Chapter 12. Disorders of the Emotional and Volitional Sphere
5 topics with brief reviews: definitions, key facts, and class questions.
Emotions, drives, and will are the foundation of goal-directed human activity. In this chapter, we examine how this mechanism breaks down in mental illness: from mild mood fluctuations to severe catatonic states.
This section covers both isolated symptoms and full-blown syndromes. You will study individual disorders of emotion and will, pathological changes in drives, as well as basic affective and motor-volitional syndromes. Understanding these topics is the key to diagnosing schizophrenia, bipolar disorder, and personality disorders.
In graded tests and exams, professors most frequently require you to clearly differentiate affective syndromes (depressive and manic, along with their atypical variants), distinguish compulsive drives from obsessive ones, and recognize the types of catatonic stupor and excitement. The material is presented systematically so you can quickly extract the essentials for answering at the patient's bedside.
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 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).
In a compulsive drive, insight is preserved and the patient understands the pathological nature of the state, even though they cannot resist. In an impulsive act, insight is completely absent from the very beginning.
In a compulsive drive, insight is preserved and the patient realizes the impropriety of the urge, although volitional control is almost lost. In an impulsive act, both insight and the conflict of motives are absent.
How does apathetic depression differ from apathetic-abulic syndrome?
The decrease in volitional activity, dysphoria, and inactivity in apathetic depression are unstable and completely reversible states, whereas the apathetic-abulic syndrome represents a persistent process defect.
Do patients with apathetic-abulic defect realize their illness?
No, insight into the condition is completely absent. Patients do not consider themselves ill, do not suffer because of their defect, and do not present complaints.
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