Pathopsychology arose at the intersection of psychology, psychopathology and psychiatry, which is the merit of such prominent domestic figures as B. V. Zeigarnik, Yu. F. Polyakov and others.
Pathopsychology as a psychological discipline proceeds from the patterns of development and structure of the psyche in the norm. She studies the patterns of decay mental activity and personality traits in comparison with the patterns of formation and course mental processes normally, it studies the patterns of distortions of the reflective activity of the brain. Consequently, despite the proximity of the objects of study, psychiatry and pathopsychology are different in their subject matter. 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". The problems and tasks that pathopsychology must solve with its own methods and in its concepts are replaced by problems that fall within the competence of psychiatrists themselves, which leads not only to inhibition of the development of pathopsychology, but also does not benefit psychiatry itself.
Pathopsychology, according to B. V. Zeigarnik, 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. The question of delimiting the subject of pathopsychology and psychopathology as a branch of psychiatry often remains debatable. This is inevitable, since both sciences deal with the same object - disorders of mental activity. As noted by V. M. Bleikher, psychopathology is not limited to pathological changes in the psyche. This is a science that not only describes the clinical manifestations of mental disorders, but also studies their mechanisms, including psychological ones.
Tasks of pathopsychology:
Analysis of the patterns of mental disorders, in particular changes in the personality of mental patients;
Psychological diagnostics of mental disorders of the patient to clarify the diagnosis, conduct labor, judicial, military examination.
The analysis of pathological changes is carried out on the basis of comparison with the nature of the formation and course of mental processes, states and personality traits in the norm.
Pathopsychology as an interdisciplinary field of knowledge: its connection with psychopathology and special psychology
Pathopsychology is closely related to such disciplines as psychiatry, psychopathology, neurology, psychopharmacology, physiology of higher nervous activity, psychophysiology, valeology, general psychology, psychodiagnostics, special psychology and pedagogy.
Relationship of pathopsychology with psychiatry. Psychiatry pays little attention to how mental processes proceed normally, in healthy people. The coinciding subject matter of psychiatry and pathopsychology is mental disorders. However, clinical psychology also deals with disorders that are not diseases (the so-called "borderline mental disorders"). In fact, modern psychiatry and pathopsychology differ not in the subject, but in the point of view on the same subject: psychiatry focuses on the morphofunctional (somatic) side of a mental disorder, while clinical psychology focuses on the specifics of the psychological reality that arises in mental disorders.
The connection of pathopsychology with psychopathology can be traced in a special area medical science- psychopathology. Both pathopsychology and psychopathology deal with the same object: disorders of mental activity. Therefore, there is an opinion that these disciplines coincide with one another and differ only in the point of view from which they consider sick people. B. V. Zeigarnik argued that pathopsychology (unlike psychopathology) studies the laws of the breakdown of mental activity in comparison with the laws of the formation and course of mental processes in the norm, while psychopathology allegedly studies only disturbed mental functions.
The connection between pathopsychology and neurology is manifested in the concept of psychoneural parallelism: each event in the mental sphere necessarily corresponds to a separate event at the level nervous system(not only central, but also peripheral).
The relationship of pathopsychology and psychopharmacology lies in the study of the latter psychological effects of drugs. This also includes the problem of the placebo effect in the development of new drug compounds.
The connection of pathopsychology with the physiology of higher nervous activity and psychophysiology is manifested in the search for correlations between pathopsychological processes and their physiological correlates.
The connection of pathopsychology with valeopsychology and psychohygiene lies in the joint determination of the factors that oppose the emergence of mental and somatic disorders, and the clarification of the criteria for mental health.
The connection of pathopsychology with special psychology and pedagogy is manifested in the search for ways to correct the problematic behavior of children and adolescents caused by impaired mental functioning or anomalies in personal development.
Recently, the sciences have ceased to have strict distinctions, today the names "biochemistry" and "biophysics" no longer surprise anyone, but it turns out that the process of erasing the boundaries has begun a long time ago. In the 1930s, at the junction of psychology and psychiatry, a new scientific discipline- pathopsychology. What is included in the sphere of interests of this science, we have to find out.
How did the science of pathopsychology appear?As a science, pathopsychology began its development in the 1930s, during the Second World War and the post-war period, when many people with war injuries appeared, whose mental functions needed to be restored. But science reaches rapid development by the 1970s. It was then that the foundations of domestic pathopsychology were outlined in the works of the first practical psychologists in our country. Finally, the disputes around the tasks, subject and place of pathopsychology ended by the 80s of the last century. Today there is a process of dividing science into separate areas, for example, today the direction of forensic pathopsychology has taken shape.
Subject and object of pathopsychology
Pathopsychology studies disorders of mental processes and states with the help of psychological methods. At the same time, an analysis of pathological changes is made on the basis of a comparison with the course and nature of the formation of mental processes and states in individuals whose mental indicators correspond to the norm. Based on the definition, we can say that pathopsychology is a practical branch of medical psychology, the subject of which is the study of the patterns of formation of psychopathologies, and as an object, anomalies and disorders of mental activity are considered, different in manifestations, but similar in severity, that is, bordering on normal ( healthy) states.
Author Zaporozhets N.N.
Introduction
Recently, mental health is one of the most common problems. Prevalence rates for mental health disorders are quite high. Psychiatric disorders can result in disability, which include a large number of chronic diseases. To conduct a study of mental processes, to consider their features and to study the structure of the personality sphere in a mental disorder, such a branch of science as pathopsychology helps.
Pathopsychology is one of the branches of psychological science that examines and studies changes in mental activity due to mental and somatic diseases. Pathopsychology has both practical and theoretical significance for disciplines such as psychiatry and medical psychology. It is associated with a number of practical tasks in psychiatry: differential diagnosis, revealing the structure and severity of disorders, dynamic monitoring of changes in mental disorders due to drug treatment and psychotherapy.
The study of mental processes and the characteristics of their disorders helps to consider the structure and formation of human mental activity. The results of pathopsychological examinations have great importance to interpret the human psyche.
Thus, conducting a pathopsychological study is a help in establishing a diagnosis, it helps in identifying disorders in thinking, personal sphere, mental performance, and also determines preserved mental functions, which become the basis for corrective and rehabilitation measures.
CHAPTER 1 Pathopsychology as a science of mental disorders.
1. The concept of pathopsychology. Goals and objectives of pathopsychology
Recently, one can note the relevance of the existence and development of interdisciplinary areas of science. The formation of interdisciplinary spheres is also noted in psychology. The concept of pathopsychology reflects the branch of psychological science as an applied field of knowledge.
Pathopsychology (from the Greek "pathos" - illness or suffering) is a branch of medical psychology that studies the patterns of decay of mental activity and personal properties in relation to the patterns of development, formation and course of mental processes in the norm.
Pathopsychology relies on the structure and patterns of development of the psyche. In pathopsychology, the following problems can be considered: the relationship between the psyche and brain activity; correlation of social and biological; psychosomatic and somatopsychic relationships; problems of pathology and norms.
Pathopsychology, studying the psyche, has its own specifics, since the object of pathopsychology is mental disorders or pathological conditions of the brain.
The subject is the study of the psychological patterns of disturbance or disintegration of the psyche in various mental illnesses in comparison with the norm. The most complete and accurate definition of the subject of pathopsychology was given by B. V. Zeigarnik: “pathopsychology as a psychological discipline proceeds from the patterns of development and structure of the psyche in the norm. She 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, she studies the regularities of distortions of the reflective activity of the brain.
Pathopsychology makes it possible to study mental disorders, creates a qualification of psychopathological phenomena using a categorical apparatus common to all branches of psychology. Pathopsychology can operate clinical concepts such as symptom, syndrome, etiology, pathogenesis.
In pathopsychology, there can be several tasks, one of which is obtaining additional information about the mental state of a person, about the features of his cognitive, emotional-volitional and personal spheres. Experimental psychological research helps to detect signs of mental disorders, to consider their structure. Determination of the structure of disorders in various areas is an important part for the diagnosis of the disease.
Another task is to conduct an experimental psychological study for the purpose of psychiatric examination: medical and social, labor, military, judicial. In the process of conducting a study, questions can be resolved about establishing the structure of disorders and their relationship with intact mental processes, issues of differential diagnosis.
A number of factors can influence the research process: interest in the results of the research, since a person may underestimate the severity of painful disorders (dissimulation), may strive to increase the severity of existing disorders (aggravation) or simulate painful manifestations of the psyche in order to avoid legal liability or in order to get disability.
Among the tasks should be noted the study of changes in mental activity under the influence of therapy. For this purpose, a repeated study of the patient is carried out using the same set of techniques, which allows you to track the dynamics of changes and demonstrate the effectiveness of treatment. The results of a pathopsychological study should be correlated with the mental status of the patient.
Thus, pathopsychology reveals the description and properties of the signs of the main mental illnesses. Currently, pathopsychology has found its application in a psychiatric clinic. Dynamic monitoring of the patient's mental state, identification of changes in his performance and personality characteristics are necessary in various fields of medicine (in therapeutic, surgical clinics).
The goals and objectives of pathopsychology are focused on providing assistance in working with mental disorders in various mental illnesses. An important task of pathopsychology is diagnostics aimed at solving the issues of differential diagnosis and substantiation of ongoing drug therapy.
1.2. Relationship of pathopsychology with other sciences
Pathopsychology is a branch of psychiatry and medical psychology. Pathopsychology as a branch of psychiatry is interested in the issue of etiology and pathogenesis, as well as in the treatment of patients. The relationship between pathopsychology and psychiatry can be traced in the study of the dynamics of mental activity.
Pathopsychology as a branch of medical psychology reveals psychopathological phenomena in the structure of a sick personality and its dynamic connection with a premorbid personality.
Pathopsychology is associated with medical psychology and psychopathology, as the pathopsychologist assists the doctor in identifying signs of mental disorders.
Pathopsychology is practically significant for defectology and pedagogy. Also, pathopsychology is closely connected with a number of disciplines: with general psychology, developmental psychology, forensic psychology, neuropsychology, psychophysiology, special psychology.
For general psychology studies of people with mental disorders can be significant in order to better understand the psyche of a healthy person. For example, the study of individuals with autism helps to assess the impact of communication on personality development.
The connection of pathopsychology with special psychology can be seen in the fact that the pathopsychologist evaluates the child's learning ability.
1.3. The structure of pathopsychology as a science and its theoretical foundations
In the structure of pathopsychology, theoretical and applied pathopsychology are distinguished. theoreticalpathopsychology studies general patterns changes in mental activity in pathological conditions of the brain in comparison with the norm. Its purpose is to assist in understanding the processes that occur in pathological conditions of the brain.
The methodological basis of pathopsychology is the general psychological theory. As you know, pathopsychology studies the laws of the decay of mental activity in comparison with the norm, therefore, knowledge about the essence of the psyche is necessary, a correct understanding of the problem of its origin and development in the norm.
The most significant contribution to the development of pathopsychology was made by the works of V. M. Bekhterev, A. F. Lazursky, G. I. Rossolimo, S. S. Korsakov, V. P. Serbsky, A. N. Bernshtein, V. A. Gilyarovsky and others. In Russia, the first experimental psychological laboratories were opened in 1885 by V. M. Bekhterev in Kazan. The laboratory worked with
neuropsychiatric clinics and, in addition to research activities, implemented applied aspects that are directly related to the practice of providing assistance to mentally ill people.
So, V. M. Bekhterev stood at the origins of Russian pathopsychology. The formation of its principles and methods was greatly influenced by I.M. Sechenov and his work "Reflexes of the brain" (1863). The successor of I.M. Sechenov on this path was V.M. Bekhterev, who is the founder of the pathopsychological direction in the national psychological science. Representatives of the school of V. M. Bekhterev developed many methods of experimental psychological research of psychiatric patients, which are still widely used by pathopsychologists (“pictograms”, “classification of objects”). The basic principles of pathopsychological research were also formulated. Also contributed huge contribution in the development of the methodology and practice of pathopsychology A.F. Lazursky, who introduced the method of natural experiment into psychology, which began to be used in clinical psychology.
The fundamental theoretical foundations are the studies of the outstanding Russian psychologist L.S. Vygotsky and his followers (first of all, A.N. Leontiev and A.R. Luria). L.S. Vygotsky introduced modern psychology as the main concept of higher mental functions (HMF).
The development of higher mental functions is carried out in the process of training, education and communication with carriers of cultural and historical experience. In domestic psychology a view was formed of higher mental functions as expanded forms of objective activity that arise on the basis of elementary sensory and motor processes, which are then curtailed, internalized, turning into mental actions. In the formation of the HMF, the leading role belongs to speech, thanks to which they become conscious and arbitrary.
Such an understanding of the nature and essence of the HMF allowed L. S. Vygotsky to put forward a number of provisions that are significant for pathopsychological and neuropsychological research in our country.
Since the human brain has a fundamentally different organization than the animal brain, and the development of HMF is not predetermined by the morphological structure of the brain, mental disorders have a complex nature and structure. Therefore, the features of mental disorders according to L. S. Vygotsky are determined by:
- the nature of the localization of the violation (in this regard, it is customary to single out general and particular defects);
- the time of the lesion (the lesion of the same zones of the cortex has an unequal significance at different stages of mental ontogenesis);
- systemic nature of disorders, in which primary (biologically determined) and secondary (which are derivatives of primary, hindering social development functions) violations.
Ideas about the nature, genesis of HMF have found their logical development in the theory of activity of A.N. Leontiev.
According to this theory, activity as a special form of human activity is the unity of its external (practical) and internal (mental) sides. Internal mental activity arises in the process of internalization of external practical activity and has the same structure as practical activity. Thus, by studying external practical activity, it is possible to reveal the patterns of mental activity.
This provision formed the basis for the development of the methodology of pathopsychological research. B.V. Zeigarnik repeatedly pointed out that it is possible to understand the patterns of mental activity disorders only by studying the practical activity of the patient, and to correct mental activity disorders by managing the organization of practical activity.
Thus, the cultural-historical concept of the formation of higher mental functions and the activity approach became the theoretical basis of pathopsychology, defining the methodology and technology for pathopsychological research.
Applied pathopsychology meets the needs of practice when conducting an examination, evaluating the effectiveness of treatment, especially when using psychopharmacological agents.
As another basis for distinguishing branches of pathopsychology, it is proposed to take into account age characteristics. There are the following branches of pathopsychology:
- preschool pathopsychology;
- pathopsychology of younger schoolchildren;
- pathopsychology of adolescents;
- juvenile pathopsychology;
- pathopsychology of adults;
- pathopsychology of the elderly.
2. PATHOPSYCHOLOGICAL STUDY AND ITS SIGNIFICANCE
2.1. Significance of pathopsychological research for psychiatric issues
Pathopsychological research is a systemic qualitative analysis mental disorders, which uses the method of quantitative data assessment, in which it becomes necessary to use a complex of diagnostic methods when examining a patient.
The data of pathopsychological studies may also be useful in resolving theoretical issues of psychiatry. Pathopsychological examination allows approaching the mechanisms of symptom formation, revealing their syndromic structure, which allows not only to establish a complete and accurate diagnosis, but also to adequately prescribe treatment.
The main tasks of pathopsychological research in a psychiatric clinic V. M. Bleikher and his staff include the following six:
- Obtaining data for diagnostics.
- Study of the dynamics of mental disorders in connection with the ongoing therapy.
- Participation in expert work.
- Participation in rehabilitation work.
- Participation in psychotherapy.
- A study of understudied mental illnesses.
Pathopsychological examination helps the psychiatrist in the selection of drug treatment, and the psychotherapist in the choice of methods of psychotherapeutic influence. And since the treatment is usually carried out in a complex way: drug therapy and psychotherapy, in their adequate combination, the result of this treatment will be as effective as possible.
2.2. Significance of pathopsychological research for theoretical and methodological issues of psychology
Research in the field of pathopsychology is of great importance for many general theoretical issues of psychology. Modern psychology has overcome the view of the psyche as a set of "mental functions".
The main cognitive processes, such as perception, attention, memory and thinking, began to be considered as various forms of objective activity, or, as it is often called, “meaningful” activity of the subject. In the works of A. N. Leontiev, it is shown that any activity receives its characteristic through motivation.
Consequently, the role of the motivational (personal) factor should be included in the characterization of the structure of all mental processes. When studying the pathology of perception, E.T. Sokolova showed how, under the influence of various motivated instructions, the process of perception could act as an activity. Experimental psychological studies have revealed that with various disorders motivational sphere various forms of disturbed thinking appear (B. V. Zeigarnik, Talat Mansur Gabriel). Thus, the role of the motivational (personal) component in the structure of cognitive processes was established and proved.
Also, pathopsychology made it possible to reveal the question of the relationship between biological and psychological in human development. Research data have shown that the process of the disease can lead to a distorted development of the personality. To address the issue of the relationship between biological and social, the coverage of the issue of the relationship between the development and decay of the psyche plays an important role.
Experimental studies of I.P. Pavlov and his collaborators on animals confirm the thesis that in pathology, what was acquired later is violated first of all. Thus, acquired conditioned reflexes are destroyed in diseases of the brain much more easily than unconditioned ones. Further studies in the field of physiology of higher nervous activity have established that the defeat of phylogenetically later formations entails a weakening of their regulatory role and leads to the “release” of the activity of earlier ones.
From these data, it is often concluded that in some diseases of the brain, human behavior and actions are performed at a lower level, corresponding to a supposedly certain stage. child development. Based on the concept of the regression of the psyche of a mentally ill person to a lower ontogenetic level, many researchers have tried to find a correspondence between the structure of the decay of the psyche and a certain stage of childhood. So, back in his time, E. Kretschmer brought together the thinking of patients with schizophrenia with the thinking of a child at puberty.
Thus, these views are based on the idea of the layer-by-layer disintegration of the psyche from its higher forms to the lower ones. However, this idea turned out to be untenable. First of all, the disintegration of higher functions is not always found in illness. Quite often it is violations of elementary sensorimotor acts that create the basis for complex pictures of the disease (A.R. Luria).
In patients suffering from Alzheimer's disease (an atrophic brain disease), a loss of motor stereotypes (writing, reading), a loss of complex human skills due to the loss of past experience are revealed. It was not possible to identify any compensatory mechanisms in them, while impairments in skills in patients with vascular diseases of the brain appeared “framed” by compensatory mechanisms (which, in turn, complicated the picture of impairments). Consequently, the decay of skills is complex. In some cases, its mechanism is a violation of the dynamics, in others - a violation of compensatory
mechanisms, in some cases the very structure of the action is violated.
In all these forms of skill impairment, no mechanism of action has been found that resembles the stage of skill development in a child.
Psychological analysis of the clinical material shows that the structure of the behavior and mental activity of an adult patient does not correspond to the structure of the child's behavior and thinking.
Thus, when conducting systemic research, it should be remembered that not only different aspects of any phenomena (for example, thinking) are studied, but the main factor that allows studying the integrity of a given system is singled out. Such an integral factor is the analysis of a sick person in a real life situation for pathopsychology.
2.3. The practical significance of pathopsychological research
2.3. 1 Significance of pathopsychological research in childhood psychiatry
The results obtained during the study of various aspects of the psyche of a sick child are compared with the same parameters of a healthy child of the same age (for example, the level of development of thinking, features of the development of the motivational sphere).
Based on L.S. Vygotsky’s theory of the “zone of proximal development” and the prognostic significance of a child’s potential to master educational material, child pathopsychologists use in their work the principle of constructing an experiment of the “training” type. The construction of the latter makes it possible to assess qualitatively and take into account quantitatively the potential level of mental capabilities.
Experimental - psychological research helps to develop corrective recommendations for training and education. The pathopsychologist, on the basis of the experimental data obtained, can, to a certain extent, participate in deciding the question of the most expedient forms of employment for adolescents.
Thus, in this case, pathopsychological diagnostics, aimed at identifying the structure and severity of an intellectual defect, is an integral part of a comprehensive medical, psychological, and pedagogical study.
2.3.2 Pathopsychological research in expert work
The question of the nature of mental disorders is especially acute when conducting a psychiatric examination (military, labor, judicial), in which experimental psychological research is necessary.
Pathopsychological research is important in a situation of setting a differential diagnosis. Many mental disorders have similar clinical symptoms. Difficulties are observed when it is necessary to differentiate between psychopathy and psychopathic personality changes in schizophrenia, neuroinfection.
In the case of early diagnosis of mental disorders, when psychopathological symptoms have not yet fully formed, it can be quite difficult to determine the nature of the disorder. For example, in the picture of the disease, which in the initial stages proceeds according to a neurosis-like type, the pathopsychologist during the study can reveal disorders of thinking and emotionality that manifest themselves in those characteristic of schizophrenia. This facilitates early diagnosis and enables early treatment.
Psychological research carried out for the purposes of military expertise mainly resolves the issue of the degree and characteristics of mental underdevelopment, identifying personality traits. Often there is a need to distinguish between pedagogical neglect and mental illness, the need to identify violations of the emotional-volitional sphere or personality psychopathization from mental instability after mild organic brain damage.
Labor psychiatric examination requires a thorough pathopsychological analysis of disturbed and remaining intact mental functions. The peculiarity of its implementation is that the patient, usually interested in a certain expert decision, sometimes shows a tendency to dissimulation or aggravation. In both cases psychological experiment can objectively reveal the existing degree of mental disorder. By the nature of the errors, one can establish not only the fact of aggravation, but also the depth of the mental defect.
In recent years, psychologists have been increasingly involved in the conduct of complex forensic psychological and psychiatric examinations. Psychological research for the purpose of a forensic psychiatric examination should be carried out especially carefully.
The main requirement for a psychological experiment is to resolve the issue of the correlation of mental disorders with the deed. In accordance with the specific tasks of forensic examination, a psychological experiment is also being built.
In forensic psychiatric practice, it is important not only to establish the presence of a mental illness, for example, oligophrenic dementia, but also to clarify the degree of its severity, since an expert opinion is important for making a judicial decision on sanity or insanity, on the measure of responsibility for one's actions.
When conducting a forensic examination, the role of a psychologist is not limited to issues of nosological diagnosis and determining the severity of a mental defect. As part of the psychological and psychiatric examination, the psychologist gives a structural and dynamic analysis of the personality of the subject.
Forensic psychological examination is often carried out in cases of minors, even those who do not have mental disorders. At the same time, the level of their cognitive activity and the nature of their individual and personal characteristics are determined; only with such integrated assessment it is possible to judge the ability of the subject to be aware of the unlawfulness of his actions and to control them. It is important to note that not only the accused, but also the victims or witnesses can be the object of the forensic psychological examination, since the data obtained by the psychologist contribute to an adequate assessment of the reliability of their testimony.
2.3.3 The role of pathopsychological examination in psychocorrection and rehabilitation measures
Research conducted by a pathopsychologist has become one of the constituent parts psychocorrection and rehabilitation measures. The pathopsychologist must perform his own tasks of a psychodiagnostic and socio-psychological nature and thereby help the doctor organize the psychotherapeutic process.
In relation to psychotherapy, the following tasks of pathopsychological research are distinguished:
This is, firstly, the participation of a pathopsychologist in the diagnosis of a mental illness, since the volume of indications for psychotherapy and the choice of the most appropriate forms of its implementation for a given patient depend on the solution of these issues.
Secondly, pathopsychological research contributes to the discovery of such personal properties of the patient, to which special attention should be paid in subsequent psychotherapeutic work.
Thirdly, a psychological experiment helps to establish productive contact with patients, as it gives the psychotherapist an idea of their intellectual level and interests. The nature of the patient's intellectual activity and the peculiarities of his motivation largely determine the system for constructing psychotherapeutic measures, influence the strategy of psychotherapy, as well as the choice of specific methods of psychotherapeutic influence.
Fourthly, pathopsychological research in itself carries a psychotherapeutic, psychocorrective load, since in the course of solving experimental tasks it becomes possible to show the patient a certain safety of his mental functions, which the patient considers grossly impaired, and thereby emphasize the availability of resources to resist the disease.
Clinical case
according to the pathopsychological examination dated 6.08.2015.
Timofey, date of birth: 12/5/2002, 12 years old
Lives in Tyumen, studies in the 4th grade.
During the examination, the subject goes into contact with a psychologist. Contact is unproductive, it is formal. The subject finds it difficult to explain the purpose and objectives of the survey. The subject is tense, hurried, fussy. In a conversation, he answers all the questions posed verbosely, he gives answers that are not to the point, slipping is noted in the answers (“When asked about the date of birth, he answers that they give chocolate for his birthday”).
The subject tends to switch from one topic of conversation to another. He can give random answers. Shows no initiative in conversation. The subject says that he likes school, but he school items does not name. The circle of communication is limited, the subject is friends mostly only with girls. He has few friends. The range of interests is limited.
The subject does not talk about his interests. The speech is unemotional, scrambled. Gestures are inexpressive. When performing experimental tasks, he does not show interest in obtaining positive results. Criticism of the results of their cognitive activity is reduced, since the subject does not respond to comments, does not correct his behavior. Indifferent to failure.
The study was conducted using the following methods: "memorizing 10 words", "eliminating the 4th", comparing concepts, Veksler's intelligence research technique (children's version), projective methods.
The subject does not immediately learn the instructions for the proposed experimental tasks. The mode of their implementation does not hold for a long time, due to a decrease in the purposefulness of cognitive activity. The subject is prone to violating instructions, he can perform tasks at his own discretion, making it easier for himself to complete.
The volitional component of cognitive activity is moderately reduced. The subject is rarely focused on the correctness in the performance of tasks, makes insufficient efforts. Help of a meaningful nature, he uses passively, is not effective. When performing tasks, sometimes focuses on the speed of execution. In the process of work, the subject makes mistakes, does not correct them independently. When working with assignments, he often comments on them. The subject has difficulty switching from one task to another, as he transfers the instruction of the previous task to the next.
The memorization curve for 10 words - 2,3,2,5,5, delayed - 4 words, indicates a moderate decrease in short-term auditory memory with a weakening of long-term memory. During playback, the subject names a large number of random words.
Active attention is unstable, there is a slight decrease in its concentration. No errors were noted during the performance of tasks for concentration of attention. In the “missing parts” subtest, out of the 20th sample, -10 was correctly completed. There is a lack of skills to differentiate the essential from the secondary in visual images.
In the study of the operational side of thinking, attention is drawn to the decrease in the purposefulness of cognitive activity. There is an unstable level of generalization. When performing the operation of generalization and abstraction, specific and functional features of objects predominate, and minor features are also present. There is a formality in the performance of tasks. In the subtest "similarity" there are answers: "plum / peach - similar in that cucumbers need to be salted", "cat / mouse - similar in that the cat eats fish." Understanding the conventional meaning of proverbs is difficult for the subject, he is prone to reasoning and answers out of place (“bright head - brown hair”, “golden hands - yellow”; “stone heart - red heart”).
During the examination on the Wechsler scale total score intellectIQ=58, verbalIQ=55, non-verbalIQ=69. The decrease in the indicators of the methodology is due to the weakening of the motivational-volitional component of cognitive activity. Research reveals limited supply general information about the world around in accordance with age and level of education. When answering, the boy is long-winded, prone to reasoning, reasoning is observed (“how many units are in five?”, “Five is an assessment, and there is also an assessment of 4.3 ...”). The subject is poorly oriented in social situations and uses his knowledge. Arithmetic abilities are developed at a low level in relation to the age norm, the subject does not perform all mathematical operations well enough.
The subject does not always understand the meaning of the task, he counts on his fingers. Ability to identify causes investigative links and understanding of the sequence of events and phenomena are moderately reduced in accordance with the age norm. In the performance of tasks, unevenness was noted. The subject experiences difficulties in compiling stories from pictures, tells something for each picture separately, but cannot compose a complete story. Constructive abilities are slightly weakened for this age period.
In the personal sphere, attention is drawn to the manifestation of self-centeredness, anxiety, restraint, closeness, and possibly internal tension. Separation, fenced off, orientation to own opinion(internal criteria).
There is introversion, lack of sociability, unstable motivation, emotional lability. Difficulties in communication with others (difficulties in establishing and maintaining contacts). Communication is somewhat superficial.
Thus, the survey revealed:
- on the Wechsler scale, general intelligence IQ=58, verbal IQ=55, non-verbal IQ=69. The decrease in the indicators of the methodology is due to the weakening of the motivational-volitional component of cognitive activity;
- the motivational-volitional component of cognitive activity is reduced, which is manifested in the weakening of volitional qualities, formality, indifference to the mistakes made;
- reduction of critical capabilities;
- moderate decrease in short-term memory and long-term memorization;
- slight decrease in the weakening of the functions of attention;
- instability of the level of generalization (coexistence of several levels of abstraction; slippage, reasoning);
- in personal characteristics, self-centeredness, tension, isolation, isolation, difficulties in communicating with others, lack of sociability came to the fore.
Conclusion
In this paper, the idea of pathopsychology as a science of mental disorders was considered. Pathopsychology is a branch of science that examines and studies changes in mental activity due to the impact of a disease of a somatic and mental nature.
One of the interdisciplinary sciences, bordering on a number of other disciplines, has become pathopsychology. It proceeds from the patterns of development and structural features of the psyche. Pathopsychology studies the psychological patterns of disturbance or disintegration of the psyche in comparison with the norm.
Pathopsychology can be divided into two structural components: theoretical and applied. Pathopsychological research has its theoretical and practical significance for psychiatry and psychology. The purpose and objectives of pathopsychology as a science are aimed at helping to work with mental disorders in various diseases. Diagnosis becomes the main task of pathopsychology. Research in pathopsychology reveals violations of memory, attention, thinking, perception, intelligence, all higher mental functions in general. Research helps in the diagnosis of pathology as a mental and behavioral areas.
Pathopsychological examination allows solving the issues of differential diagnosis, which helps in establishing or confirming the diagnosis. The study provides an opportunity to Additional information about the mental state, about the features of its cognitive, emotional and volitional spheres. Experimental psychological research may be part of a psychiatric examination. In the course of the study, questions can be resolved about establishing the structure of disorders and their relationship with intact mental processes. Pathopsychological study allows us to consider the dynamics in the mental activity of a person and changes under the influence of ongoing drug therapy. Recently, pathopsychology has found its application, both in psychiatric and somatic clinics.
Literature
1. Balabanova L.M. Forensic pathopsychology (issues of determining the norm and deviations). — D.: Stalker, 1998 — 432 p.
2.Bleikher V.M., Kruk I.V. Pathopsychological diagnostics. Kyiv, 1986.
3. Bizyuk, A. P. Pathopsychology: short course in the context of general and clinical psychology [Text]: textbook. allowance / A. P. Bizyuk; ed. L. M. Shipitsyna. - St. Petersburg: Speech, 2010.
4. Repina N.V., Vorontsov D.V., Yumatova I.I. Fundamentals of clinical psychology.
5.Zeigarnik B.V. Pathopsychology. - From Moscow State University, 1986. - 287 p.
6. Zeigarnik B.V., Introduction to pathopsychology. Moscow University publishing house, 1969.
7. Zeigarnik B.V., Bratus B.S. Essays on the psychology of abnormal personality development. M., 1980.
8. Clinical psychology [Text] / Ed. M. Perret, W. Bauman. - 2nd ed. intl. - St. Petersburg: Peter, 2007.
9. Maksimova N.Yu., Milyutina E.L. "A course of lectures on child pathopsychology" Rostov-on-Don "Phoenix" 2000
10. Rubinshtein S.Ya. Experimental methods of pathopsychology. — M.: April-Press, 2007. — 224 p.
The data obtained during research within this discipline are of great theoretical and practical importance. Let us consider further the basics of pathopsychology.
general characteristics
In the modern scientific environment, there is some confusion of different concepts, incorrect use of certain terms. In this regard, it is natural to separate pathopsychology and psychopathology. The latter is considered a branch of medical science. It focuses on the study of diseases of the mental system. Within the framework of this discipline, various kinds of violations and their mechanisms are studied. Pathopsychology is based on the regularities of the structure and development of the psyche in the norm. It explores and compares the decay of personality traits with the normal course of processes. Thus, both of these sciences have similar objects of study, but different subjects.
Tasks
Pathopsychology is a science aimed at obtaining additional information about the patient's condition. In particular, his cognitive activity, emotional-volitional sphere, and personality as a whole are subject to research. This information is essential for making a diagnosis. Experimental methods of pathopsychology make it possible to identify many signs of disorders, to establish their structure and connection with each other.
Another important task that is solved within the framework of the discipline is to conduct research for examination (judicial, military, labor). In the process of such a procedure, a specialist can establish the structure of disorders and their relationship with the intact aspects of the activity of the psyche or conduct differential diagnostics. Such a study is associated with certain difficulties. They are primarily driven by the interest of the patient. In this regard, the patient may underestimate the manifestations of violations, intensify them, or even simulate them in order to avoid responsibility or to obtain disability. Another problem that pathopsychology solves is the study of changes under the influence of therapy. In such cases, the same type of sets of techniques are used. With repeated research with their help, the dynamics of the state is established, the effectiveness of treatment is determined.
Additional functions
During recent years experimental pathopsychology began to be used to solve two additional problems. The first is related to rehabilitation measures. During their conduct, specialists pay great attention to the discovery of the intact aspects of the personality and psyche of the patient. In addition, the patient's social environment, the nature of relationships with other people, educational and work attitudes are studied. The task of such a study is to develop recommendations that would contribute to faster rehabilitation. The second independent function of specialists is their participation in psychotherapeutic activities. Here, however, it is worth noting that the question of the participation of a doctor in them is not sufficiently regulated at the legislative level.
Development of science
As an independent branch, pathopsychology began to take shape at the beginning of the 20th century. The most clear ideas about the subject of science are reflected in the works of Bekhterev. According to him, pathopsychology is the process of studying abnormal manifestations on early stages the formation of the system. Various courses were taught at the institute organized by Bekhterev. At the same time, a clear line was immediately drawn separating pathopsychology and psychopathology.
Domestic figures
From the very beginning, the development of the industry was based on strong natural science traditions. The formation of principles and techniques was carried out under the influence of Sechenov's works. He attached particular importance to the connection between psychology and psychiatry. Bekhterev became Sechenov's successor on this path. He is considered the founder of the pathopsychological branch in psychological science. Representatives of his school developed many mental patients. They are still widely used in the discipline today. The main principles of the study were formulated:
Child pathopsychology
Before the works of Zeigarnik appeared in science, there was an opinion that with a number of neurotic diseases, the patient's behavior begins to move to a lower level, which reflects a certain stage of the child's development. Based on this concept, many scientists have tried to identify a correspondence between the process of personality decay and a specific stage of childhood. For example, Kretschmer brought the thinking of a schizophrenic closer to adolescent development. In 1966, at the 8th International Congress, Azhuriaguerra (Swiss scientist) defended the opinion about the layered mental decay from higher to lower forms. These conclusions were based on a number of observations:
Luria, Zeigarnik, Rubinstein: pathopsychology and biological patterns
The data of these researchers concerned reading and writing in patients with vascular diseases, Alzheimer's disease, who had brain injuries. Based on the information received, a new point of view was justified. It consisted in the fact that the flow is under the influence of biological laws. They cannot repeat the principles and stages of development. Even when young, specific brain regions are affected by the disease, the patient's psyche does not acquire the structure of a child at an early stage of development. The fact that the patient is unable to reason and think in high level, indicates the loss of complex forms of cognition and behavior. But this does not mean that he returns to the childhood stage.
Myasishchev's theory
She also played an important role in the development of pathopsychology. In accordance with the theory, the human personality is presented as a system of relationships between a person and the outside world. Such interactions are characterized by a complex structure and find expression in mental activity. The disease brings changes and destroys the formed system of relations. These disorders, in turn, can provoke the disease. Through this kind of contradiction, Myasishchev studied psychoses.
2) pathopsychology- This is a branch of psychology, borderline between psychology and psychiatry, which studies the patterns of the course of mental activity in various forms of pathology, in comparison with the norm.
E.T. Sokolova:
- Pathopsychology as theoretical discipline deals with the following issues:
o Biological and sociocultural patterns of abnormal development;
o Mechanisms of symptom formation;
o Individual, personal and motivational factors in determining the structure and dynamics of psychopathological syndromes (manic, depressive, hallucinatory-delusional, etc.).
§ How applied Science pathopsychology is used in psychiatry as diagnostic criteria when determining the degree of intellectual decline, when conducting an examination, evaluating the effectiveness of treatment, especially when using psychopharmacological agents.
3.1. The subject and practical tasks of pathopsychology. The difference between psychopathology and pathopsychology.
pathopsychology(from Greek. pathos- suffering) - an area of clinical psychology, borderline between psychology and psychiatry.
The first attempts of pathopsychological research belong to the middle. XIX century., and are associated with the demands of practice. Questions:
1. How to understand what the role is psychological factors in mental disorders?
2. How to describe the structure of mental disorders in terms of psychology?
3. How can you psychologically help a mentally ill person?
Thus, psychologists begin to work in isolated cases in psychiatric hospitals (see below).
Because pathopsychology is closely connected with maternal disciplines, it is necessary to point out the qualitative features of these connections. Question: why? Answer:
To isolate the range of tasks available to specialists of this profile
This is important for the methodology of pathopsychology
This is necessary for an adequate selection of practical tools
In this regard, it is advisable to turn to the subjects of maternal disciplines:
Ø Psychiatry is a field of knowledge dealing with the diagnosis of mental illness, their etiology (i.e., causes), pathogenesis (i.e., course), as well as the treatment and prevention of mental disorders. General psychopathology- branch of psychiatry. It operates with general medical concepts (symptom, syndrome, etiology, pathogenesis, etc.) and uses general medical criteria for assessing the mental state (blood test, EEG, etc. + criteria according to ICD or DSM classifications). Basic method psychopathology - clinical-descriptive: a combination of long-term observation and clinical conversation.
Ø Psychology- the science of the generation, structure and functions of the mental reflection of reality in the processes of the individual's activity (A.N. Leontiev). Other definitions are also possible.
pathopsychology- This is a branch of psychology that studies the patterns of the course of mental activity in various forms of pathology (mental and somatic), in comparison with the norm. Thus, “Pathopsychology studies the patterns of disintegration of mental processes and personality traits of patients and compares them with the patterns of formation and course of mental processes in the norm” (Bleicher, 1976, p. 9).
Psychopathology ≠ pathopsychology. The object of pathopsychology with psychiatry is common, i.e. mental disorders! But the conceptual apparatus and methods are psychological! Item:
- Psychiatry: a disease
- Pathopsychology: man and his functioning in society.
Practical tasks of pathopsychology(B.V. Zeigarnik, V.M. Bleikher, V.V. Nikolaeva, N.K. Korsakova):
1. Participation of the pathopsychologist in the establishment disease diagnosis. BUT the diagnosis is never made by one specialist ... Types of diagnosis (according to N.K. Korsakova):
¨ Topical diagnostics- determination of the location of the focus (tumor, hemorrhage, traumatic injury) within the brain. Actually, this is the task of a neuropsychologist, but still ...
¨ Nosological diagnostics(basic for pathopsychology). The psychologist helps the doctor with the diagnosis. The role of a psychologist is important if there are weak, indistinct, blurred, diffuse symptoms and manifestations of mental disorders. Ex: with a clinical picture of the disease sometimes outwardly formed according to a neurosis-like type, a pathopsychologist, in a special study, finds disorders of thinking and emotional-personal sphere characteristic of schizophrenia.
¨ Functional diagnostics. The problem of diagnosis is not considered here. The doctor turns to the psychologist to determine the cognitive and personality profiles of the patient (" psychological picture patient"). This type of diagnostics assumes that the subject will be involved in the process of pharmacological and / or psychotherapeutic treatment, during which it is necessary to evaluate, as it were, longitudinal changes in cognitive processes and emotional and personal characteristics. Thus, here we are talking about the evaluation of the effectiveness of treatment procedures (see below) + long-term follow-up of the patient is required.
¨ individually-personal typological diagnostics. The identity of the patient is diagnosed. For what? Such a diagnosis is needed for the preventive tasks of preventing mental pathology in relation to the so-called. "risk groups". Task: on the basis of the data obtained, to prevent the actualization of the pathologising protective mechanisms of the personality, to enter into the functioning of conscious mechanisms of co-ownership, for example, in AIDS and oncological diseases. Ex: Do I need to tell the patient that he has cancer? It all depends on the diagnostic data!
2. Expert task. Expertise examples:
1. Labor expertise. Issues on the appointment of a disability group, admission to a certain field of activity are being resolved. Here diagnostics of expert installations is very important:
ü Aggravation - setting the patient to exaggerate his existing violations.
ü Dissimulation is an understatement (for example, in order to quickly leave the hospital, etc.).
In this regard, the psychologist can also participate in the selection of new activities that do not reduce the patient's previous social status, but at the same time are sparing.
2. Military expertise. Question: "Can a person be in certain, harsh conditions?". 1) The question of the possibility of service; 2) The issue of continuing the service of military personnel. It is also important to take into account expert settings + simulation. Do not take: schizophrenics, epileptics, psychopaths, people with mental retardation and mental retardation.
3. Forensic psychological and psychiatric examination. Psychologists take part in this examination in order to resolve questions about the client's sanity at the time of the crime. The decision is made by the court. Here, the simulation of mental illness is already possible.
4. Medical and pedagogical expertise. The psychologist is involved in assessing the child's learning opportunities. We are talking about children with sensory deficits, disorders associated with damage to the motor sphere (ICP), brain disorders, mental retardation, etc. What school should the child go to?
5. Civil expertise. Divorce of parents: with whom does the child stay? Important psychological features personalities of children and parents.
3. Description, characteristics of the structure of a mental defect. Here it means scientific goals: Recently, diseases that have been little studied have begun to appear. Ex: acute stress disorders and PTSD associated with terrorist attacks, etc. This needs to be investigated in order to properly build psychotherapy and organize an emergency psychological help. Another example: bad ecology, crowded people, monotony, gray spaces, high gray walls, lack of architectural delights and nature lead to apathy and depression (moreover, somatized, with pain, etc.).
4. Evaluation of the effectiveness of treatment(psychopharmacological means or psychotherapy) of patients with mental pathology. Pharmacological treatment of patients with mental disorders (psychosis, depression, borderline disorders) is now developing very intensively. How to conduct such a study? Two groups of patients with the same pathology are taken, one group (control) is given dummy pills (to remove the placebo effect), and the other (experimental) is given the drug.
5. Participation in rehabilitation work. Restoration of the position of the mentally ill in society, family, at work. It is also the prevention of disability (with schizophrenia, organic brain damage). Principles:
o Orientation to the preserved elements of personality and cognitive functions.
o Individual approach.
o Study « social climate", which will surround the patient after discharge; This is what psychotherapy is based on.
o Systematic.
6. Participation in psychotherapy. Aspects of:
I. The role of the pathopsychologist in medical psychotherapy:
1) Psychodiagnostics. It allows you to choose one or another form of psychotherapy.
2) Detection special properties psyche (in particular, personality traits), which the doctor should pay attention to during psychotherapy. Ex: application of projective methods.
II. Psychological psychotherapy. Can be used for:
o Neuroses
o Somatic diseases
o Borderline personality disorder
In pathopsychology, everything is not as structured and unambiguous as in neuropsychology. In the most general form:
pathopsychological symptom- a single phenomenon of impaired mental activity, manifested in a pathopsychological examination (at the same time, it may not manifest itself outside the experimental examination). Ex: slippage, distortion of the generalization process, inadequate association, etc.
There are primary, secondary and tertiary symptoms.
o Primary. Associated with pathology of the brain.
o Secondary. Compensation of primary - psychological mechanisms.
o Tertiary. Also compensation, but on a different level - psychological mechanisms.
Example: pathopsychological syndrome in epilepsy. The leading syndromic factor is a violation of the analytical and synthetic activity of the brain with a sharp violation of the dynamics of nervous processes.
1. Primary violations:
ü change in the dynamics of mental processes (slowness, inertia),
narrowing of the scope of attention, difficulties in its distribution,
ü lack of flexibility, mobility of behavioral programs,
ü General cognitive decline.
2. Secondary violations. Arise as compensation for primary defects:
- confabulation when remembering,
- reasoning,
- a complex of personal characteristics: obsequiousness, politeness, pedantry.
3. Tertiary disorders
Chronic behavioral and emotional tension (expectation of a negative assessment),
Inflated self-esteem, as compensation for chronic failure.
Pathopsychological syndrome- this is a natural combination of symptoms (expressed in psychological terms) caused by an existing mental disorder.
There are other understandings.
V.V. Guldan: Pathopsychological syndrome- this is a combination of signs of violations of mental activity, its intact aspects and individual features mental activity, united psychological mechanisms functioning of the individual.
F.S. Safuanov: Pathopsychological syndrome is a set of disorders or features of cognitive processes, emotional and behavioral reactions that are relatively specific for a particular clinical nosology and are based on certain psychological mechanisms.
Yu.F. Polyakov: there are psychopathological and pathopsychological syndromes. What is the difference? Differences:
Ø Psychopathological syndromes. They simply state the presence of certain pathological manifestations of the psyche. Example: paraphrenic psychopathological syndrome includes delusions of grandeur, delusions of persecution, mental automatisms and affective disorders.
Ø Pathopsychological syndromes. Mechanisms should be shown here!
This distinction between psychopathological and pathopsychological syndromes follows from the same difference between psychopathology and pathopsychology (see above).
Classifications of pathopsychological syndromes:
I. According to B.V. Zeigarnik: violation of the operational side of thinking, violation of the dynamics of thinking, violation motivational component, personal, etc. That these are pathopsychological syndromes, Bleicher (1976) said, but then (in 2002) he revised his views - these are too generalized syndromes.
II. Nose-specific approach to pathopsychological symptoms. As for neuropsychology, the central task is to make a topical diagnosis, for pathopsychology, the main task is to determine the nosological affiliation of the patient (nosological or differential diagnosis). Therefore, pathopsychological syndromes should provide information about nosology (see, for example, the definition of a pathopsychological syndrome according to Safuanov).
1) I.A. Kudryavtsev, worked at the Institute. Serbian. Identified the following pathopsychological syndromes:
§ Schizophrenic (dissociative). Inadequacy of emotions (formality and emasculation), the use of latent signs or subjective criteria when generalizing, reasoning, diversity phenomena, slippage in judgments, pretentious statements, a distorted interpretation of figurative meaning, fluctuations in attention, decreased activity.
§ Organic. Low level generalizations, concreteness of associations, misunderstanding of the conventional meaning, difficulties in establishing logical connections, thoroughness, a tendency to excessive detail, a decrease in the amount of memorization, fluctuations in attention and a decrease in activity, fatigue, slowness in the pace of mental activity.
§ Oligophrenic.
§ Psychopathic. Emotional saturation of associations, pretentiousness of judgments, a tendency to evaluative comments, affective reasoning, affective logic, the use of latent signs, distortion of figurative meaning.
§ Psychogenic disorganization.
2) V.M. Bleicher. Introduced the concept of "register-syndrome". Register-syndromes:
Schizophrenic
Affective-endogenous (in the clinic, it corresponds to MDP and functional affective psychoses of late age)
Oligophrenic
Exogenous-organic (in the clinic, it corresponds to brain damage like atherosclerosis, the consequences of TBI, substance abuse, etc.)
Endogenously organic (in the clinic - true epilepsy, primary atrophic processes in the brain)
Personality-abnormal (accentuated and psychopathic personalities and psychogenic reactions largely due to abnormal soil)
Psychogenic-psychotic (reactive psychoses)
Psychogenic-neurotic (neurotic disorders, neurotic reactions).
