It does not apply to the directions of modern pathopsychology. Pathopsychology: its subject and tasks. The concept, tasks and structure of clinical psychology

leading direction clinical psychology considered pathopsychology. Pathopsychology emerged at the turn of the twentieth century. Its founder is considered to be V.M. Bekhterev, who, together with the students, revealed the qualitative and quantitative features of neuro- mental activity individual patients, as well as the dynamics of mental disorders depending on various external factors. The development of this area of ​​clinical psychology was significantly influenced by A.F. Lazursky, G.I. Rossolimo, B.V. Zeigarnik and other scientists.

Pathopsychology is a branch of clinical psychology that studies the patterns of disintegration of mental activity and personality traits when compared with normally formed and ongoing mental processes. N.L. Belopolskaya notes that within the framework of pathopsychology, issues of abnormal mental development are being developed, defects in individual mental functions, as well as involutional and destructive mental states are being studied. The author points out that pathopsychology provides the material necessary for understanding the essence of the concept of "normal mental development", and because of this, it has a significant impact on the solution of many fundamental problems general psychology. However, pathopsychology has its own subject and methods, while being an applied discipline. Pathopsychology is closely interconnected with other sections psychological science. For example, studying the patterns of functioning of various mental processes carried out in more detail if there is evidence of their possible violations. The mechanisms of mental activity, normally often hidden from the researcher, can be studied and analyzed much more easily in case of their disintegration or violation.

V.A. Kulganov and others offer a distinction between pathopsychology and psychopathology. Psychopathology as a science differs from pathopsychology in that it describes the signs of a mental illness in the course of an illness, in dynamics. If pathopsychology operates largely in psychological terms, then psychopathology operates in medical clinical terms (etiology, pathogenesis, symptom, syndrome). The author calls the main tasks of pathopsychology the following:

1. Obtaining data for pathogenetic and differential diagnosis.

2. Study of the dynamics of mental disorders in connection with the ongoing therapy - an assessment of the effectiveness of the treatment process.

3. Participation in expert work (military, medical and social, judicial, psychological, medical and pedagogical expertise).

4. Participation in rehabilitation work.

Thus, pathopsychology as a subject considers not just the human psyche, but the psyche against the background of some kind of violation. B.V. Zeigarnik described the subject of pathopsychology in the most detailed way: “pathopsychology as a psychological discipline proceeds from the laws of development and structure of the psyche in the norm. It studies the laws of the decay of mental activity and personality traits in comparison with the laws of the formation and course of mental processes in the norm, it studies the laws of distortion of the reflective activity of the brain ". Summarizing the above, we can conclude that pathopsychology studies mental activity against the background of various disorders. In this regard, it should be noted that the most popular concept in pathopsychology is the concept of mental disorder. This concept, in accordance with the International Classification of Diseases, is interpreted as a disease state with psychopathological or behavioral manifestations associated with impaired functioning of the body as a result of exposure to biological, social, psychological, genetic or chemical factors. In other words, this concept means deviation from the norm. From the point of view of N.L. Belopolskaya, a deviation from the norm is a condition in which the following aspects are detected:

1) inadequacy of emotional reactions, actions, speech statements, facial expressions, gestures and behavior in general;

2) reduction or lack of criticality to their actions, physical and mental state;

3) unproductive activity.

The opposite concept in pathopsychology is the concept of mental health. The term "mental health" was first introduced by the World Health Organization in 1979. In foreign countries (USA, Great Britain), the concept of "mental health" is considered as the successful implementation of mental functions, resulting in productive activity, establishing relationships with other people and the ability to adapt to changes and cope with troubles. The essence of mental health lies in the fact that it is the basis of intellectual activity and communication skills, learning, emotional growth, resilience and self-esteem.

From the point of view of many authors (SM Grombakh, N. Sartorius), mental health is an integral characteristic of the full value of the individual's mental functioning, including an understanding of the nature and mechanisms of its maintenance. The basis of mental health is the full development of higher mental functions, mental processes and mechanisms at all stages of ontogenesis.

IN domestic psychology the term "mental health" defines the state of mental well-being, in which there are no painful mental manifestations, adequate regulation of behavior and activity is ensured. In other words, the mental health of an individual is characterized by the integrity and coordinated activity of all the mental functions of the body, which contributes to a certain level of comfort, the formation of adequate forms of behavior. The main characteristics of mental health include mental processes and conditions, as well as personality traits. The most complete criteria for mental health are described by N.D. Lakosina and G.K. Ushakov:

Permanence of habitat

Correspondence of age and maturity of feelings,

Lifestyle,

Correspondence of reactions to external stimuli and their adequacy,

A sense of responsibility for offspring,

Changing your own behavior depending on life situations,

Self-affirmation in the team.

Thus, mental health as a set of criteria is an acute problem today. modern society. To study it in order to maintain a favorable state in the framework of clinical psychology, various studies are being carried out.

V.A. Kulganov et al. note that the following problems are being investigated within the framework of pathopsychology:

1. Violations of mental processes in patients:

Sensations, perceptions (visual, auditory, tactile (tactile), olfactory and gustatory disorders, as well as disturbances in the level of perception: agnosia, illusions, hallucinations, etc.),

Violations of voluntary movements and actions (motor disorders, including tics, hyperactivity, etc.),

Speech disorders (specific disorder of speech articulation; disorder of expressive, impressive speech; stuttering), communication and learning skills,

Memory disorders (dysmnesia - amnesia, hypermnesia, hypomnesia; paramnesia - pseudo-reminiscences, cryptomnesia, echomnesia, confabulation),

Thinking disorders (impairments of the operational side of thinking, the dynamics of thinking, the personal component of thinking),

Emotional disturbances. Disorders of the emotional sphere consist in painful experiences of certain emotional states. The main violation is a change in the emotional state in the direction of oppression or uplift. Disturbances in the emotional sphere include hypothymia, hyperthymia, parathymia, as well as disturbances in the dynamics of emotions,

Mood disorders (depressive disorders and bipolar affective disorder),

Violations of consciousness (detachment from the outside world, a deafened state of consciousness, a twilight state of consciousness, etc.).

2. Psychosomatic and psychogenic disorders in various diseases (cardiovascular, gastrointestinal, skin, etc.). Within the framework of this direction, neuroses, their manifestations, factors of occurrence, etc. are also studied in detail.

Thus, pathopsychology studies the characteristics of the psyche of a sick person, his personality changes in situations of mental disorders. This direction helps to collect medical and psychological data about what mental changes occur with a sick person in order to determine the most favorable treatment option. Pathopsychology provides information to other areas for the formation of an optimal psychotherapeutic and correctional program. Therefore, the significance of this direction is fundamental for other areas of clinical psychology.

Pathopsychology, like neuropsychology, can rightfully be considered a domestic branch of clinical psychology, at the origins of which were L. S. Vygotsky, B. V. Zeigarnik and S. Ya. Rubinshtein. Pathology began its development in the 1930s, during the years of the Great Patriotic War(1941-1945) and post-war years when it turned out to be in demand, like neuropsychology, for the restoration of mental functions in patients with military trauma. Pathopsychology, along with somatopsychology and neuropsychology, is integral part clinical psychology and therefore bears all the main features inherent in clinical psychology as a whole. Pathopsychology refers to the borderline branches of science that have arisen at the intersection of disciplines that are similar in object and research issues. If clinical psychology is an area bordering between psychology and medicine in general, then pathopsychology is most closely bordered by a special section of clinical science and practice - psychiatry. It can be said that pathopsychology- this is a special section of clinical psychology, in particular, studying the nature of the course and structural features of mental processes leading to disorders observed in the clinic

Psychiatry- describes, investigates and systematizes MANIFESTATIONS of disturbed mental functions, i.e. explores the disturbed phenomenon

Object of study- mental disorders

Subject of study- regularities of the decay of mental activity and personality traits in comparison with the regularities of the formation and course of mental processes in the norm

Tasks- psychodiagnostics in order to clarify the medical diagnosis and justify treatment, in particular psychotherapy and occupational therapy

Thus, psychopathology studies the causes, manifestations, course, treatment and prevention of various mental disorders.

2) tasks of pathopsychology

Pathopsychology is aimed at providing specific practical assistance to clinicians dealing with mental disorders in a variety of mental disorders.

The main tasks of pathopsychological research include the following six:

1. Obtaining data for diagnostics.
2. Study of the dynamics of mental disorders in connection with the ongoing therapy.
3. Participation in expert work.
4. Participation in rehabilitation work.
5. Participation in psychotherapy.
6. A study of understudied mental illnesses.

Obtaining additional data on the mental state of the patient(about the features of his cognitive activity, emotional-volitional sphere and personality as a whole) is one of the most important tasks of practical pathopsychology

Study of the dynamics of mental disorders in connection with the therapy is also an important task implemented by the pathopsychologist in the clinic.

Another important task of the pathopsychologist is participation in expert work. Pathopsychological studies play an important role in the conduct of forensic psychiatric, military and labor examinations. At the same time, the psychologist not only provides data that facilitates the solution of diagnostic issues, but also objectively establishes the severity of the mental defect.

Participation in rehabilitation work is currently of particular importance. Modern psychiatry pays much attention to the problems of rehabilitation and resocialization of patients. The provision of medical care to mentally ill people involves not only active and supportive therapy, but also the implementation of measures to restore their social status. The prevention of disability also depends on properly constructed rehabilitation measures.

Participation in psychocorrection, as well as carrying out rehabilitation measures, should be carried out by a psychologist under the guidance and at the request of a psychiatrist. IN Lately there has been a trend of active inclusion of psychologists in the conduct of psychotherapy.

Less often, the pathopsychologist has to solve the problem research on understudied mental illnesses. As a rule, such studies are carried out in clinics operating on the basis of research institutes. The purpose of such scientific research is the analysis of still insufficiently studied psychopathological manifestations of certain mental illnesses. At the same time, a study of large groups of patients with similar psychopathological symptoms is carried out. Here, the statistical reliability of the data obtained acquires a special role. Moreover, the solution of this problem differs significantly from pathopsychological research aimed at solving issues of a clinical and practical nature.

3) methods and techniques of pathopsychology

In assessing the mental state, conversation and observation still occupy the main place, while the somatic state of the patient is studied by a variety of modern laboratory and experimental methods. Meanwhile, when analyzing the pathology of the psyche, the methods of questioning and observation must necessarily be supplemented by experiment, since it is the experimental method that allows one to move from describing the phenomenon to analyzing the causes and mechanisms of symptom formation.

Pathopsychology, being a branch of psychology, uses the entire arsenal psychological methods, and among them the experiment occupies a leading place. Due to the specifics of the subject and the practical problems it solves, we can say that pathopsychology is an experimental science.

4) violations of sensations and perception in psychiatry and pathopsychology

In pathopsychology, the emphasis is not on describing symptoms and syndromes, but on revealing their psychological mechanisms and patterns of formation.

DISTURBANCE OF PERCEPTION

agnosia- violation of the semantic side of perception, that is, the patient can describe the object, but cannot name it, cannot say why it is needed

pseudoagnosia in dementia- violation of not only semantic but also structural components. Patients snatch out individual parts of the image and cannot catch this image as a whole.

deception of the senses- hallucinations, cases of difficult concentration on the source, increased orienting activity of the analyzers, contribute to the occurrence of hallucinations. The main role in the occurrence of hallucinations is played by a change in the activity of external and internal analyzers, the presence of subthreshold (unconscious) stimuli that cause an overload of these analyzers.

motivational component- (the motivation of perception is not set; the study of the imagination; the study of mental capabilities)

healthy- interest in tasks varied depending on the "motive of expertise"

schizophrenia- no interest in the task, no motive for expertise, only own motive for perception

epilepsy- too much interest in the task

Change motivational component leads to a change in perceptual activity, respectively, some disturbances in perception are a manifestation of a violation motivational sphere

MEMORY DISTURBANCES

-impaired immediate memory

Violation of remembering images

1. Korsakov's syndrome is a violation of immediate memory for current events. violation of the reproduction of events, and not the imprinting of traces. Missing memories can be replaced by fictional events (confabulations)
2. progressive amnesia - impaired memory for current events and events from the past. The disturbance spreads gradually, the earliest memories being the last to be cut. Patients confuse the past and the present, lose their orientation in time and space. Repeated repetition of the material does not improve its memorization, the total amount of memorization is reduced.

- mediated memory impairment

violation of remembering the image with the help of any symbols denoting this image (mediated image)

Pictograms of Luria

Patients cannot establish a conditional connection adequate to the content of the task
Epileptics could not independently choose one of the many options.
Schizophrenics make overly formal connections, such as sound
May be too detailed

Due to such disturbances in thinking, patients remember material worse if they resort to mediation, unlike healthy people.
In case of violation of mediated memory, the playback process does not go as indicated in the scheme of A.N. Leontieva A-Kh-A, it can be A-X-X or even A-X-Y

Depending on the disease and the structure of the impairment of activity specific to each disease, there is a specific impairment of mediated memory (that is, it is impaired differently in different patients)

- violation of the dynamics of mnestic activity

Violation of the efficiency of memorization and reproduction depending on time (today is good, tomorrow is bad), usually associated with similar disorders in all forms of their activity, their cognitive and affective-emotional sphere.

Accordingly, a violation of the dynamics of memory is an indicator of the instability of mental performance in general.

Violations of the dynamics of mnestic activity can also be associated with affective-emotional instability or effective capture of patients. Affective disorganization of patients, often found in organic brain diseases of various origins, can manifest itself in forgetfulness, inaccuracy in assimilation, processing and reproduction of material. Effective capture of patients, excessive focus on the mandatory success of activities can also lead to forgetting intentions, undifferentiated perception and retention of material.

- violation of the motivational component of memory

In patients with a disturbed motivational sphere, memorization and reproduction is at a lower level than in healthy people, which is explained by the lack of desire for proper memorization and reproduction.

DISTURBANCE OF THOUGHT

Violation of thinking - a violation of the components included in its structure

1) operational side of thinking

1. the decrease in the level of generalization lies in the fact that direct ideas about objects and phenomena dominate in the judgments of patients. Operating with general features is replaced by the establishment of purely specific relationships between objects. That is, objects are combined on the basis of secondary and particular features. The book and the sofa will be combined because the book is convenient to read on the sofa, and the ball and tomato because they are red. In particularly severe cases, patients may lack the ability to classify objects. A narrow circle of connections, few associations.
2. the distortion of the level of generalization consists in reflecting only the random aspects of phenomena, while the essential relationships between objects are little taken into account, the subject content of things and phenomena is often not taken into account. For example, when performing a task on the classification of objects, patients are guided by excessively general features that are inadequate to the real relationships between objects. So, the patient combines a fork, a table and a shovel into one group according to the principle of "hardness". There are a lot of associations, but they are incorrect and reflect only excessively general connections.

2) the dynamics of thinking

1. The lability of thinking is characterized by the instability of the way the task is performed, that is, by the alternation of adequate and inadequate solutions. The level of generalization of patients generally may not suffer, patients are able to correctly generalize the material, they do not violate the operations of comparison, transfer. However, the adequate character of judgments can be unstable.
2. inertia of thought. In these cases, there is a pronounced difficulty in switching from one mode of work to another. Patients cannot change the course of their judgments, switch from one type of activity to another. Patients with such a disorder hardly change their behavior model, algorithm of actions, the way of solving when changing activities, changing the task.

3) personal component of thinking

Violation of the motivational component, thinking is tied to motives and needs that are different in patients from those accepted in society. When classifying objects, healthy people also rely on personally significant meanings based on personal experience and experiences, and socially accepted, based on the developed body of knowledge about the subject.

1. diversity. Patients with such a violation in the process of performing one task rely either on adequate knowledge about the subjects, or on personal experiences associated with these subjects. The judgments of such patients about some phenomenon proceed in different planes.
2. reasoning. fruitless sophistication, unproductive long-winded reasoning. the reasoning reasoning of the patient is determined not so much by a violation of his intellectual operations, but by increased affectivity, inadequate attitude, the desire to bring any, even an insignificant phenomenon, under some kind of concept. Reasoning is expressed in the patient's pretentious and evaluative position and a tendency to generalize more in relation to the small object of judgments. Affectivity is manifested in the very form of the statement: significant, with inappropriate pathos. The grammatical structure of speech reflects the emotional features of reasoning: the syntax is peculiar, the vocabulary of reasoning statements, inversions and introductory words are often used.

Diversity and reasoning are reflected in speech, which acquires the character of "disintegration". Its main characteristics:

1. in the rather lengthy utterances of the patients there is no reasoning;
2. in the speech of patients it is impossible to detect a specific object of thought;
3. patients are not interested in the attention of the interlocutor; they do not express in their speech any relation to other people.

Thus, the "torn" speech of patients is devoid of the main features characteristic of human speech. It is neither an instrument of thought nor a means of communication between people.

4) violation of critical thinking

Critical thinking in this case is the deliberateness of actions, their verification and correction in accordance with objective conditions.

Patients show critical thinking in different ways, some are ready to correct mistakes on their own, others do it only under external pressure, and still others stubbornly defend their point of view. Worst of all, errors related to the diversity of judgments lend themselves to correction, i.e. with a violation of the motivational component of thinking

PERSONALITY DISTURBANCES

1) violation of the structure of the hierarchy of motives

The most obvious examples are dependency generation.
Motives become less mediated, correspondingly less controllable. Gradually, the leading motive - the satisfaction of a need (dependence) subjugates the entire personality of a person.

This is the transformation of a social need into a pathological attraction that subjugates all human activity.

2) the formation of pathological needs and motives

Initially, an adequate motive as a result of some events (trauma, stress, illness, lifestyle change) becomes dominant in a person’s life. The hierarchy of motives changes, the actions necessary to satisfy the need themselves become a motive, and all human activity begins to be built around the satisfaction of this need, this need becomes pathological.

3) violation of meaning formation

1. the weakening of the meaning-forming function of the motive, the motive becomes simply known. "paradoxical stabilization of some circle of semantic formations" (Kochenov)
2. the narrowing of the circle of semantic formations, that is, the motive, while retaining the motivating force, began to direct it to a smaller number of phenomena than before the disease. As a result, the motivating force of the motive decreased

Such patients are not included in common system relationships of people. Therefore, one of the most important measures of psychocorrection is the inclusion of patients in labor activity.

4) Violation of self-regulation and mediation

Mediation occurs at the level of operations

A sign is a means of mastering behavior, mastering behavior is an indirect process

By mediating his behavior, a person gets the opportunity to develop new ways of acting, activity, new motives. Human behavior becomes more arbitrary and conscious

In patients with organic diseases of the brain, the inability to operate with a sign is part of a wider pathology - a violation of mediation, regulation of one's actions

Mediated behavior is a "path" to the goals that a person sets for himself, while realizing not only his actions, but also the motives behind them. The ability to make knowledge and experiences about the situation and their capabilities in it the object of their consciousness. The process of meaning formation is possible only in the presence of mediation.

Self-regulation is awareness of the situation, setting goals.

In patients, due to impaired mechanisms of mediation and self-regulation, the process of meaning formation is disrupted, despite the understanding of the need to perform some actions, the motivating force of the motive may not be enough for them to begin to perform these actions.

5) Violation of criticality and spontaneity of behavior

If the critical controlled attitude to oneself and to the environment is violated, it becomes impossible to realize the kaleidoscope of impressions of the surrounding patient, the ability to resist these impressions is lost. The actions of patients cease to be dictated by internal motives and needs. A person begins to act on the basis of the situation around him, without relying on motivation, a new object that appears in the field of attention can easily force the patient to change activities. This phenomenon is called aspontaneity. The loss of the ability to evaluate oneself and others leads to the loss of motives, goals, awareness of actions and judgments. Such patients have anosognosia not only in relation to the disease, but also in relation to their behavior.

6) Violation of the formation of characterological features of the personality

The character of a person, both healthy and sick, is formed in vivo depending on the conditions, the disease creates conditions leading to anomalies of motives.

PATHOPSYCHOLOGICAL SYNDROMES

In pathopsychology, as in psychiatry, a syndrome is understood as a pathogenetically determined community of symptoms, signs of mental disorders, internally interdependent, interrelated. This is the greater diagnostic significance of syndromes compared with symptoms. In the diagnostic thinking of a doctor, the correct qualification of the syndrome is an approach to determining the nosological affiliation of the disease. Each of the pathopsychological syndromes includes a number of symptoms. The totality of symptoms is a symptom complex (syndrome). A syndrome (symptom complex) is a stable combination of interrelated positive and negative symptoms due to a common pathogenesis.

Symptoms and syndromes are the material from which the clinical picture of the disease is created. Syndromes and their dynamics manifest the pathogenesis of the disease, the sequence of its stages. When recognizing a mental illness (nosological form), one should focus not only on the dominant this moment in the patient's state of psychopathological syndrome, but mainly on the entire context of the disease: how this syndrome is associated with other symptoms and syndromes, what is their dynamics, how it affected the safety of the patient's personality, that is, what are the depth and dimensions of the lesion, the degree of involvement of mental spheres in the painful process.

According to the peculiarities of origin, all psychopathological symptoms with a certain degree of conventionality can be divided into positive and negative. Positive symptoms (productive, plus symptoms) arise in connection with the pathological production of the psyche. This includes hallucinations, delusions, obsessions, overvalued ideas and other pathological formations. Negative symptoms (deficient, minus symptoms) are a sign of persistent loss of mental functions, a consequence of gender, loss or underdevelopment of some links of mental activity. The manifestations of a mental defect are memory loss, dementia, dementia, a decrease in the level of personality, etc. It is generally accepted that positive symptoms are more dynamic than negative ones; it is changeable, capable of becoming more complex and, in principle, reversible. Deficiency phenomena are stable, they are highly resistant to therapeutic effects.

Isolation of positive and negative symptoms in the patient's condition corresponds to the clinical reality. Since the time of the neurologist J. Jackson, who proposed the concept of productive and deficient symptoms in the first half of the 19th century (within the framework of the theory of a single psychosis), many concepts have accumulated to clarify the term "deficiency" in the mental sphere. Deficiency is not only an irreversible defect, loss of mental function, but also its inhibition, temporary shutdown. The clearer the destruction of the brain, the weaker the mental reaction, the more clearly the signs of deficiency appear, which are most pronounced in organic dementia.

Productive (positive) psychopathological syndromes are an indicator of the depth and generalization of damage to mental activity. Positive psychopathological syndromes include neurotic, affective, depersonalization-de-realization, confusion syndrome, hallucinatory-delusional syndromes, syndromes of movement disorders, clouding of consciousness, eyleptiform and psychoorganic.

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 (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 purposefulness of thinking, changes in emotional spheres with affective lability, violation of 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.

REASONING

Reasoning is a type of thinking characterized by a tendency to empty, fruitless reasoning based on superficial, formal analogies. It manifests itself in philosophizing, verbosity and banality of judgments that are inadequate to the real situation. At the same time, the goal of the mental task is relegated to the background, and the patient’s desire for “reasoning” comes to the fore.

The psychological structure of resonant thinking was revealed by T. I. Tepenitsyna (1965, 1968, 1979). The author found that reasoning is not associated with any particular type of error in the implementation of the mental operations. It is due to the peculiarities of the personal-motivational sphere of patients. This variant of the patient's personal position is defined as an excessive need for "self-expression" and "self-affirmation". This explains such typical features of resonant thinking as the exaggerated pretentious and evaluative position of the patient, the affective inadequacy of the choice of the subject of discussion, the latter’s inconsistency with the methods of evidence and reasoning, the tendency to “overgeneralize” on a trifling matter, insufficient self-criticism, a peculiar manner of speech (floridity, a tendency to meaningful intonations, the use in excess of concepts that are often completely inappropriate for the subject of discussion, verbosity)

Lecture 1

Pathopsychology: theoretical foundations and practical significance.

Lecture plan:

1. object and subject of pathopsychology;
2. methodological foundations and theoretical problems of pathopsychology;
3. practical tasks of pathopsychology;
4. methods of pathopsychology and principles of construction of pathopsychological research.

1. 1. Object and subject of pathopsychology.

Pathopsychology is a practical branch of psychological science that emerged at the intersection of psychology and psychiatry. Her data are of theoretical and practical importance for both "mother" disciplines. In this sense, it can be classified as an applied field of knowledge.

object pathopsychology, like psychiatry, in a broad sense is a person suffering from a mental illness. However, the fact that pathopsychology is psychological discipline, defines it item as distinct from the subject of psychiatry.

Psychiatry, like any branch of medicine, focuses on understanding the causes of mental illness, the study of syndromes and symptoms typical for a particular disease, the patterns of their appearance and alternation, as well as the treatment and prevention of the disease.

Pathopsychology as a psychological discipline proceeds from the laws of development and the structure of the psyche in the norm. It studies the regularities of the disintegration of mental activity and personality traits in comparison with the regularities of the formation and course of mental processes in the norm.

Consequently, despite the proximity of the objects of study, psychiatry and pathopsychology excellent in their subject. Any forgetting of this provision (ie, the provision that pathopsychology is a psychological science) leads to blurring of the boundaries of this field of knowledge, to the substitution of its subject for the subject of so-called "minor psychiatry". Only in the case when the analysis of the results of a pathopsychological experiment is carried out in terms of modern psychological theory, they turn out to be useful for clinical practice, not only supplementing it, but also revealing new facts.

2. Methodological foundations and theoretical problems of pathopsychology, like the discipline itself, originate at the intersection of psychology and psychiatry.

Pathopsychology, along with somatopsychology and neuropsychology, is an integral part of clinical psychology and therefore bears all the main features inherent in clinical psychology. If clinical psychology is an area bordering between psychology and medicine in general, then pathopsychology borders very closely with a special section of clinical science and practice - psychiatry.

It is no coincidence that pathopsychology as a branch of clinical psychology emerged as one of the first and developed most intensively, especially in the early stages of the existence of clinical psychology. Psychiatry to this day, despite the huge interest in it, is the least developed in theory and the most difficult in practical terms. medical science and practices most associated with psychology. This is due to the fact that its subject is a special class of diseases - mental disorders, the essence of which is manifested in all kinds of mental disorders. To investigate mental disorders, it is necessary to understand well what the psyche itself is in all its diverse manifestations. That is why a knowledge of psychology is so important to psychiatry. Ivan Mikhailovich Sechenov wrote about this back in 1876, noting that psychology "obviously becomes the basis of psychiatry, no matter how physiology underlies the pathology of the body."

It should be noted that in Russia there have always been the closest ties between psychiatry and psychology. The most significant contribution to the development of psychology as a science in general and pathopsychology in particular was made by the works of domestic psychiatrists, such as V. M. Bekhterev, A. F. Lazursky, G. I. Rossolimo, S. S. Korsakov, V. P. Serbsky , A. N. Bernshtein, V. A. Gilyarovsky and others. It is interesting to note that the first experimental psychological laboratory abroad was opened by Wilhelm Wundt in 1879 at the University of Leipzig, and its activities were rather of a scientific and theoretical nature. In Russia, the first experimental psychological laboratories, starting with the one opened in 1885 by V. M. Bekhterev in Kazan, worked at neuropsychiatric clinics and, in addition to research activities, implemented applied aspects that were directly related to the practice of helping mentally ill people.

In the 20s of our century, works on medical psychology by well-known foreign psychiatrists appeared: E. Kretschmer's Medical Psychology, which interprets the problems of decay and development from the standpoint of constitutionalism, and P. Janet's Medical Psychology, in which the author dwells on the problems of psychotherapy.

The development of domestic pathopsychology was distinguished by the presence of strong natural science traditions. The direction of the work of psychological laboratories in psychiatric clinics opposed the idealistic direction of the psychological science of that time.

Especially a large number of experimental psychological research was carried out in the Clinic of Mental and Nervous Diseases of the Military Medical Academy under the direction of Vladimir Mikhailovich Bekhterev. The works of his staff and students were devoted to an experimental study of attention and mental performance in various mental illnesses.

V.M. Bekhterev emphasized that an experimental study of patients is necessary to supplement and deepen clinical observations, and together with S.D. Vladychko developed a number of fundamental guidelines and specific methodological techniques for the objective psychological study of the mentally ill. The number of methods used in the school of V.M. Bekhterev for the study of the mentally ill was very large. Among them, the verbal associative experiment, the methodology for defining and comparing concepts, the proofreading test, counting tasks for taking into account the dynamics of the patients' working capacity, etc., received the greatest use.

V.M. Bekhterev considered it mandatory that the methods used in the clinic should be previously tested on a large number of mentally healthy individuals of various education and age. Therefore, in almost all experimental works of the Bekhterev school, groups of healthy and mentally ill people, relatively homogeneous in terms of education, were studied. So, in the works of L.S. Pavel O vskoy was compared free associations, judgments and conclusions of healthy and suffering from paralytic dementia.

prominent role in determining the direction of Russian experimental psychology played by a student of V.M. ankylosing spondylitis Alexander Fyodorovich Lazursky.

According to A.F. Lazursky, psychology, like the natural sciences, must base all its conclusions on the study of concrete facts. Created by A.F. Lazursky psychological laboratory at the Psychoneurological Institute, founded by V.M. Bekhterev, has become one of the most important centers of Russian scientific psychology.

In the experimental and methodological field of A.F. Lazursky was an innovator: he pushed the boundaries of the experiment in psychology, applying it in ordinary conditions. Everyday life, and made the subject of experimental research specific forms of activity and complex manifestations of personality.

Lazursky proposed a system of experimental techniques, which were called "natural experiment", when the subject should not suspect that experiments are being carried out on him. The method of "natural experiment" occupies, as it were, an intermediate place between observation and classical experiment. At first, these techniques were applied to children, and then they were transferred to a psychiatric clinic.

In the study by the method of natural experiment, the conditions in which the activity under study takes place are affected, while the activity of the subject is observed in its natural course. For example, it is preliminarily established in which game this or that trait of the child's character is most clearly manifested. Then, in order to study the manifestation of the trait in different children, the latter are involved in a similar game. During the game, the researcher observed the manifestation of this particular character trait in children. The path of research went from simple observation to the creation of an experimental situation - an experimental lesson or game.

The second center in which clinical psychology developed was the psychiatric clinic. Sergei Sergeevich Korsakov in Moscow. Since 1886, the second psychological laboratory in Russia was organized in this clinic, which was headed by A.A. Tokarsky.

Like all representatives of progressive trends in psychiatry, S.S. Korsakov was of the opinion that knowledge of the foundations of psychological science makes it possible to correctly understand the disintegration of the mental activity of a mentally ill person; it was no coincidence that he began reading the course of psychiatry with a presentation of the foundations of psychology. Similar traditions were followed by the followers of S.S. Korsakov - V.P. Serbian, A.N. Bernstein and others.

In the works published by S.S. Korsakov, contains provisions that make a valuable contribution to the theory of psychological science. Works by S.S. Korsakov and A.A. Tokarsky is led to the idea that disorders of the intellectual activity of patients are not reduced to the disintegration of individual abilities, but that we are talking about complex forms of violations of all purposeful mental activity.

In 1911 a book was published Alexander Nikolaevich Bernstein devoted to the description of methods of experimental psychological research; in the same year F.G. Rybakov published his Atlas of the Psychological Study of Personality.

It should be emphasized that the leading psychiatrists and neuropathologists of that time, such as S.S. Korsakov, V.M. Bekhterev, V.P. Serbian, G.I. Rossolimo, A.N. Bernstein, were themselves the conductors of the advanced ideas of psychology and contributed to the development of psychology in the scientific and organizational direction.

An important role in the development of pathopsychology as a certain field of knowledge was played by the ideas of the outstanding Soviet psychologist Lev Semenovich Vygotsky, namely its provisions that:

1. the human brain has different principles of organization of function than the animal brain;
2. the development of higher mental functions is not predetermined by the morphological structure of the brain alone; mental processes do not arise as a result of the mere maturation of brain structures, they are formed in vivo as a result of training, education and appropriation of the experience of mankind;
3. lesions of the same areas of the cortex have different meaning on different stages mental development.

It should be noted that L.S. Vygotsky used the data of pathopsychological research to build his theory of higher mental functions.

Intensive experimental psychological research was carried out at the Leningrad Institute of the Brain. V.M. Bekhterev for several decades under the leadership Vladimir Nikolaevich Myasishchev

Techniques for objective registration of the emotional components of a person's mental activity were developed (the electrocutaneous characteristic of a person, recorded with a galvanometer, was used as an objective indicator).

This laboratory produced works devoted to the peculiarities of the intellectual activity of patients with brain injuries, the characteristics of mental activity and the ability to work in patients with epilepsy and schizophrenia.

The significance of this cycle of works goes beyond their narrowly expert application. Analyzing disability, employees paid much attention to the study of various forms of mental activity.

During the Great Patriotic War, pathopsychologists got involved in rehabilitation work in neurosurgical hospitals. The subject of pathopsychological research is mental disorders caused by brain injuries and their recovery.

On present stage development of science, domestic pathopsychologists are actively developing a number of the most important theoretical and applied problems of this field of knowledge.

One of the leading problems in the field of pathopsychology is the problem of the decay of cognitive activity. Work in this area is carried out in different directions:

Changes in the personality component in the structure of disorders of cognitive processes are being studied (the laboratory of the Moscow Institute of Psychiatry and the laboratory of pathopsychology of the Faculty of Psychology of Moscow State University),

The question of the connection between violations of cognitive processes and the process of updating knowledge is being developed (laboratory of the Institute of Psychiatry of the Academy of Medical Sciences).

Another line of research is aimed at the psychological analysis of personality disorders observed in a psychiatric clinic.

By changing the mental activity of a person, the disease leads to various forms of pathology of personality traits. In the psychiatric literature, there are exceptionally vivid and truthful descriptions of personality disorders characteristic of various diseases and conditions. However, the analysis of these violations is carried out mainly in terms of everyday or outdated empirical psychology. Therefore, the analysis of personality shifts in terms of modern psychology is currently one of the most promising tasks. These studies are needed not only in psychiatric practice, they are also useful for resolving theoretical issues of personality psychology.

3 . Practical tasks of pathopsychology

The applied value of pathopsychology is extremely significant. Practical tasks The challenges facing pathopsychological research are varied. First of all, the data of a psychological experiment can be used to differential diagnostic purposes . Of course, the establishment of a diagnosis is the business of a doctor; it is made on the basis of a comprehensive clinical study. However, experimental data have been accumulated in psychological laboratories that characterize disturbances in mental processes in various forms of diseases that serve additional material when establishing a diagnosis.

For example, in the clinical assessment of the mental state of the patient, it often becomes necessary to delimit the asthenic state of an organic nature from the state of schizophrenic lethargy. The slowness of mental processes, poor memorization and reproduction of the material presented - all this is found more often in organic disease, while the inactivity of the patient, accompanied by inconsistency of judgments and diversity of thinking in good memory, more often it is an indicator of changes in the personality of a patient with schizophrenia.

Before a psychological experiment, the task can be set defect structure analysis, establishing the degree of mental disorders of the patient, his intellectual decline, regardless of the differential diagnostic task, for example, when establishing the quality of remission, taking into account the effectiveness of treatment.

At present, when a large number of new therapeutic agents are being introduced into clinical practice, the use of adequate psychological research helps to determine effectiveness of therapeutic effects . In these cases, repeated examination of the patient with the same set of techniques makes it possible to establish the dynamics of changes in the psyche under the influence of treatment and thus demonstrate its effectiveness.

In the last decade, pathopsychology has become increasingly used to solve two more problems.

First, it is the participation of a psychologist in rehabilitation activities during which special attention is paid to revealing the preserved aspects of the psyche and the personality of the patient, as well as the study of the nature of his relations in the social environment, labor or educational settings. The purpose of such a study is development of recommendations, contributing to labor and social patient rehabilitation .

Secondly, independent task psychologist in a psychiatric clinic becomes his participation in the system of psychotherapeutic measures .

Especially great importance acquire data from experimental pathopsychology when solving issues psychiatric examination: labor, judicial and military.

The tasks that the forensic psychiatric examination poses to the psychologist are varied and complex. Often the task is to distinguish between true painful manifestations and their simulation.

When conducting a labor examination, it is necessary to take into account the correlation of the results of the study with the requirements of the patient's profession. The question is not only about restoring reduced performance, but also about preventing such a decrease.

A special place is occupied by the use of a pathopsychological experiment in a psychiatric clinic for children. Along with the task of differential diagnosis, establishing the degree of decrease and taking into account the effectiveness of treatment, there is a specific question for a child psychiatric clinic about predicting learning and the related issue of selecting children for special schools.

Especially valuable in this regard is the dynamic tracking of children, it makes it possible to analyze the prognostic assessments of the child's learning ability given by the pathopsychologist. Also in the pediatric clinic, a large corrective work to restore both individual impaired functions and impaired development as a whole.

The dynamics of the development of modern society is such that it makes increased demands on the endurance of the central nervous system: urbanization is growing, leading to congestion of people, communication between people is changing, and sometimes it becomes difficult, new professions appear that require great mental stress, are violated Natural resources. All this leads to the fact that the problem of protecting mental health comes to the fore, which is what the pathopsychologist's work is aimed at.

1. 4. Methods of pathopsychology and principles of pathopsychological research.

Consider the methods of pathopsychological research.

Pathopsychology, like any other branch of psychology, relies on a system of methods that has developed in modern psychological science. However, the nature of the tasks facing it and the features of the subject of research determine the specifics of the choice of methods and techniques used, the technology of their application. The pathopsychological study is complex, since its purpose is to identify not individual components, but the integral structure of the mental activity of mentally ill people.

The main method of pathopsychology, according to domestic pathopsychologists (B. V. Zeigarnik, S. Ya. Rubinshtein, V. V. Lebedinsky, etc.), is experiment, and observation, conversation, analysis of products of activity, analysis of the life history of a sick person, comparison of experimental data with the life history are used as additional ones. Recently, psychodiagnostic methods and techniques (tests, projective methods, questionnaires) are also actively used in pathopsychology (or rather, clinical psychology).

Among the methods used for pathopsychological research, one can single out quantitative and qualitative, standardized and non-standardized.

Methods quantitative measurement are still leading in the work of many psychologists abroad working in the field of psychiatry, but they do not allow predicting the further development of mental processes. When examining patients with methods aimed at dimension functions, neither the features of mental activity, nor the qualitative side of the violation, nor the possibility of compensation, the analysis of which is so necessary in resolving clinical problems, especially psycho-corrective ones, can be taken into account.

By measuring, only the final results of the work are revealed, its very process, the attitude of the subject to the task, the motives that prompted the subject to choose one or another mode of action, personal attitudes, desires, in a word, all the variety of qualitative features of the subject's activity cannot be detected.

One of the basic principles of the pathopsychological experiment is systemic qualitative analysis researched disorders of mental activity. This principle is due to the theoretical provisions of general psychology.

Based on the thesis of K. Marx that "people are the products of circumstances and upbringing, that, consequently, changed people are products of other circumstances and changed upbringing ...", Soviet psychologists (L. S. Vygotsky, A. N. Leontiev, P Ya. Galperin, B. G. Ananiev, V. N. Myasishchev) showed that mental processes are formed in vivo according to the mechanism of appropriation of universal human experience in the process of the subject’s activity, his communication with other people. That's why pathopsychological experiment is not aimed at the study and measurement of individual processes; but on the study of a person performing a real activity. It is aimed at qualitative analysis of various forms of the disintegration of the psyche, the disclosure of the mechanisms of disturbed activity and the possibility of its restoration.

non-standardized methods of pathopsychological research are aimed at determining specific disorders of mental activity and are compiled individually for each patient. Within this large group, various subgroups are distinguished depending on the principle of grouping methods, so, depending on the studied mental processes, the following are distinguished:

1. Methods for the analysis of sensations.
2. Perception analysis methods.
3. Methods for measuring the time of mental processes.
4. Replay analysis methods:
   1. simple reproductions,
   2. complex presentations.
   3. Methods of analysis of complex mental acts.

Consider the methods directly used in the pathopsychological diagnosis of mental disorders:

1) the method of "formation of artificial concepts", developed by Lev Semenovich Vygotsky to identify the features conceptual thinking with various mental illnesses, primarily with 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" for the study of thinking;

4) Bourdon's "correction tests" method and Schulte's "black-and-red numerical tables" method (for the study of attention and memory), as well as the methods of Kraepelin and Ebbinghaus (for the study of short-term memory);

5) the method of "unfinished sentences";

6) the method of "paired profiles";

7) thematic apperceptive test (TAT), etc. 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 diagnostic methods are more widely used in foreign clinical psychology. In this case, specially selected tasks - tests - are presented in the same form to each subject. However, these methods are not connected with the study of the structure of mental processes themselves. They are aimed only at establishing and determining the severity of certain properties of the psyche. This group of methods has all the shortcomings described above when considering methods for the quantitative measurement of psychological phenomena.

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.

Bluma 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.

Construction of a pathopsychological study

Before conducting research, medical history study:

1. To establish psychological contact.
2. To avoid additional psychotrauma.
3. To clarify the tasks of psychodiagnostic research.

Disease history:

1. Anamnesis - the history of the patient's life (according to the subject, relatives, acquaintances, etc.).
2. Psychological status - the attending physician describes the clinical symptoms, as well as his assumptions about the leading psychopathological syndrome.
3. Data from an objective study (neuropathologist, etc.).

Principles of pathopsychological research

1. Organization of research by type functional test. This principle was taken from medicine - in order to see the work of an organ, it is necessary to give it a certain functional load. By analogy, certain (reproducible and controlled) situations are modeled in a pathopsychological study, during which changes of certain aspects of mental activity that are of interest to the experimenter appear. For example, the "fourth extra" method models the activity associated with the selection of essential features of objects and their generalization, which allows us to evaluate the ability to abstraction and abstraction.

2. Mandatory accounting personal relationship the subject to the research situation, reactions to his own mistakes, to the result, comments from the psychologist. In general, the situation of success and failure. Reactions to the researcher.

3. Mandatory qualitative analysis research results:

• evaluation of instruction perception;
• organization of activities for initial stage(whether the subject quickly learns tasks);
• when, what and where mistakes are made. The criticality of the subject and the use of assistance by him.
• the reactions of the subject to the evaluations of the experimenter. Whether the person himself is interested in the results of the study.

1. 4. Quantitative analysis.

This method has already been discussed above, so we will focus on two important points when applying them:

1. even with a single study, it is necessary to use several methods aimed at studying one function;
2. in pathopsychological work, it is desirable to conduct repeated studies.

An important step in pathopsychological research is conversation.

1. Introductory: complaints of the subject, the level of criticality, etc. We develop a strategy of personal behavior.
2. Accompanying: carried out during testing.

The final stage. Results, evaluation of work, recommendations.

Let us dwell in more detail on such an important point of the study as conversation of a pathopsychologist with a subject and observation of his behavior during the study.

Above, we said that the pathopsychological study also includes a conversation with the subject, which is often called "directed", "clinical".

Conversation consists of two parts. First part It is a conversation, in the narrow sense of the word. The experimenter talks to the patient without doing any experiment yet. The interview can take place before or after experimental work.

Second part conversations are conversations during an experiment, because an experiment is always communication with the patient. Communication can be verbal, i.e. the experimenter says something to him, indicates, prompts, praises or, on the contrary, condemns. But this "conversation" may not be on a verbal plane, but with his facial expressions the experimenter shows the patient whether he is doing well or badly; As in real life, you can shrug your shoulders, raise your eyebrows, you can look in surprise, smile, frown, i.e. depending on the circumstances (this is also a type of communication).

Let us dwell on those issues that relate to the conversation in a narrower sense. First of all, conversation cannot be held "in general". It always depends on the task at hand. Further, always in your conversation, you should take into account the attitude of the subject to the situation of the experiment, to the experimenter, as well as the well-being and emotional state of the subject at the time of the study.

Observation of the behavior of the subject during the study

An element of observation of the patient's behavior is always included in the situation of experiment and conversation. The experimenter must have time to "see" how the patient enters: confidently, uncertainly, how he sits down, how he looks at the experimenter. It is important to note how the subject takes the conversation, whether he is embarrassed or indignant, whether he blushed at the hint or assessment of the experimenter.

You should pay attention to whether the subject is distracted by extraneous stimuli. At the same time, the observation should be imperceptible to the subject.

All this should be noted in the protocol of the experimenter.

1. Subject and tasks of pathopsychology………..…..……………………………..4

2. Principles of organization and rules for conducting an experimental

pathopsychological research…………………………………………..6

3. Disturbances of consciousness…………………………………………….…………...13

4. Personality disorders…………………………………………………………...18

5. Disturbances of perception……………………………………………………....26

6. Memory disorders…….………………………………………………………..33

7. Violations of thinking…..…………………………………………………...37

8. Disorders of mental performance……………………………….55

9. Pathopsychology of neuroses. Psychopathies……….…………………………...58

10. Pathopsychology of psychosomatosis…..…………..….………………………..73

11. The value of pathopsychological research for theoretical and

methodological issues of psychology .............................................................. ......77

12. Pathopsychological syndromes…………………………………………….....81

13.Questions for the exam……………..…………………………………………...84

14. References………….………………………………………………….85

SUBJECT AND OBJECTIVES OF PATHOPSYCHOLOGY

Pathopsychology is an applied branch of psychological science and, as a psychological discipline, proceeds from the patterns of development and structure of the psyche in the norm. Pathopsychology is not only an applied branch of psychological science. This is an interdisciplinary, integrative field of knowledge about a person, bordering on medicine and sociology, in particular.

When conducting systemic research within the framework of pathopsychology, special attention should be paid to the fact that not so much different aspects of any phenomena (for example, cognitive processes) are studied, but the main factor that makes it possible to study the integrity of this system is singled out. Such an integral factor for pathopsychology is the analysis of the activity of a sick person in real life. life situation. Therefore, pathopsychological research is always aimed at a real person in his inextricable relationship with the social environment.

Subject pathopsychology is the psyche of mentally and somatically ill people, while studying the patterns of decay of mental activity and personality traits in comparison with the patterns of formation and flow of mental processes in the norm. In general, within the framework of pathopsychology, the patterns of distortions of the reflective activity of the brain are studied.

Despite the fact that pathopsychology is very close in its subject matter to psychiatry, there is a fundamental difference between these branches of knowledge about a person. Given difference manifests itself, first of all, in the fact that psychiatry, like any branch of medicine, is aimed primarily at clarifying the causes of mental illness, at studying the syndromes and symptoms typical for a particular disease, the patterns of their manifestation and alternation, at analyzing criteria for the prognosis of the disease, for the treatment and prevention of mental illness.

Practical tasks The challenges facing pathopsychological research are extremely diverse.

1. Differential diagnostic task: experimental data characterizing disturbances of mental processes in various forms of the disease serve as additional material for making a diagnosis.

2. Analysis of the structure of a mental defect, establishing the degree of mental disorders in a patient, his intellectual decline, regardless of the differential diagnostic task (for example, when assessing the quality of remission, when analyzing the effectiveness of treatment).

3. Definition the nature of the action of therapeutic agents(for example, studying the effectiveness of the use of medicines for the relief of certain symptoms and syndromes) .

4. Psychoprophylactic tasks: issues of professional selection and professional hygiene (psychological state, performance, personal characteristics of a person, upcoming activities may be associated with significant neuropsychic stress, including the problem of professional deformation of the personality).

5. Problem solving psychiatric examination(judicial, military, professional).

6. Substantiation of psychological recommendations for psychological correction ( focus on psychocorrection). Effective psychological correction must be based on an in-depth analysis and qualification of the mental state of a sick person. The work of a pathopsychologist should be aimed not only at qualifying one or another violation of the cognitive or motivational sphere or characterizing an altered self-esteem, the level of claims of the patient, but also at assessing its potential, the disclosure of which will lead to an improvement in the patient's mental state, i.e. focus not only on establishing the presence of a particular disorder, but also on qualifying the hidden, potential possibilities of the patient's personality - what L.S. Vygotsky called "social development".

7. Specific tasks of child pathopsychology: along with the tasks of differential diagnosis, establishing the degree of decrease and taking into account the effectiveness of treatment, the issue of predicting learning ability and the related issue of selecting children for specialized educational institutions are among the features of child pathopsychology.

Particularly valuable in this regard is the dynamic tracking of children, which opens up the possibility of analyzing data on the forecast of a child's learning and comprehending those theoretical principles on which the prediction was based.

However, the tasks of pathopsychological work in the clinic of childhood are not limited to the search for criteria for diagnosis and learning. A lot of psycho-correctional work is being done in this area. It concerns both the restoration of individual damaged mental functions, and the correction of impaired development of children in general. The most important task is the correction and prevention of problematic development of children.

So, the most important characteristic of pathopsychology at the present stage is the focus on restoring altered mental activity, on returning a sick person to his social status, preventing (preventing) the possibility of such a loss in children and adults, correcting and preventing abnormal development in children, i.e. to mental health in general.

The main trends in modern pathopsychology include:

1. in-depth systematic analysis of the mental state of the patient;

3. individual nature of research and correction.

2. PRINCIPLES OF ORGANIZATION AND RULES OF EXPERIMENTAL CLINICAL PATHOPSYCHOLOGICAL STUDY

Pathopsychological research includes a number of components (stages):

1. setting the goal of the study by the doctor with specification of its tasks;

2. conversation with relatives and friends of the patient;

3. analysis of the history of life and illness of the patient (study of the anamnesis of life and illness according to medical records);

4. conversation with the patient (with the most important goal - establishing contact);

5. conducting the actual pathopsychological experiment (the structure and set of methods of which are related to the task of the study);

6. observation of the patient's behavior and conversation with him during the study;

7. comparison of experimental data with the history of life and illness of the patient;

8. drawing up a conclusion and discussing it with a doctor;

9. communication to the patient of psychodiagnostic information;

10.determining, together with the doctor, ways of psychological correction.

Principles of constructing a pathopsychological experiment.

The pathopsychological conclusion is based on the results of observation, verified by experiment. To study a phenomenon means to determine its constituent parts, its general properties And characteristics; the causes that cause it, and the consequences that are conditioned by it, - therefore, bring it into full connection with the rest, already verified facts; so experiment is crucial here.

At the same time, the patient's self-observation data can be a significant factor in the analysis of mental phenomena, representing a certain fact of mental life.

The pathopsychological experiment itself must be strictly thought out in advance: it is necessary to create certain conditions in order to obtain, isolate the phenomenon being studied. The experiment as a whole should give an explanatory characteristic, and not an establishment of a fact, explain the cause, determination human behavior of one or another psychic phenomenon.

It should be noted that in line with the method of quantitative measurement of individual mental functions, only the final results of the work are revealed, its very process, the attitude of the subject to the task, the motives that prompted the subject to choose one or another mode of action, personal attitudes, desires, in a word, the whole variety of qualitative features the subject's activity cannot be detected. Therefore, one of the basic principles of the pathopsychological experiment is system qualitative analysis researched disorders of mental activity.

A pathopsychological experiment should not be aimed at the study and measurement of individual mental processes, but at holistic study a person doing real work. As a result of the experiment, a qualitative analysis of various forms of the disintegration of the psyche should be carried out, the mechanisms of disturbed activity and the possibilities of its restoration should be revealed.

Taking into account the fact that any mental process has a certain dynamics and direction, it is necessary to construct experimental studies so that they reflect the safety or violation of these parameters. The results of the experiment should give not so much a quantitative as a qualitative characteristic of the disintegration of the psyche.

Based on the above, the main principle of constructing a pathopsychological experiment is the principle of a qualitative analysis of the features of the course of mental processes in a sick person as opposed to the task of only one quantitative measurement of them. It is important not only what difficulty or what volume of the task the patient completed, but also how he did it, what caused his mistakes and difficulties.

Error Analysis, arising in patients in the process of performing experimental tasks, is indicative material for assessing one or another violation of their mental activity.

It should be noted that the same pathopsychological symptom can be an indicator of various pathological conditions and be caused by different mechanisms. For example, a violation of mediated memory or instability of judgments may arise due to pathological changes in the patient's mental performance (as is the case with asthenia of organic origin). The same disturbances can be caused both by insufficient purposefulness of motives (for example, in lesions of the frontal parts of the brain), and serve as a manifestation of deautomatization of actions (with vascular changes in the brain, epilepsy).

The nature of mental disorders, as a rule, is not pathognomonic, i.e. specific for a particular disease or form of its course; he is only typical of them and should be appreciated in combination with the data of a holistic pathopsychological study.

Psychological research in the clinic can be equated to "functional trial"- a method widely used in medical practice and consisting in testing the activity of a functional system. In the situation of a pathopsychological experiment, the role of a “functional test” can be played by those experimental tasks that are able to actualize the mental operations that a person uses in his life, to reveal his motives that encourage this activity.

A pathopsychological experiment should update not only the mental operations of the patient, but also his personal attitude. Pathopsychological phenomena can only be understood on the basis of taking into account a person's attitude to work, his motives and goals, attitudes and requirements to himself, to the result of work, etc.

Such an approach, in general, requires deep knowledge and careful study of personality psychology and is dictated by a correct understanding of the determination of mental activity. Speaking about the mechanisms of mental determination, S.L. Rubinstein emphasized that external conditions by themselves do not yet directly determine the behavior and actions of a person, that the cause acts through "internal conditions". This means that judgments, actions, actions of a person are not a direct reaction to external stimuli, but that they mediated his attitudes, motives, needs. These attitudes are formed in vivo under the influence of education and training, and, having formed, they themselves determine the actions and deeds of a person, healthy and sick.

Relationships are inextricably linked to structure of his personality, with his needs, emotional and volitional characteristics. In the needs of a person, material and spiritual, his connection with the outside world, people is expressed. Evaluating a person, we, first of all, characterize the range of his interests, the content of his needs. We judge a person by the motives of his actions, by what he rejoices at, what his thoughts and desires are directed to.

Pathological personality change It is manifested by the fact that under the influence of the disease, a person’s interests become scarce, needs become smaller, an indifferent attitude to what he used to worry about is manifested, his actions lose their purposefulness, actions become inadequate. A sick person ceases to consciously regulate his behavior, is unable to adequately assess his capabilities, his attitude towards himself and the environment changes pathologically.

It must be remembered that a pathopsychological experiment is essentially mutual activity, mutual communication between the experimenter and the subject. Therefore, its construction cannot be rigid. No matter how tough the instruction, often the look of the experimenter, his facial expressions can change the situation of the experiment, the attitude of the patient. In other words, a qualitative analysis is necessary because the situation of a pathopsychological experiment is a segment of real life. That is why the data of pathopsychological research can be used in solving real issues related to the fate of specific people.

We should dwell on one more feature of the pathopsychological experiment. Its construction should make it possible to reveal not only the structure of altered mental processes, but also to evaluate the remaining intact forms of the patient's mental activity. The need for such an approach is important in addressing issues restoration of impaired functions.

In order for a pathopsychological experiment to be able to reveal the preserved links of the patient's altered mental activity, it must be aimed not only at assessing the productive side of his activity, not only at analyzing the final product. The design of the experiment should reflect the nature of the search for solutions the patient, to allow the experimenter to intervene in the “strategy” of the experiment in order to find out how the patient perceives the “help” of the experimenter, whether he can adequately use it.

Pathopsychological research is diverse, big amount applied methods. This is explained as follows. The process of disintegration of the psyche does not occur one-dimensionally. It practically never happens that in one patient only the processes of synthesis and analysis are violated, while in another, only the purposefulness of the personality suffers. When performing any experimental task, one can to a certain extent judge various forms of mental disorders. However, despite this, not every methodological technique makes it possible to judge one or another form or degree of violation with equal clarity, clarity and reliability.

Since in a situation with a sick person, the entire course of the experiment often changes of necessity (if only because the patient's condition changes), a comparison of the results of various variants of experimental methods becomes mandatory.

Such a comparison is also necessary for other reasons. Performing this or that task, the patient not only solves it correctly or erroneously; solving a task often causes awareness of one's defect; patients seek to find an opportunity to compensate for it, to find strong points for correcting the defect. Different tasks provide different opportunities for this.

It should be noted that the violation of the mental activity of the patient is often unstable. When the patient's condition improves, some changes in his mental activity disappear, while others remain resistant. In this case, the nature of the detected violations may vary depending on the characteristics of the experimental technique itself. Comparison of the results of various variants of any diagnostic method, repeatedly used, gives the right to judge the nature, quality, dynamics of disorders of mental processes and the patient's personality traits.

It is quite obvious that in the study of the disintegration of the psyche one should not confine oneself to any one method, but should apply a set of methodological techniques.

The focus of pathopsychological research on the disclosure of the qualitative characteristics of mental disorders is of particular necessity. in the study of children with developmental anomalies. With any degree of mental underdevelopment or disease, there is always a further (albeit slow or distorted) development of the child. Psychological experiment should not be limited to establishing the structure of the mental processes of a sick child; he must reveal, first of all, his preserved potentialities.

Another feature of pathopsychological research should be taken into account. Performing experimental tasks has for different patients different meaning. For example, in some subjects, experimental tasks evoke a cognitive motive, other subjects perform tasks out of courtesy to the experimenter (the so-called “business subjects”), and still others are addicted to decision processes (“naive subjects”). Relation to the experiment depends on the attitude of the patient to the fact of stationing, on his attitude to the experimenter himself. It should also be taken into account that a pathopsychological study inevitably means for the patient a situation of some "expertise".

In connection with the foregoing, the pathopsychologist has to operate in his conclusion with a system of concepts that characterize the patient's personality as a whole (his motives, purposefulness, self-esteem, etc.). However, this does not exclude the rejection of the characterization of individual processes. But this characteristic should be deepened by an analysis of the general condition of the patient. We can say that the pathopsychological experiment is aimed not only at analyzing individual symptoms, but also at identifying pathopsychological syndromes.

Also important is the question interpretations received data, which is based on one or another theoretical concept. For example, a patient has a poor memory: this can be regarded as the result of cognitive impairment due to vascular diseases, but it can also serve as a manifestation of a decrease in motivational activity, as occurs in patients with schizophrenia. Therefore, a qualitative interpretation can only be carried out on the basis of a system analysis.

Summarizing the above, it should be noted once again that the real segment of activity presented to the subject in the course of a pathopsychological study, the experimenter's remarks cause an equally real experience and a certain emotional state in the patient. In other words, pathopsychological research reveals the real layer of his life. That's why research program cannot be fundamentally uniform, standard, it depends on the clinical task. For example, if it is necessary to differentiate schizophrenia from schizophrenia-like pictures in organic diseases of the central nervous system, the main attention will be paid to identifying the features of thinking disorders (by the method of “classifying objects”, “pictograms”, comparing concepts), on the one hand, as well as characterizing mental performance (samples “to combine”, “search for numbers”, etc.) - on the other.

A psychologist's conversation with the patient and observation of his behavior during the study.

The conversation between the psychologist and the subject can be conditionally divided into two parts. The first part is conversation, in the narrow sense of this word, in the process of her experimenter talks to the patient, without conducting any experiment yet, in order to establish contact.

The second part of the conversation is conversation during the experiment, i.e. communication with the patient during the study. Communication can be verbal - when the experimenter says something to the patient, indicates, prompts, praises or, conversely, condemns. But communication can also be non-verbal, when the experimenter shows the patient with his facial expressions whether he performs the task well or badly; as in real life, you can shrug your shoulders, raise your eyebrows, you can look in surprise, smile, frown, etc.

In the beginning, let us dwell on those issues that relate to the conversation in a narrower sense. First of all, the conversation always depends on task, which is set mostly by the attending physician. The doctor asks to see experimentally such and such a patient, when, for example, the diagnosis is not clear to him. Or, on the contrary, the patient is in the hospital for examination: labor, military, judicial. Or the doctor wants to know what the effectiveness of the use of psychopharmacological drugs that this patient is taking.

Thus, the doctor puts before a psychologist practical task. According to this task, an experiment is carried out, i.e. the psychologist chooses the strategy of his actions and conversations depending on the task that was set before him. Before the interview, the psychologist should study the patient's medical history well.

After reading the case history, finding out who is sitting in front of him, the psychologist decides “why he will conduct the experiment”, and, in particular, conduct a “narrow conversation”. It should be emphasized that during the conversation the questions of the doctor should not be repeated, i.e. you should not ask such questions that the doctor has previously asked and which are reflected in the medical history.

The psychologist should not collect the medical history reflected in the documentation. It is necessary to approach the issue of the current state of the patient very subtly. The psychologist must be able to do this not directly, but, as it were, in a “roundabout” way. But the most important thing is to always know and remember why this patient was sent to you. This applies not only to a sick person, but also to conversations that a psychologist conducts with a normal, healthy person to study, for example, logical abilities.

Further, always in your conversation, you should take into account the attitude of the patient to the situation of the experiment, to you as an experimenter. Need to know premorbid features patient, i.e. the features that were this person before his illness.

The psychologist must try to win the patient's trust. It is very important how the patient relates to the very fact of the experiment.

After all, the fact is that even before you conduct an experiment, he knows what you will show him (in his opinion, these are some kind of “toys”), that he will draw, answer some questions ( other patients told him, because it spreads very quickly). And he can be very dismissive and distrustful of both the experiment and the experimenter: “We know your toys. It doesn't give you anything." In this case, you must be able to convince the patient that it only looks like toys, that these are tasks that require mental stress, the mobilization of creative thinking.

The psychologist should be able to prove to the subject that all these “toys” that are shown to him, all these pictures like the “classification of objects” or thematic apperception test, the Rorschach test (which seem to him to be toys) require great skill. After all, the patient sometimes really comes in an antagonistic mood, and sometimes, on the contrary, with a desire to test his abilities.

It often happens that patients only during the experiment for the first time learn about the shortcomings of their memory, their thinking. Often they work quite seriously together with the experimenter, and this is felt during the conversation.

In most cases, the patient understands that the experiment that will be carried out is related to the diagnosis, to the specification of the extract, to the choice of drugs. And if sometimes the patient does not understand, then you can tell him that “indeed, what we will do with you is a serious matter.”

One should absolutely seriously, with full respect for the personality of the patient, although a deeply mentally ill person may be sitting in front of us. This is especially true for neurotics. Patients with neurosis are very emotionally sensitive people. They are completely occupied with their experiences and only a correct and absolutely serious attitude towards the patient guarantees success in the conversation.

It is necessary to explain to the patient that the study is one of the private moments of his life, that it will not only not harm him, but will be of great importance for him in the future.

Thus, both the conversation and the experiment must contain elements of psychocorrection. For example, if a patient solves problems poorly (this conversation should take place at the end of the experiment), then you need to talk with him and say that he made such and such mistakes, but, in general, there were not very many of them. Or, if the patient did not solve the problem well or did not solve it at all, you need to pretend that he completed it, but only used your hint, and this is natural. This also happens in healthy people. You can tell him some figures that so many percent of healthy people do not solve immediately, but decide only after the third or fifth attempt.

Elements of psychotherapeutic techniques should always be present in communication with the patient. If you are sitting in front of a depressed patient who is disappointed in himself, who has low self-esteem, self-esteem, then you should have a conversation after the experiment.

This psychotherapeutic nuance of the conversation should come out especially clearly in conversations with patients with severe somatic diseases, say, cancerous, cardiovascular. When a patient learns that she has a serious, life-threatening disease, say, breast cancer, then she has only one motive, one goal - to survive. But the patient underwent surgery, she survived. She was told that she did not have a malignant tumor, but nevertheless she was registered. Her fear of death passed, and another problem arose: how would her husband react to the fact that she had changed physically? Conversations with such patients should have a pronounced psycho-corrective component.

The most important thing in this conversation is the ability to show the patient that the matter is not only in the doctor and not only in medicines, but also in himself, that he himself, with his behavior, his attitude, doing what is required of him, helps treatment.

The second part of the conversation is, as noted earlier, a conversation or communication with the patient during the experiment.

An experiment is always some "expertise" And not just for the sick person. If a healthy person participates as a test subject in a situation where perception, reaction speed are examined, the nuance of “expertise” exists. A person has a question: “Did I cope with the task or did I not cope?” This point is very important to consider.

The behavior of the experimenter depends on the behavior of the subject and on what needs to be learned about this subject. The patient's reaction to the experimenter's prompts, to his facial expressions - all this should be reflected in the protocol, since these data are compared, if we are talking about a sick person, with the data that are in the medical history, and with the data obtained during the experiment.

The situation of experiment and conversation always includes observation element for the behavior of the patient. The experimenter should see how the patient enters: confidently, uncertainly, how he sits down, how he looks at the experimenter. The experimental situation is a joint work of the patient and the experimenter, so it is important to note how the patient takes part in the conversation, whether he is embarrassed or indignant, whether he blushed at the hint or assessment of the experimenter. You should pay attention to whether the patient is distracted by an extraneous stimulus. At the same time, observation should not be intrusive and be invisible to the patient. Observation is also carried out during the experiment. It is important to note how the patient begins to complete the task, for example, when correlating phrases to a proverb. It should be noted that he considered various options sayings and phrases, or impulsively refers the first phrase that comes across to him to a proverb. All this should be entered into the protocol of the experimenter.

DISTURBANCES OF CONSCIOUSNESS

The concept of consciousness in psychiatry does not coincide with its philosophical and psychological content.

From the point of view of the psychiatrist A.V. Snezhnevsky - “if we approach consciousness in a philosophical sense, then we naturally must say that with any mental illness highest form the reflection of the world in our brain is disrupted.”

Therefore, clinicians use the conditional term of impaired consciousness, meaning the special forms of its disorder.

Consciousness is considered as a background against which there is a change of various mental phenomena.(K. Jaspers). Accordingly, in mental illness, consciousness can be disturbed independently of other forms of mental activity, and vice versa.

Disturbances of consciousness from a clinical point of view can be divided into two types:

1. clouding of consciousness;

2. increased clarity of consciousness (hyperwakefulness).

clouding of consciousness they call such a disorder in which the reflection of the real world is disturbed not only in its internal connections (abstract cognition), but also in external ones (sensory cognition), the direct reflection of objects and phenomena is upset; this is a transient disorder that occurs with mental illness requiring emergency medical care.

General signs of clouding of consciousness according to K. Jaspers:

1. Detachment from the real world, expressed in the indistinct perception of the environment, the difficulty of fixing or the complete impossibility of perception; at the same time, reality is reflected only in the form of separate incoherent fragments.

2. disorientation in time, place, surrounding persons, situation.

3. Violation of thought processes in the form of incoherence with the weakening or complete impossibility of forming judgments.

4. Difficulty remembering ongoing events and subjective painful phenomena (memories of the period of obscuration of consciousness are fragmentary or completely absent).

When diagnosing the state of stupefaction, it is necessary to establish totality all of the above symptoms. The presence of one or more symptoms does not yet indicate clouding of consciousness. So, detachment from the real world happens not only with clouding of consciousness, but also with apathy, autism. Disorientation in time, situation, place and surrounding persons occurs, in addition to stupefaction, with amnesia, some forms of delirium, apathy. The weakening of thinking, its incoherence are noted not only in clouding of consciousness, but also in other conditions, for example, in intellectual insufficiency. There are the following confusion syndromes.

Stun

most often occurs in acute disorders of the central nervous system, infectious diseases, poisoning, craniocerebral trauma.

It is expressed in a sharp increase in sensitivity thresholds for all external stimuli, difficulty and slowdown in the formation of associations. At the same time, there is a slowdown in mental activity, "emptying" of consciousness; difficult perception and processing of impressions; the phenomena of the external world do not attract attention, are not noticed. Questions are not perceived immediately, the patient understands their meaning with great effort. Answers are pronounced with difficulty, are inaccurate, incomplete, sometimes inconsistent. The complex content of the question is not comprehended. The ability to memorize and recall is extremely weakened. All movements are slow, facial expressions are poor, the patient is silent, often indifferent, his gaze and facial expression are indifferent, he easily falls into a drowsiness, often he is constantly drowsy. Memories of the stun period are usually not retained.

When the condition worsens, the stun turns into sopor, precoma and coma.

Delirium

observed mainly in patients with organic disorders of the brain after injuries, infections, intoxications.

This syndrome, in contrast to stupor, in which there is an "impoverishment" of mental activity, the scarcity of associations, on the contrary, is characterized by an influx of vivid ideas, an abundance of figurative, continuously emerging visual memories. In this case, not just disorientation occurs, as with stunning, but a false orientation in the environment. Delirium is characterized by visual and verbal hallucinations, delirium. The mood is very changeable. There is either panic fear, or excited curiosity, or irritable capriciousness and tearfulness, or euphoria.

The patient is talkative, and his statements are fragmentary, extremely inconsistent and sometimes come down to separate cries. Facial expressions are tense, constantly changing, the look is either wandering or fixed. The patient is restless, often tends to run, and resists holding.

Hallucinations in delirium are scene-like. Patients become participants, reacting vividly and adequately to all ghostly events. They run away in fear, defend themselves, examine something with curiosity. Before them, images of the wandering dead, bandits, monsters, animals, insects emerge, demonstrations, murders, violence, battles take place, funeral processions take place. At the same time, the opposition of oneself to one's visions and the preservation of orientation in one's own personality are noted.

The depth of delirious stupefaction of consciousness is changeable. Delirium is usually interrupted by periods of clear consciousness. The patient recognizes the surroundings, the answers to questions become correct, he correctly assesses his condition, and shows a critical attitude to the visions that arise. In the evening and at night, the delirious stupefaction of consciousness intensifies. Memories of the delirious period are incomplete, often incoherent.

Oneiroid

Dreamlike, fantastically delusional clouding of consciousness, expressed in a bizarre mixture of fragments of the reflection of the real world and vivid fantastic representations (hallucinations) abundantly popping up in the mind.

The patient is completely detached from the environment, there is a deep disorder of self-consciousness (reincarnation), as well as dissociation between sequentially developing, as in a dream, fantastic events and external immobility or senseless excitement.