Psychotic and Non-Psychotic Mental Disorders: Their Characteristics and Syndromes

All mental disorders are divided by severity into psychotic and non-psychotic.

Non-psychotic disorders – symptoms and syndromes accompanied by an adequate assessment of one's surroundings, the presence of critical insight, and a striving in behavior to conform to socially accepted norms.

Psychotic disorders (psychoses) are characterized by:
1) gross disintegration of the psyche - inadequacy of mental reactions and reflective activity in relation to processes, phenomena, events, and situations; the grossest disintegration of mental activity corresponds to a number of symptoms - the so-called formal signs of psychosis: hallucinations, delusions; however, the division into psychotic and non-psychotic levels is to a greater extent based on a clear syndromal orientation - paranoid, oneiroid, and other syndromes;
2) disappearance of critical insight (lack of criticism) - the inability to comprehend what is happening, the real situation and one's own place in it, and to predict the features of its development, including in connection with one's own actions; the patient does not recognize his own mental (pathological) errors, inclinations, or inconsistencies;
3) disappearance of the ability to voluntarily direct oneself, one's actions, memory, attention, thinking, and behavior based on one's real personal needs, desires, motives, assessment of situations, one's own morality, life values, and personality orientation; an inadequate reaction arises toward events, facts, situations, objects, people, and also toward oneself.

Non-psychotic disorders are characterized by:
1) adequacy of mental reactions to reality in content, often with an inadequate sharpening in intensity and frequency due to the fact that sensitivity and reactivity change sharply, and the occasion for a reaction becomes stimuli and situations that are insignificant or of little significance in strength, frequency, etc.
2) preservation of critical insight (though often, however, exaggerated, sensitively sharpened);
3) a limitation of the ability to regulate one's behavior in accordance with the laws of psychology, society, and nature, and situational dependence of psychopathological manifestations.

Non-psychotic disorders include:

• positive syndromes: emotional-hyperesthetic, affective (depressive and manic), neurotic (obsessive, hysterical, depersonalization, senestopathic, hypochondriacal);
• negative syndromes: mild mental retardation (debility), syndromes of acquired mental defect.

Psychotic disorders include:

• positive syndromes: psychotic variants of manic and depressive syndromes, paranoid and verbal hallucinosis syndromes, catatonic, paraphrenic (oneiroid), hallucinatory-paranoid (Kandinsky syndrome), clouding of consciousness (delirium, amentia, twilight state), paramnesias, convulsive and psychoorganic syndromes;
• negative syndromes: imbecility and idiocy, syndromes of mental defect with a decline in level and regression of personality, mental marasmus.

Diagnosis of non-psychotic disorders, comparison with psychotic disorders

The criteria for the non-psychotic register are:

— the patient's preservation of the capacity for realistic reflection of reality. Distortions of the overall picture of the world and of individual aspects of life are possible here as well, but they remain, to a certain degree, accessible to correction by past and present experience;

— adequate social behavior overall, based on an awareness of real relationships and the dominance of non-pathological personality tendencies;

— A clear understanding by the patient of the fact that he has mental disturbances, and a conscious striving to overcome and compensate for them.

Diagnosis of non-psychotic disorders

Among the most characteristic signs of borderline psychopathology are:

• - a neurotic level, functional nature, 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;
• - ego-dystonia (unacceptability to the patient's "self") of the pathological manifestations and 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 ego-syntonicity (harmony, consonance with the patient's "self") of symptoms characteristic of endogenous mental disorders

According to Myasishchev, the fundamental diagnostic criteria are:

1. The psychogenic disorder is connected with the personality of the patient, with a psychotraumatic situation, with the inability of the personality under these specific conditions to independently resolve it;

2. The onset and course of a neurosis are related to the pathogenic situation and the individual's experiences; a definite correspondence is observed between the dynamics of the patient's states and changes in the psychotraumatic situation;

3. The clinical manifestations of a neurosis are, in their content, to a certain degree related to the psychotraumatic situation and the individual's experiences, to her most powerful and deepest strivings, representing an affective reaction, a pathological fixation of one or another of her 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 pathological disturbances, regardless of its 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 relationship system, and the patient's pathogenic conflict situation;

3. the specificity of clinical manifestations, consisting in the predominance of emotional-affective and somatovegetative 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 the surrounding world, 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».

See also

• neuroses
• psychoses