Reduction and distortion of emotions
Changes in emotional background can be either deficit (negative) or productive in nature. Some mild manifestations occur even in healthy individuals prone to deep introspection.
- Apathy — a negative symptom, complete indifference to loved ones, events, and one's own appearance. Speech becomes monotonous. A specific marker of apathy: inability to make an emotional choice (the patient cannot answer whom they love more or which food tastes better). In schizophrenia, apathy develops in stages: from blunting of reactions to emotional coldness and, finally, dementia. It also occurs in lesions of the frontal lobes of the brain.
- Anaesthesia psychica dolorosa (Anaesthesia psychica dolorosa) — a typical manifestation of depressive syndrome. Unlike apathy, emotions are preserved, but the patient suffers agonizingly from the feeling of their own numbness (inside "like a block of wood" or an "empty tin can"). Often combined with delusions of self-blame.
Disorders of emotional dynamics
This group includes pathological mobility or, conversely, fixation of affect.
- Emotional lability — extreme mobility and ease of changing emotions (from laughter to tears). Feelings are superficial and quickly forgotten. Characteristic of hysteria, acute psychoses with clouded consciousness (delirium), and dementia.
- Symptom of feeble-mindedness — emotional weakness, loss of control over tears. The patient deeply experiences even trifles, cries from emotion and sympathy. This is a typical sign of vascular brain diseases (cerebral atherosclerosis), often occurring in elderly people who previously possessed a strong will.
- Emotional rigidity — inertia of emotions, the tendency to dwell on grievances for a long time (vindictiveness, stubbornness). Manifests in speech as circumstantiality (viscosity). Found in epilepsy and in psychopathic personalities with a tendency to fixation.
Quantitative disorders of volition
Patient behavior does not always match their declarations. For example, an addict may claim they are in control, but continue to commit offenses.
- Hyperbulia (in mania) — a total increase in drives. Appetite, sexual drive, and the need for communication and care increase. Patients are intrusive, ready to defend everyone in sight (forgetting about their own children). At the same time, strong will is preserved, so they are not prone to gross crimes.
- Hypobulia (in depression) — a temporary decrease in all needs. Appetite disappears (patients must be fed through persuasion), the instinct of self-preservation is suppressed (suicidal attempts). Characteristic is a sense of guilt for one's helplessness (e.g., inability to care for an infant in postpartum depression).
- Abulia — a persistent loss of higher social needs (no interest in communication, entertainment, work). The key difference from hypobulia: physiological instincts (food, sex) are preserved, but satisfied in the most primitive way (the patient asks neighbors to feed them or inappropriately pesters relatives).
Parabulias and degrees of drives
Perversions of drives (parabulias) are recognized as pathological if they lead to social maladaptation. These include appetite disorders (bulimia, anorexia, eating inedible items—pica, coprophagia) and the urge for antisocial acts (kleptomania, dromomania, pyromania, gambling).
Pathological drives are divided into three degrees:
- Obsessive — the patient can control the urge, but refusal to act causes severe distress (obsessive-compulsive disorder, early stages of addictions).
- Compulsive — an irresistible urge equal to a vital thirst. Attempting to restrain oneself causes unbearable physical discomfort. Internal struggle quickly gives way to action, despite punishment (withdrawal syndrome, psychopathies).
- Impulsive — occurs instantly, without a struggle of motives or deliberation. Often occurs against the background of narrowed consciousness (with partial amnesia). Actions are absurd and devoid of meaning.
Briefly: answers to topical questions
What symptoms make up the classical depressive triad?
The classic depressive triad consists of three main symptoms:
- Lowered mood (hypothymia) — the main syndrome-forming sign, manifested by anguish, depression, and sadness unrelated to the real situation.
- Thinking deceleration (associative inhibition or ideational inhibition) — impoverished, monosyllabic speech, prolonged deliberation on answers, difficulties with comprehension.
- Motor retardation (motor retardation) — stiffness, slowness, clumsiness, up to depressive stupor.
What clinical manifestations are characteristic of manic syndrome?
Manic syndrome is characterized by a classic triad of symptoms, as well as changes in self-esteem and drives.
- Elevated mood (hyperthymia) — very good mood, optimism.
- Accelerated thinking (tachypsychia) — acceleration of thought processes.
- Psychomotor agitation — pronounced, always purposeful motor activity that the patient fails to complete due to distractibility.
Additional manifestations include inflated self-esteem, delusions of grandeur, and hyperbulia (increased appetite, hypersexuality, hedonism, obsessive desire for communication, and altruism).
What autonomic disorders are included in Protopopov's sympathicotonic triad?
Protopopov's sympathicotonic triad, characteristic of depressive syndrome, includes:
- Tachycardia.
- Pupillary dilation (mydriasis).
- Constipation.
To memorize the stages of drives, use the rule "OCI": Obsessive (can endure, but tormented by thoughts), Compulsive (physically painful to endure, giving in), Impulsive (done instantly, without hesitation).
Class and exam questions
What is the main difference between apathy and mournful insensitivity?
In apathy, emotions truly disappear (a negative symptom), and the patient is indifferent. In mournful insensitivity (scorbsnoye bessuvstviye), emotions are preserved, but the patient subjectively feels "empty" and suffers greatly from this (a productive/positive symptom).
How to distinguish hypobulia from abulia?
Hypobulia is a reversible suppression of absolutely all drives, including basic ones (appetite, self-preservation). In abulia, only social needs disappear, while physiological desires (food, sex) remain and are satisfied in a primitive way.
Why do patients with hyperbulia rarely commit dangerous crimes?
Despite sharply increased instincts, such patients retain a strong will. They may be overly intrusive or flirtatious, but are not prone to sexual assault or gross illegal acts.
What else to study on this topic
- Formation of the apathetic-abulic syndrome in the progressive course of schizophrenia.
- Eating behavior perversions (anorexia nervosa, bulimia, pica).
- Specificity of impulsive actions and twilight state of consciousness.
- Differential diagnosis of hysterical lability and vascular feeble-mindedness.
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Other topics in "Chapter 12. Disorders of the Emotional-Volitional Sphere"
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