Lecture
Non-psychotic disorders – symptoms and syndromes accompanied by an adequate assessment of one's surroundings, the presence of insight, and a striving in behavior to conform to socially accepted norms.
The criteria of the non-psychotic register are:
— the patient's retained capacity for a realistic reflection of reality. Distortions of the general picture of the world and of individual aspects of life are possible here as well, but they are, to a certain extent, amenable to correction by past and present experience;
— adequate social behavior overall, based on taking real relationships into account and on the dominance of non-morbid personality tendencies;
— the patient's clear understanding of the fact that he has mental deviations, together with a conscious striving to overcome and compensate for them.
Diagnosis
Among the most characteristic features of borderline psychopathology are:
- a neurotic level, functional character, and reversibility of the existing disturbances;
- vegetative "accompaniment," the presence of comorbid asthenic, dyssomnic, and somatoform disorders;
- a connection between the onset of the illness and psychotraumatic circumstances and personality-typological characteristics;
- egodystonicity (unacceptability to the patient's "self") of the morbid manifestations and the preservation of a critical attitude toward the illness.
Borderline psychopathology excludes:
- psychotic disturbances (delusions, hallucinations);
- progressively increasing dementia;
- severe personality changes, disturbances of thinking and behavior, and egosyntonicity (harmony, consonance with the patient's "self") of symptoms, which are characteristic of endogenous mental disorders
According to Myasishchev, the fundamental diagnostic criteria are:
1. The psychogenic condition is linked to the personality of the patient, to the psychotraumatic situation, and to the personality's inability, under the given specific conditions, to independently resolve it;
2. The onset and course of the neurosis are linked to the pathogenic situation and the personality's experiences, with a certain correspondence observed between the dynamics of the patient's states and changes in the psychotraumatic situation;
3. The clinical manifestations of the neurosis, in their content, are to a certain degree linked to the psychotraumatic situation and the experiences of the personality, to its main strongest and deepest strivings, representing an affective reaction, a pathological fixation on certain of its experiences;
4. a higher effectiveness of psychotherapeutic methods is noted with respect to the illness as a whole and to its individual clinical manifestations, compared with biological interventions.
Neurosis is characterized by:
1. the reversibility of the pathological disturbances, regardless of their duration;
2. the psychogenic nature of the illness, which is determined by the existence of a meaningful connection between the clinical picture of the neurosis, the features of the patient's system of relationships, and the pathogenic conflict situation;
3. the specificity of the clinical manifestations, consisting in the dominance of emotional-affective and somato-vegetative disorders.
+Therefore, in constructing pathogenetic psychotherapy, Myasishchev recommends striving not only to help the patient recognize the connection between psychotraumatic events and the system of relationships that are especially significant to him, but also to change this system as a whole — to restructure the patient's attitude toward his surroundings, and to correct his life positions and attitudes.
«If you cannot change your life, change your attitude toward it, and you will preserve your health».
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