Mental illness is a violation of the functions of the brain. The recognition and treatment of such diseases is the area of interest of psychiatry. But since human mental activity is incredibly complexly organized, it is sometimes very difficult to draw a line that strictly delimits the mental norm, its diversity and variability from directly mental deviations. Psychiatry is distinguished from most sections of clinical medicine by the fact that, for the most part, it does not have convincing data on the causes, course and outcome of diseases.
The main criterion for determining the disease is the clinical picture. Although psychiatry became an independent field of medicine more than two centuries ago, and the knowledge of specialists has been constantly expanding, the assessment of some mental states remains subjective. For this reason, clinical practice is so important. According to the medical literature, certain mental disorders are observed in 2-5% of people. In modern psychiatry, there are several equal classifications of mental illnesses, which are based on different principles. In this article we adhere to the provisions of Russian classical psychiatry.
A lot of credible data suggests that mental illnesses arise and develop for many reasons. The main experts believe the following:
- Heredity. This factor is especially important when it comes to the occurrence of diseases associated with flaws in the subtle mechanisms of brain activity, such as the exchange of neurotransmitters, the number and level of development of neuronal communication, and so on. Scientists have been arguing for a particularly long time about the type of inheritance of schizophrenia and epilepsy. According to the data of population genetics and genealogical research, first of all, the twin method, we are talking about polygenetic heredity. In this case, the low penetrance of the genes responsible for the inheritance of mental illnesses is also important, which makes it possible for them to accumulate contrary to natural selection.
- Biochemical disorders, both caused by heredity and received later. Thanks to research in this area, complexes of psychopharmacological drugs have been developed. Most of the hypotheses are divided into three groups to determine the causes of pathology:
- violation of neurotransmitter metabolism (the dopamine and neurotransmitter hypotheses determine the role of serotonin, GABA and MAO, which provide the exchange of mediators);
- violation of the metabolism of neuropeptides-endorphins (natural morphinomorphic substances);
- violation of the exchange of enkephalins.
- Immunological changes at the level of insufficiency of nonspecific humoral protection, properdin and autoimmune abnormalities. Changes in the activity of T-lymphocytes are particularly highlighted.
- Mental illnesses of organic nature. Injuries and poisoning lead to them. There have been repeated attempts to describe the patho-anatomy of psychoses, but no patterns have been revealed at the cellular and macroscopic level.
- Infections, penetration of parasites. A striking example is progressive paralysis, which is a special form of syphilitic lesion of the nervous system.
- Psychological traumas that lead to a change in the “barriers of mental adaptation” and exceeding the compensatory capabilities of a person. The theory has a biological and social basis.
For the most part, psychiatrists divide diseases into two types:
- Endogenous – generated by internal causes (this is schizophrenia, manic-depressive psychosis).
- Exogenous – generated by the environment.
The causes of the second type of diseases are more obvious. But, in any case, the pathogenesis of most mental ailments is only hypotheses.
Symptoms and syndromes of mental illness are described by general psychopathology. They are very diverse, many classifications have been adopted that take into account the spheres of mental activity, to which it is possible, albeit somewhat conditionally, to apply symptoms (emotional, mental, volitional disorders, as well as memory and perception disorders). But the authors of all classifications pay special attention to the ambiguity of the manifestations of the disease. The following are the main groups of symptoms, their definition and the necessary explanations. In some cases, literary examples will be given to illustrate dry definitions.
Receptor disorders are the most elementary signs of mental illness, to which experts refer such disorders:
- hyperesthesia is hypersensitivity to external stimuli that are perceived neutrally by people in a normal state. For example, the light seems too bright, the sounds are incredibly loud, the touches are hard. At the same time, in reality, the strength of the stimulus does not go beyond the threshold familiar to the body;
- hypesthesia is a decrease in sensitivity when objects appear shapeless, tarnished, toneless;
senestopathy – vague painful feelings that come from parts of the body – “burns”, “itches”, “pulls”, “presses”, although there are no grounds for them;
- metamorphopsies – incorrect perception of the size and shapes of the phenomena of the surrounding world: the illusion of the curvature of the space of the room, the apparent lengthening of the street or body;
- derealization is a very complex symptom when the patient feels the ghostliness of the material world. Objects are seen as in a dream, the sense of reality is lost, “previously seen” and “never seen” are practically not differentiated, well-known things seem unknown and vice versa;
- personified awareness – the patient, being in an empty room, simultaneously feels someone’s presence and is aware of his loneliness;
- violation of the awareness of time – it “moves” then accelerated, then slowly, then “it is not there”;
- apperception disorder – the patient cannot establish a connection between phenomena or understand the meaning of the phenomenon.
Disorders of the ability to navigate (in time, in a situation, on the ground, in one’s personality):
- confusion is a painful state of mind, perceived as extraordinary, attempts to find out: “What was it? What happened?”;
- depersonalization is a violation of the awareness of one’s personality, a person feels his own thoughts, feelings, actions of others, introduced, loses self-consciousness.
Disorders of feelings are a whole group of signs, some of them may occur in a healthy person as a result of the influence of some factors. Among them are:
- hyperthymia is a too cheerful mood, in which drives increase, violent activity develops, a person considers himself deprived of absolutely all diseases, looks optimistically into the future. Extreme severity – euphoria, ecstasy;
- hypo–thymia (depression) – despondency, sadness;
- dysphoria – a person is overcome by sullenness, gloom, anger, he becomes aggressive;
- fear is an extreme tension that arises when waiting for a certain threat;
- anxiety – a sense of threat from nowhere;
- lability – the patient’s mood changes without any reason;
- apathy is complete indifference to oneself and what is happening around;
- the feeling of loss of feelings is the emptiness of emotions experienced by the patient extremely strongly, when “both joy and sadness have disappeared.”
Disorders of mental activity are a variety of symptoms, some of them are evidence of very serious mental disorders. Among such signs are:
- acceleration of thinking – thoughts, associations, images are born too easily in a person, while there is a tendency to distraction. The extreme manifestation of the symptom is menthism – a stream of thoughts that cannot be controlled;
- inhibition of thinking – in the case when new associations and images arise with difficulty, because they are hindered by existing ones – is thoroughness of thinking. But when there is only one thought for a long time, and a person expresses it automatically in all situations, perseverance of thinking is diagnosed;
- incoherent thinking – the patient loses the ability to establish associative connections, cannot carry out elementary generalizations, analysis or synthesis;
- blockage of thinking is an unmotivated stop of the thinking process, thoughts and speech are cut off;
- paralogical thinking is a combination of ideas and images that cannot be compared.
Obsessions, also called obsessive phenomena:
- abstract obsessions (counting, mental reproduction of events and images);
- sensual obsessions (persistent unpleasant thoughts);
- an enduring feeling of disgust;
- blasphemous thoughts;
- mastering ideas – a person takes the fictional for the real, contrary to logical reasoning;
- obsessive compulsions – the patient has a desire to perform this or that action, it is impossible to resist this impulse;
- phobias are obsessive, unfounded fears. Today, almost 400 species have been described;
- obsessive doubts;
- obsessive actions – some of them are a protective ritual that protects against phobias, some arise by themselves. But at the same time, they are not all uncontrolled.
Delirium is the irreducible establishment of a connection between phenomena and incidents, devoid of valid grounds. It is accompanied by a belief that cannot be shaken, although illogicality, lack of motivated connections (crooked logic) are visible to the naked eye. Delirium completely takes possession of consciousness. Primary (interpretive) nonsense is distinguished, which is formed on the basis of real facts and incidents that have been processed, distorted and supported by a certain number of false or unmotivated arguments.
The second type of delirium is sensual (figurative), which necessarily occurs in combination with other disorders. It is evidence of an acute condition. Such nonsense is devoid of a system, it is fragmented and inconsistent. As a result of treatment, imaginative delirium may remain the only symptom. In this case, it gets the name residual. In some cases, induced delirium occurs in people who have been forced to contact a mentally ill person for a long time. It reflects the subject of the patient’s delirium, but after the contact is stopped, it quickly disappears. From delirium it is necessary to distinguish super-valuable ideas that arise as a result of certain circumstances, but occupy too significant a place in consciousness.
Perception disorders – they are false representations that arise involuntarily in the area of one or more analyzers:
- hallucinations are perceptions that occur when there is no real stimulus. They are presented as visions, sounds, smells, sensations (heat, cold). In reality, none of the above exists, although the patient does not doubt their reality;
- pseudo–hallucinations are perceived as actually existing “special” images that the patient perceives as the result of the action of an extraneous will, for example, a visible image behind his back, voices in his head;
- hypnagogic hallucinations are visions that appear in the dark field of vision immediately before falling asleep;
- hypnopompic hallucinations – appear at the moment of awakening;
- illusions are distorted perceptions of existing objects and phenomena characterized by the fact that the image of the present object is combined with the presented one;
- functional hallucinations – appear only when there is a real external stimulus, exists in parallel with it, without combining until the end of the impact. This may be a reaction to the noise of water, the sound of wheels, music, howling wind, etc.;
- reflex hallucinations – occur in the sphere of another analyzer, and not in the one that is directly affected by the stimulus.
Memory disorders. Memory gives us the opportunity to capture information “in the head” and reproduce it at the right moments. When a person has a memory disorder, he may have such conditions:
- fixation amnesia
- progressive amnesia
Amnesia implies a state when a person “erases from memory” certain events or the entire past entirely by his own decision. With the fixation type of amnesia, the patient cannot remember what is happening to him at the current time. With a progressive form of amnesia, the patient first forgets what happened recently, and gradually begins to forget more and more long-standing events. The term “confabulations” refers to false memories. That is, a person allegedly remembers those events that never happened to him.
Disorders of impulses. This is an increase or, conversely, a decrease in the dynamic properties of the personality. A person can be inadequately active or passive, too proactive or with no initiative at all. The main disorders of impulses:
A mental illness in which a person has increased willpower, active urges and the desire to realize desires is called hyperbulia. Akinesia means the absence of voluntary movements, which is why a person is immobilized. The opposite state is called raptus. A person with such a disorder has violent motor arousal, such patients can be aggressive.
Drive disorders. This group includes well-known disorders: anorexia and bulimia. Polydipsia is also included here; this is a condition in which a person constantly wants to drink. Among the drive disorders are also more complex diseases associated with sexual desire.
Impulsive actions and attraction. People with such mental illnesses do something unconsciously, without motivation. From the outside, the action can be described as ridiculous. Aggression may be present. This includes dipsomania, pyromania, kleptomania. The last of these disorders is widely known. It is characterized by the desire to appropriate other people’s things, even those that do not carry any value.
Speech disorders. The symptoms of this group are fixed mainly in neurological disorders. Among mental disorders, there are those associated with speech:
- broken speech
- symbolic speech
- cryptolalia , etc .
Syndromes of mental illness
Mental illnesses consist of certain syndromes. Syndromes are complexes of symptoms that are important for the diagnosis of the disease. By changing the syndromes, the doctor can recognize this or that mental deviation. Syndromes need to be accurately determined for the treatment and prognosis of the disease.
Psycho – organic syndrome
It is a consequence of organic brain damage, which occurs with brain tumors, intoxication, atherosclerosis of cerebral vessels and injury to this organ. The composition of the syndrome includes:
- weakening of understanding
- memory disorders
- incontinence of affect
- affective lability
There may be small delusional ideas that are aimed at the closest people. A person may think that he is constantly being watched, that a certain thing has been stolen from him, etc. In such patients, hallucinations, mainly auditory, are observed in some cases. Neurological symptoms are present in 100% of cases.
These are sudden, short-lasting states in which a person loses consciousness and makes convulsive movements (or other involuntary movements). Seizures can be different. A large epileptic seizure is common. In front of him, a person begins to have a headache, he becomes sluggish, hardly works. This condition lasts from 2 to 4 hours. Then there are hallucinations, there is a state of derealization. A person perceives the shape of objects that he sees differently. Vegetative disorders are typical for 2-4 seconds. Then the person faints, he begins a tonic contraction of the muscles of the body. He falls to the ground, screaming loudly. Then the so-called tonic convulsions begin, followed by clonic convulsions, in which foam flows from the mouth. After that, the person falls into a comatose state, and then falls asleep. After 2-4 hours, the patient returns to consciousness. He does not remember about convulsions and comatose state, he cannot tell.
Confusion of consciousness
A person either does not fully perceive reality, or perceives everything around him very indistinctly; there is a loss of orientation, thinking is disrupted, a person remembers events poorly. In case of confusion of consciousness, urgent medical help is needed. These states include the following:
- oneiroid, etc.
In the last of these states, a person sees scenes that do not exist in reality, and silently watches them, without trying to take part or escape. He remembers everything that happened.
With twilight confusion of consciousness, a person can commit acts that pose a threat to others. After the patient returns to normal consciousness, he characterizes what he has done as alien actions. There are also fugues. These are states in which a person commits stereotypical actions, and when consciousness returns, he does not remember what happened.
It can be like excitement, in which a person is distracted, mannered, his speech is not connected, thinking is disturbed, there are impulsive movements. And the second form of catatonic syndromes is completely opposite, it is called catatonic stupor. A person is flexible as wax, or his muscles become numb.
The condition of patients with this syndrome is characterized by speech and motor arousal. Behavior is characterized as mannered and silly, ridiculous actions are possible. Gaiety is not caused by external reasons. Often patients with this syndrome commit antisocial actions. Thinking is characterized at the same time as broken, there may be delusional states and fragmentary hallucinations. Catatonic symptoms are likely in some cases.
A person has a large number of hallucinations in which consciousness remains clear. Paranoid syndrome is typical, which in some cases has an acute beginning and end, etc. This includes the paraphrenic syndrome, which is characterized by fantastic delusions of greatness, systematic delusions of persecution, etc.
In a person with such mental illnesses, excessive attention is paid to health. He constantly has a fear of getting sick (and the fear may be in front of a certain pathology). Patients complain about their health, they can constantly make an appointment with a doctor, hypochondriacal delirium is likely. Hypochondriac syndromes are also characterized by delusions of physical disability. That is, the patient begins to believe that something is wrong in his appearance, and it is necessary to perform an operation as soon as possible to eliminate this flaw.
This includes the well-known manic syndrome. People with this diagnosis have accelerated thinking, hyperthymia is typical, they are very active. Depressive syndrome also belongs to this group of diseases, in which thinking slows down, movements become slow and smooth, hypo-thymia is characteristic.
This group includes:
- hysterical states
- phobia syndrome
A classic hysterical seizure is extremely rare today. A person in a fit falls to the floor (without hitting anything), makes expressive involuntary movements (very different from convulsions). In some cases, the body resembles an arc, since the patient rests on the ground / floor with his heels / feet and the back of his head. Pupils react to light normally.
This is a depletion of mental activity, which is irreversible. Moreover, the disease can be both congenital and acquired. The latter form is called dementia. It can be caused by poisoning of the central nervous system with medications or other substances, severe brain injury, encephalitis. Some of the cognitive functions of the patient may be reduced. A person has impaired attention, memory, etc.
Classification of mental illnesses
In classical psychiatry , the following classification is accepted:
- endogenous mental illnesses
- endogenously organic
- pathology of mental development
The last of these groups include psychopathy and oligophrenia (dementia, which is found in a person from birth). Psychogenic diseases are reactive psychoses and neuroses. Smoking and alcoholism, as well as symptomatic psychoses, are referred to as exogenous mental disorders.
Doctors evaluate the facial expression of the patient who needs to be diagnosed. They answer for themselves the question of how constant the facial expression is. This helps to identify the dominant affect. If the patient is angry or is in a state of excitement, there is a change of affective reactions, this should alert the specialist.
With orientation disorders, a person is absent-minded, he looks perplexed. The doctor may ask questions about where he is at the moment, how to go somewhere or drive. The patient may look around with a helpless look. With thinking disorders, speech is impaired. But, if the disorders are not rough, they are very difficult to identify, only an experienced specialist can cope with this.
Delirium manifests itself both in speech and in movements. Movements contribute to the realization of certain delusional ideas. For example, a patient may think that they want to kill him. Then he will do everything to stay safe. He can sit in a corner to have a wide field of view. He can pick up something heavy for defense, etc. If a person is not in a clinic, but freely acts and moves, he can contact the police. The specialist needs to remember that in such cases, no dissuasion with logical arguments will help. The reaction to disputes can be resentment of the patient, as well as his aggression directed at you.
With perception disorders, a person listens to any sounds, can carefully observe the environment around. Gestures and facial expressions give out what a person hears and sees in his “head”. If a person imagines terrible images in reality, he will run, cry or scream from fear, etc. Patients who hear sounds may plug their ears or search the room for where this sound comes from (melody or speech, in different cases in different ways). It should be borne in mind that hallucinations are not isolated, this is a manifestation of psychosis.
Such persons are dangerous to others:
- patients with imperative hallucinations
- older men who have paranoid delusions
- patients with dangerous behavior on the background of depressive or manic affect
- patients with delusions of jealousy
- people with drive disorders
- alcoholism, including abstinence, etc.