Lecture
All mental disorders are traditionally divided into two levels: neurotic and psychotic.
P. B. Gannushkin proposed calling the entire group of non-psychotic mental disorders «minor» psychiatry, while V. A. Gilyarovsky called it «borderline» psychiatry.
The concept of borderline mental disorders is used to denote mildly expressed disturbances that border on a state of health and separate it from actual pathological mental manifestations accompanied by significant deviations from the norm. Disorders of this group disrupt only certain spheres of mental activity. Social factors play a significant role in their emergence and course, which, with a certain degree of convention, allows them to be characterized as a breakdown of mental adaptation. The group of borderline mental disorders does not include neurotic and neurosis-like symptom complexes that accompany psychotic (schizophrenia, etc.), somatic, and neurological disorders.
Borderline mental disorders according to Yu. A. Aleksandrovsky (1993)
1) predominance of the neurotic level of psychopathology;
2) association of the mental disorder with autonomic dysfunctions, disturbances of nocturnal sleep, and somatic disorders;
3) the leading role of psychogenic factors in the emergence and decompensation of morbid disturbances;
4) the presence of an "organic" predisposition (minimal brain dysfunction) that facilitates the development and decompensation of the illness;
5) the interrelation of morbid disturbances with the personality-typological characteristics of the patient;
6) preservation of insight into one's own condition and the main morbid disturbances;
7) absence of psychosis, progressive dementia, or personality-related endogenous (schizophreniform, epileptic) changes.
The most characteristic features of borderline psychopathology:
neurotic level = functional nature and reversibility of the existing disturbances;
autonomic "accompaniment," the presence of comorbid asthenic, dyssomnic, and somatoform disorders;
the connection between the onset of the illness and psychotraumatic circumstances and
personality-typological characteristics;
ego-dystonicity (unacceptability to the patient's "self") of morbid manifestations and preservation of a critical attitude toward the illness.
Neurotic disorders (neuroses) — a group of psychogenically conditioned morbid states characterized by the partial nature and ego-dystonicity of their diverse clinical manifestations, which do not alter the individual's self-awareness or awareness of the illness.
Neurotic disorders disrupt only certain spheres of mental activity, are not accompanied by psychotic phenomena or gross behavioral disturbances, but they can nevertheless significantly affect quality of life.
Definition of neuroses
Neuroses are understood as a group of functional neuropsychic disturbances that include emotional-affective and somato-autonomic disorders caused by psychogenic factors leading to a breakdown of mental adaptation and self-regulation.
A neurosis is a psychogenic illness without organic pathology of the brain.
A reversible disturbance of mental activity caused by the effect of psychotraumatic factors and proceeding with the patient's awareness of the fact of their illness and without disturbance of the reflection of the real world.
The doctrine of neuroses: two tendencies:
1. Researchers proceed from recognizing the determinacy of neurotic phenomena by certain pathological mechanisms of a biological nature, although they do not deny the role of psychological trauma as a triggering mechanism and possible condition for the onset of the illness. However, the psychotrauma itself in this case acts as one of several possible and equivalent exogenous factors disrupting homeostasis.
Within the framework of negative diagnosis the absence of disturbances of another level is indicated, i.e., of neurosis-like and pseudoneurotic disorders of organic, somatic, or schizophrenic origin.
2. The second tendency in studying the nature of neuroses consists in the assumption that the entire clinical picture of a neurosis can be derived solely from psychological mechanisms. Proponents of this direction believe that information of a somatic nature is fundamentally inessential for understanding the clinical picture, genesis, and therapy of neurotic states.
The concept of positive diagnosis of neuroses is presented in the works of V. N. Myasishchev.
Positive diagnosis stems from recognizing the substantive nature of the category of the “psychogenic.”
V. N. Myasishchev's concept In 1934
V. N. Myasishchev noted that neurosis represents a disorder of the personality, primarily a disorder of personality development.
By illness of the personality he meant the category of neuropsychiatric disorders caused by the way the personality processes or experiences its reality, its place, and its fate within that reality.
Neuroses are based on contradictions between the personality and aspects of reality significant to it, which are resolved unsuccessfully, irrationally, and unproductively, giving rise to painfully distressing experiences of:
failures in life's struggles, unsatisfied needs, unachieved goals, irreplaceable loss.
The inability to find a rational and productive way out entails psychic and physiological disorganization of the personality.
+Neurosis is a psychogenic (as a rule, conflict-generated) neuropsychiatric disorder that arises as a result of a disruption of especially significant life relationships of the personality and manifests in specific clinical phenomena in the absence of psychotic phenomena.
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