. Rubinshtein and others, cannot be standard, since the pathopsychological study itself is generally not standard. The conclusion is essentially a product of the psychologist's creative thinking about the specific task that is significant for the clinic.
The main part of the conclusion should contain information about the nature of the cognitive activity of the subject, that is, about the features of thinking, memory, attention, the rate of his sensorimotor reactions, the presence or absence of signs of increased exhaustion found during the study. Be sure to describe the features of the personal-emotional sphere identified in the study.
Based on the analysis of experimental data, it is necessary to highlight the leading pathopsychological features, and specific data from the protocols can be used as illustrations confirming the qualification of the violation.
At the end of the conclusion, the most important data obtained during the study are summarized, characterizing the features of the violation of mental activity and the personality of the subject, that is, a reasoned qualification of the pathopsychological syndrome is given.
Topic 1. Clinical psychology as a science. Subject and structure of the discipline.
Clinical (medical) psychology- a science that studies the psychological characteristics of people suffering from various diseases (both mental and somatic); methods and techniques for diagnosing mental deviations and disorders, differentiation of psychological phenomena and psychopathological symptoms and syndromes; features of the psychology of therapeutic interaction (collaboration of the patient with the doctor and other medical workers); psychoprophylactic, psychocorrective and psychotherapeutic techniques and means of helping patients, as well as theoretical aspects of psychosomatic and somatopsychic interactions.
Subject of Clinical Psychology:
a) a disorder (violation) of the human psyche and behavior
b) personal and behavioral characteristics of people suffering from various diseases
c) the specifics of the influence of psychological factors on the occurrence, development and treatment of diseases
d) features of the relationship of sick people and the social microenvironment in which they reside
medicine without psychology is veterinary medicine.
Tasks of clinical psychology:
The study of mental and psychological factors influencing the formation of the disease, their prevention and treatment, and the features of the influence of these diseases on the human psyche
Psychological analysis of the manifestations of various diseases in their dynamics
Determination of mental disorders of the patient depending on the type of disease, establishing the nature of the relationship of the patient with the medical staff and the microenvironment in which the patient resides
Development of principles and methods of psychological research in the clinic
Development and study of the effectiveness of psychological methods of influencing the human psyche for therapeutic and prophylactic purposes
The sections of clinical psychology include:
1. Pathopsychology
2. Somatopsychology (psychology of patients with various diseases - the psychology of ulcer patients)
3. Neurology
4. Neuropsychology
5. Psychosomatic medicine
6. Psychology of medical interaction (interaction of the patient with doctors and medical staff)!!! The most important section, which primarily serves the needs of practice
7. Developmental clinical psychology
8. Psychological rehabilitation
9. Mental hygiene and psychoprophylaxis
10. Psychocorrection
11. Psychology of deviant behavior (treatment and correction of dependent behavior, both chemical and psychological)
Methods of clinical psychology
In addition to general psychological methods, clinical psychology has developed and successfully applies a number of specialized methods of psychodiagnostics and psychocorrection.
1. Conversation, clinical diagnostic interview
2. Observation of the patient's behavior (included observation)
3. Analysis of the patient's life history (collection of anamnesis and catamnesis data)
4. Experimental psychological examination: standardized psychodiagnostic methods, various tests and personality questionnaires, projective research methods, drawing tests, tests with stimulus material, functional diagnostic tests:
patho- and neuropsychological studies of disorders of mental processes
some neurophysiological methods
Provocative methods
5.Standardized self-reports
In addition to standardized self-reports, elements of various art therapy techniques and techniques can also be carried out with the patient. For example, spontaneous drawing on a free topic or joint drawing with a psychologist. As part of the psychotherapeutic process, symptoms of various disorders and deviations can clearly stand out. With the help of such methods, it is possible to identify the syndrome of delusions of persecution and delusions of attitude.
Diagnostic principles-alternatives of clinical psychology:
1. Illness-personality
2. Nosos-pathos
3. Reaction-state-development
4. Psychotic-non-psychotic
5. Exogenous-endogenous-psychogenic
6. Defect-recovery-chronification
7. Adaptation-disadaptation
8. Negative-positive
9. Compensation-decomensation
Difficulties arise on the path of the diagnostic process, for the solution of which a set of alternative principles is used. It lays down the principles of the phenomenological approach in psychology and psychiatry. This approach lies in the fact that each integral individual experience of a person (phenomenon) should be considered as multi-valued, allowing to understand and explain it both in psychological and psychopathological categories.
1.Illness-personality. This alternative principle is fundamental to the diagnostic process. It involves an approach to any psychological phenomenon from two alternative sides: either the observed manifestations are psychopathological symptoms (signs of a mental illness), or they are a sign of personal characteristics (a person’s worldview, cultural or national traditions, belief in non-traditional methods of treatment, etc.)
2.nosos-pathos. Any psychological phenomenon can be interpreted in the coordinate system: nosos (disease) - a painful process that has dynamics, pathogenesis, pathos (pathology) - a pathological condition, developmental deviation, congenital pathology, oligophrenia. Nozos has the following characteristics: health-disease.
Patos has the following characteristics: norm-pathology.
The norm is 1/3 health.
3.Exogenous-endogenous-psychogenic. Some symptoms and syndromes may occur predominantly in one of the etiopathogenetic pathways:
· exogenous. The exogenous type of mental response is a mental state and developmental reactions that occur as a result of organic brain damage (craniocerebral trauma, vascular and infectious diseases of the brain, tumors and intoxication).
· endogenous. The endogenous type of mental response is understood as mental reactions and developmental states caused by internal (endogenous) hereditary-constitutional causes.
· Psychogenic. The psychogenic type of response includes mental reactions, states and development, the causes of which lie in the psycho-traumatic influence of life events.
4.Defek-recovery-chronification. This alternative principle makes it possible to evaluate, depending on the course of the clinical picture of a mental illness, the conditions that arise after the disappearance of psychopathological symptoms. A defect in psychiatry is a long-term and irreversible impairment of any mental function (personality defect, cognitive defect). The defect may be congenital or acquired. Currently, the term "defect" is used for acquired mental disorders and is due to a previous mental illness. For example, a schizophrenic defect is a persistent condition with the manifestation of psychopathological syndromes, when an acute condition is no longer observed in a patient. The most characteristic manifestation of the defect are negative disorders. Oligophrenia is a persistent defect.
The opposite of a defect is recovery - the complete restoration of lost mental functions during a neuropsychiatric illness.
Chronification of mental disorders is when psychopathological symptoms and syndromes continue to appear in the clinical picture of the disease. This is most often the case with sluggish schizophrenia.
5.Adaptation-disadaptation. Compensation-decompensation. These alternative principles make it possible to consider neuropsychiatric illness in connection with their influence on socio-psychological functions. Thanks to them, you can assess how much a person can cope with his existing violations. It also allows you to outline ways and choose methods of psychological influence for the purpose of psychoprophylaxis and psychotherapy.
Adaptation- the process of adaptation of an organism or personality to conditions environment. During adaptation, a person, as it were, comes to terms with a new painful status, adapts to it and can work, having psychopathological syndromes. For example, a person can work normally, live in a family, he will be considered mentally normal, but at the same time, a person will feel the impact on him with hallucinatory images.
Compensation- a state of complete or partial replacement of mental functions disturbed during illness. With compensation, the lost mental functions are replaced by others that are most acceptable to the individual. In compensation, a person with mental retardation performs physical work. An epileptic psychopath gets a job as an accountant. Decompensation- when a person cannot compensate for a defect.
6. Positive-negative. With the help of these alternative principles in psychiatry, one can assess the state that a person has at the moment (the active form of the disease, or the chronic course of the disease). Positive (productive) symptoms in psychiatry include those symptoms and syndromes that are called the so-called painful superstructure over the healthy psychological functions of a person. That is, the presence of symptoms and syndromes, as it were, is added to what a sick person already has. Most of the known psychopathological symptom complexes can be classified as positive. Examples: reasoning (futile philosophizing). Negative (deficiency) symptoms are psychopathological phenomena corresponding to the loss of certain mental processes. In other words, to mental processes nothing new is added, but only what was characteristic of a person before the disease is removed. Example: dementia - acquired mental retardation (due to destructive changes in the g/m cortex of both exogenous and endogenous genesis).
7.Simulation-disimulation-aggravation. These principles are alternatives that allow you to assess the degree of impaired mental functions or the degree of health. Simulation- a feigned image of the disease for selfish purposes. The pretender, by his feigned behavior, seeks to gain for himself. For example: to be released from punishment, to receive disability. Most often, the states of motor speech excitation, dementia, hallucinations and delirium are simulated. With a long simulation, there is a fence between the patient and the doctor, expressed in varying degrees, the image of childish naivety and loss of knowledge, the strengthening of one's own characteristics and experiences. Metasimulation - holding a picture of a mental illness.
Aggravation- Increased signs of mental illness. Disimulation– reduction of signs of an existing disease.
8.reaction-state-development. Reaction - any response of the body to a change in both the internal and external space of a person. From physical and biochemical changes in each individual cell to a conditioned reflex. In psychiatry, if symptoms and syndromes are observed before 6 months, this is called a reaction. If symptoms are observed for up to a year, this is a disease. This is a stable manifestation of either symptoms of a disease or signs of health. Development is a manifestation of symptoms and syndromes of a neuropsychiatric disease in dynamics.
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