Lecture
Syndrome – a regular combination of symptoms that are interconnected by a common pathogenesis and correspond to specific nosological forms.
A.E. Shcherbak (1901) regarded syndromes as a typical form of mental reaction, as the brain's response to the action of a noxious factor, the mechanisms of which are due to disturbances in the area of interneuronal contacts. According to the author, a disease manifests itself in various combinations of symptom complexes and in a certain sequence of their change over the course of its progression. The same psychopathological syndrome in different mental illnesses «acquires a distinctive tint (a nuance of the clinical picture)».
A syndrome («running together» of symptoms) is a set of symptoms sharing a common mechanism of development. A symptom by itself, outside a syndrome, is devoid of clinical meaning. Isolated disturbances of mental functions are found in most healthy individuals. Pathological phenomena have a systemic character and are expressed in the form of syndromes. The clinical picture of a disease, in both its static and dynamic aspects, is made up of syndromes and the regular sequence of their change — pathokinesis. The concept of «syndrome» should be distinguished from that of «symptom complex». A symptom complex is most often understood as the set of symptoms characteristic of a given disease. In another interpretation, a symptom complex is the sum of all disturbances identified in a patient at the time of examination.
The set of all symptoms identified during the examination of a particular patient forms a symptom complex.
In the course of mental illness, the relationship between the biological and the social changes substantially. Temporarily or for a longer period, natural-psychic phenomena may become established: disinhibition of drives in psychopathy-like states; regression of the psyche to an earlier developmental level in organic diseases, schizophrenia, and sometimes even in psychogenic (hysterical) disorders. In these cases motor stereotypies, echopraxia, echolalia, motor automatisms, loss of motor skills, and exaggerated timidity appear.
The doctrine of syndromes was significantly influenced by the concept of the evolution and dissolution of mental activity put forward by the eminent Scottish neurologist Jackson (1884). Its main tenets are as follows:
— mental activity is carried out by hierarchically arranged levels or centers, with the activity of the lower centers being regulated by the higher ones;
— when the higher levels are damaged or temporarily switched off, the activity of the lower ones does not cease;
— the consequence and clinical expression of the loss of function of the higher centers is negative symptomatology, while productive symptoms arise as a result of the release of activity of the lower centers and are not in a direct causal relationship with the disease;
— the clinical picture of the resulting mental disorders is also determined by differences in the rate at which the disintegration (dissolution) of mental activity occurs;
— neurological disorders are caused by a more localized dissolution, whereas mental disorders are caused by a global, uniform, «unitary» one.
Productive (positive) and negative (deficit) psychopathological syndromes are distinguished.
Productive symptoms – a nonspecific reaction of the psyche to the etiological factors of a disease. Qualitatively new mental manifestations associated with the illness (hallucinations, delusions, catatonic disorders).
Negative symptoms – reversible or persistent damage, impairment, or defect caused by the pathological process itself as a result of one or another morbid mental process (depletion of mental processes, disharmony of personality, decline in energy potential, decline in the level of personality, personality regression, dementia, amnesia, abulia, apathy).
Productive psychopathological syndromes are more dynamic formations; they most often indicate an active course of the morbid process and are considered to be relatively less specific for a particular disease than deficit symptom complexes.
In reality, both types of disorders are internally interconnected and appear in unity, which determines the clinical features of the disease both in its «cross-section» and in its dynamics, «along its length».
Positive and negative symptoms in the clinical picture, as a rule, have an inversely proportional relationship: the more pronounced the negative symptoms, the sparser, poorer, and more fragmentary the positive ones.
Registers of productive syndromes
Asthenia and emotional-hyperesthetic disorders.
Affective (depressive and manic).
Neurotic (phobias, obsessions, hysterical, hypochondriacal).
Paranoid, verbal hallucinosis.
Hallucinatory-paranoid, paraphrenic, catatonic.
Clouding of consciousness (delirium, amentia, twilight state).
Paramnesias.
Convulsive.
Psychoorganic.
dysontogenetic symptom complexes
Dysontogenesis – a disturbance in the rate and timing of the development of the psyche as a whole and of its individual components, a disturbance in the relationship among the components of the child's developing psyche. It is based on phenomena of «maturation dysfunction», expressed in the prolonged fixation of transient modes of neuropsychic reactivity characteristic of a given stage of postnatal ontogenesis.
dysontogenetic symptom complexes
May be determined by biological factors or by unfavorable microsocial and psychological influences.
Biological factors participate in the formation of the neuropsychic state, interacting with factors of the socio-psychological environment, while deviations of the psyche caused by environmental influences are fundamentally based on mechanisms of transition from the socio-psychological, through the natural-psychological, into neurodynamic changes.
a variant of dysontogenesis: retardation – a delay in the timely development or maturation of one or several functional systems of the organism (mental retardation, developmental delay, psychic infantilism).
There is a delay in the transition of natural-psychological functional systems into more complex socio-psychological formations, which leads to the insufficiency of the latter.
Productive disorders
Productive disorders can be of two types:
— associated with primary impairment of mental functions (for example, acute psychoses);
— caused by regression of the personality and the release of uncontrolled activity of underlying structures (for example, secondary catatonia).
There are deficiency disorders of two types:
— not accompanied by productive disturbances;
— developing in unity with productive disturbances, according to Jackson's concept
There are two relatively independent lines of development of negative disorders:
— manifesting from the very onset of the illness (disorder) as total changes of the personality. The scale of the latter may be as follows: asthenic decline in the level of personality functioning — accentuation and psychopathization of the personality, including various forms of its pathological development — dissociation of the personality — regression of the personality, for example, secondary infantilism — partial and then total dementia;
— beginning with changes in individual mental functions (attention, memory, etc.) and progressing up to a certain point without change in the personality as a whole. After this, both lines of personality disorders «merge». The mechanisms of personality integration often continue to function even in the presence of significant local disturbances.
Productive and deficiency-type mental disorders are revealed both during the processual stage of the illness and upon its completion.
the concepts «productive» and «processual», and correspondingly «deficiency-related» and «defective», are not identical.
Processual symptomatology, characterizing the active course of the illness, is marked by a certain dynamic — a regular succession of some psychopathological phenomena by others, a gradual increase in negative disorders. Excluding the defect phenomena that form in the process, this symptomatology is largely reversible.
Post-processual disturbances — phenomena of an actual mental defect (both negative and productive symptoms) — are more stable, persistent, and their possibility of reverse development is less evident.
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