Basic Concepts and Functions
In psychiatry, it is important to distinguish between the inner experience (emotion) and its external expression (affect — facial expressions, gestures, autonomic reactions). Although these terms are often used as synonyms, it is the affect that allows the physician to objectively assess the patient's condition.
Emotions perform three key functions:
- Signaling — rapid assessment of a situation (e.g., fear as a signal of danger).
- Communicative — transmission of up to 60% of information during communication via non-verbal stimuli.
- Behavior-forming — regulation of actions through conscience and evaluation of needs.
In mental disorders (e.g., depression), these functions are severely impaired: the situation is perceived in a distorted light, the capacity for empathy is lost, and behavior becomes maladaptive.
Classification of Emotions
It is customary to evaluate the emotional sphere according to several criteria:
- By valence: positive, negative, and indeterminate (surprise). Normally, polar feelings do not occur simultaneously. Their simultaneous presence is ambivalence.
- By intensity: from excessively strong (ecstasy, deep depression) to complete absence (indifference in apathy).
- By dynamics: mood (a prolonged, inert emotional state) and affect proper (in the narrow sense — a short-term violent reaction) are distinguished.
- By influence on behavior: sthenic (prompting action, excitatory) and asthenic (depleting strength, paralyzing the will).
Symptoms of Mood Disorders
Pathology manifests as the excessive expression of emotions or impairment of their mobility.
- Hypothymia — a persistent decrease in mood, sadness, and total pessimism. Unlike natural sadness, it is surprisingly persistent, independent of the current situation, and deprives one of the ability to experience joy. It may be felt physically as pain in the chest (vital sadness). This is the basis of depressive syndrome.
- Hyperthymia — an inappropriately elevated, joyful mood lasting for weeks. Patients are full of energy and optimism in spite of obstacles. It is the core of manic syndrome.
- Euphoria — a variant of hyperthymia manifested as inactive complacency. Patients are content with everything but lack initiative. It often indicates organic brain lesions (tumors) or severe intoxications.
- Moria — carefree, silly merriment and babbling characteristic of profoundly demented patients.
Dysphoria and Anxiety
- Dysphoria — sudden attacks of sullen malice, anger, and discontent. Accompanied by aggression, sarcasm, and cruelty. Frequently encountered in epilepsy, organic brain lesions, and withdrawal periods in substance-dependent individuals.
- Anxiety — a sthenic emotion, a premonition of an impending vague threat. The patient paces, experiencing muscle tension. This is a frequent early sign of any psychosis. In acute sensory psychosis syndrome, anxiety develops into perplexity (affect of bewilderment), when the patient seeks protection and does not understand what is happening.
Will, Drives, and Consequences of Apathy
Will is the inner strength that allows one to set goals and satisfy basic needs (comfort, safety, sexual drive, communication, parental instinct) while taking social norms into account. Weakness of will deprives the patient of patience and leads to antisocial acts driven by the urge to immediately satisfy a desire.
Loss of emotions and will (apathy and abulia) is often associated with damage to the frontal lobes of the brain. The consequences of apathy are severe:
- Reduced insight (the patient does not perceive problems).
- Impaired empathy.
- Decreased activity (abandonment of activity, as there is no boredom).
- Untidiness (shame and fastidiousness disappear).
Briefly: answers to topical questions
What symptoms make up the classical depressive triad?
The classical depressive triad consists of three symptoms:
- Decreased mood (hypothymia).
- Ideational retardation — slowed thinking.
- Motor retardation — slowed movements, which in extreme degrees can reach depressive stupor.
How does physiological affect differ from pathological affect?
The main difference between physiological affect and pathological affect is the state of the patient's consciousness and the resulting forensic psychiatric consequences.
| Sign | Physiological Affect | Pathological Affect |
|---|---|---|
| State of consciousness | Clear consciousness and understanding of the danger of actions are preserved | Based on twilight state of consciousness |
| Forensic psychiatric significance | Entails criminal responsibility | Serves as the basis for declaring the patient legally insane |
Physiological affect represents a form of reaction to a psychotraumatic event, whereas pathological affect is conditionally classified among emotional disorders.
What symptoms are included in the structure of manic syndrome?
The structure of manic syndrome includes the characteristic manic triad, as well as a number of additional disorders.
- Elevated mood (hyperthymia) — very good mood, optimism, and inflated self-esteem.
- Accelerated thinking (tachypsychia) — acceleration of thought processes.
- Psychomotor agitation — pronounced, always goal-directed motor excitation, in which activity is not seen through to completion due to distractibility.
Additionally, the syndrome is often accompanied by enhanced drives (hedonism, hypersexuality, increased appetite) and ideas of grandeur, which rarely acquire the character of true delusions.
"GHEDT" — the main symptoms of productive emotional disorders: Hypothymia (sadness), Hyperthymia (joy), Euphoria (complacency), Dysphoria (malice), Anxiety (anticipation of threat).
Class and exam questions
What is the difference between euphoria and hyperthymia?
In hyperthymia, the patient is full of energy, active, and proactive, whereas in euphoria, they are complacent, content with everything, but completely inactive (which often indicates an organic brain lesion).
What is vital sadness?
This is a severe degree of hypothymia, when depression is felt on a physical level—as real pain, a "weight on the chest", or tightness in the precordial region.
Why should a physician monitor non-verbal manifestations if the patient says everything is fine?
Due to the clinical rule: when there is a discrepancy between the speech content and the patient's external appearance (affect), the affect is considered a more accurate indicator of the true internal state.
What else to study on this topic
- Oneiric clouded state and states of ecstasy
- Interhemispheric asymmetry in the evaluation of emotions
- Ambivalence and ambitendency as classical symptoms of schizophrenia
- Panic attacks in the structure of anxiety disorders
- Hierarchy of motives and mechanisms of drive suppression
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Other topics in "Chapter 12. Disorders of the Emotional-Volitional Sphere"
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