General psychiatry (psychopathology). Psychiatry - brief summary Psychiatry
Psychiatry is the science of recognizing and treating mental illness.
This formulation, which dates back to W. Griesinger (1845), in its main features accurately formulates the tasks facing psychiatry, if we keep in mind that recognition, along with the assessment of the clinical picture, is also based on the study of the course, etiology, pathogenesis and outcome of the disease , and treatment also includes issues of prevention and rehabilitation of patients. It can be considered that this definition quite fully reflects the scope of the concept, since the object of study is not only psychoses (in which the behavior of patients is grossly disturbed and contrary to generally accepted norms), but also neuroses and psychopathy, neurosis-like and psychopath-like states, when there is no obvious inadequacy. In other words, the object of psychiatric research is a wide range of mental disorders of the neurotic and psychotic register.
The achievements of modern medicine in the ways of comprehensive study of patients show that psychiatric analysis turns out to be fruitful, and therefore necessary, in many cases of somatic diseases. We are talking about such frequent and severe physical suffering as diabetes mellitus, thyrotoxicosis, gastric ulcer, bronchial asthma, hypertension, coronary heart disease and other so-called “psychosomatic” diseases. Their peculiarity is the fact that the symptoms of the disease are somatic, and the most important link in the pathogenesis is neurogenic. Taking into account the above, we can summarize (as V.N. Myasishchev emphasized) that psychiatry is the science not only of mental illnesses, but also of human diseases in general in their neuropsychic conditionality.
Recognition of a disease begins with an assessment of its clinical picture, with an analysis of symptoms, psychopathological syndromes and nosological criteria of the disease. In this regard, a difficult question immediately arises about the specificity of the clinical manifestations of the disease and, above all, psychopathological syndromes. To date, in our science, the position about the non-specificity of psychopathological syndromes is indisputable, since the same syndrome can be observed in a wide variety of diseases (for example, amentive syndrome - in infectious, somatogenic, toxic and other psychoses). To explain this interesting clinical fact, K. Bonhoeffer (1910) invoked the theory of an intermediate poison, supposedly affecting the brain of patients and thus leveling the specificity of specific external hazards and the psychopathological disorders caused by them. However, this theory was abandoned. To understand the phenomenon of nonspecificity of psychopathological syndromes (and in particular - on the model of exogenous type of reactions), it is necessary to take into account the complex structure of the pathogenetic mechanisms of any mental disease, which consists of both pathological phenomena (pathological inertia of nervous processes, diseased areas of the cerebral cortex, etc.), as well as protective phenomena and, above all, transcendental inhibition and phase states. At one time, the author of this book, through experimental and clinical research, proved that the non-specificity of syndromes of exogenous type of reactions is explained by the widespread participation in their cerebral pathogenesis of the protective mechanism of transcendental inhibition. This corresponds to the position of A.G. Ivanov-Smolensky (1933) that the body responds to countless environmental hazards with a limited number of its protective reactions.
Consequently, the starting point for understanding the nonspecific nature of psychopathological syndromes is the fact that their structure always (to a greater or lesser extent) involves both intrinsic pathological and protective phenomena, in particular in the form of extreme inhibition at various levels brain. These circumstances emphasize the extremely great importance of psychopathological syndromes (along with their clinical informativeness) for understanding the pathological process as a whole, since they reflect the underlying pathophysiological disorders of higher nervous activity (HNA), i.e., cerebral pathogenetic mechanisms of the disease.
The struggle between syndromological and nosological directions in psychiatry that arose a century ago at the present stage is naturally resolved in favor of the latter with its multidimensional approach to understanding mental illnesses, their diagnosis and treatment. But this does not in any way devalue psychopathological syndromes, which, within the framework of the nosological approach, on the contrary, acquire even greater importance, since they contain valuable clinical, pathogenetic and prognostic information. As is known, more than a century ago, K. Kahlbaum (1882) emphasized the special importance for psychiatrists of the transformation of psychopathological syndromes, since, in his opinion, complete clarity about this status of the patient makes it possible to fairly reliably judge the subsequent stages of the development of psychosis and its previous forms.
In this regard, the question of using patterns of transformation of psychopathological syndromes in substantiating the final nosological diagnosis in psychiatry deserves special attention. After all, if each specific psychopathological syndrome externally expresses a certain structure of cerebral pathophysiological disorders, then the mutual transition, the change of syndromes is determined by the expansion and deepening of these cerebral pathophysiological disorders, or, on the contrary, by their limitation and weakening. And although all this is very important pathogenetic knowledge about the disease, in clinical terms it reflects only syndromological, but not nosological psychopathological disorders.
Thus, bearing in mind the well-known concepts of the exogenous type of reactions and the preference of psychopathological syndromes to certain diseases [Kerbikov O. V., 1947], the issue of the nosological role of the transformation of psychopathological syndromes should be resolved only by taking into account everything that was said above on this issue. Everyday clinical experience shows that both psychopathological syndromes themselves and their change or transformation are nonspecific for mental illnesses. This clearly appears, for example, in the mutual change of such syndromes as delirious, amentive and asthenic, which is characteristic not only of infectious, but also of somatogenic, toxic and some other psychoses. The same can be said about the mutual transitions between manic and depressive syndromes, which are observed not only within the framework of circular psychosis, but also in late traumatic and residual organic psychoses. In the latter cases (with a very mild, “openworked” residual organic lesion of the central nervous system), the differential diagnostic distinction with circular psychosis turns out to be so difficult, almost insoluble, that the clinical psychiatrist is once again convinced that the boundaries in our pathology are not so much separated as connect.
When making a final nosological diagnosis in psychiatry, first of all, the clinical picture of the disease is taken into account, starting with the status of the patient, which is based on the syndrome, and such parameters of the disease as its course, the nature of the outcome, issues of etiology and pathogenesis. Naturally, the clinical picture of mental disorders is the basis for diagnosis. But the patient’s status is not only a syndrome, it is also those most important disorders that are united by the concept of nosological features (i.e., specific features) of psychopathological syndromes. Since psychopathological syndromes reflect only general pathological patterns, then, for all their information content and genetic “sound,” they (as well as their transformation) cannot be the basis of nosological diagnosis.
It has now been established that the cause-and-effect relationship between pathogenic factors and the clinical picture of the disease is manifested in the specifics of clinical symptoms, i.e., in particular, in the nosological features of psychopathological syndromes. The syndrome as such is uniform in its structure for various mental illnesses, but within the framework of different diseases it also contains special, each time different features introduced according to different etiology. And it is they, expressing the particular pathological patterns of the disease process and its cause-and-effect relationships (of course, taking into account the course, pathogenesis and outcome of the disease), that can be the basis of a nosological diagnosis.
PSYCHIATRY
(from Greek psyche - soul and iatreia - treatment) , a branch of medicine that studies the causes, manifestations and treatment of mental illness. The history of this medical specialty is fundamentally different from the history of therapy or surgery. The history of psychiatry, from the distant past to almost the present, is a history of human dramas and strong passions, fanatical prejudices and cruel persecutions. Only in recent decades has psychiatry emerged as a modern, respected science. The reasons that it developed in ways other than therapy or surgery, and for so long won the status of a legalized branch of medicine in the public and professional consciousness, lie primarily in the special nature of mental illnesses themselves. For many centuries, people suffering from mental disorders were not considered sick. They were accused of having entered into a forbidden and shameful alliance with the devil, of maintaining relationships with sorcerers, witches and other evil spirits, of being bewitched, succumbing to spells, diabolical spells, and guilty of sinful acts, horrific and disgusting crimes. They were mercilessly persecuted and many were burned at the stake. Those few doctors who tried to convince rulers and people that “crazy people” were just sick people requiring attention and care risked their professional reputation and sometimes their lives. The following two examples are taken from the history of the Old and New Worlds. In 1636 in Konigsberg (Germany) a certain man declared himself God the Father; he felt that the angels, the devil and the Son of God recognized his authority. This man was accused and convicted. His tongue was torn out, his head was cut off, and his body was burned to ashes. Half a century later, in the Massachusetts town of Salem, several women in similar circumstances were accused of witchcraft, convicted and hanged. There is no need to go into the disgusting details of the trial of the so-called. "Salem witches". We now know that in both of these cases (as in many others) innocent people suffering from mental illness were executed. From the descriptions of hallucinations and other symptoms contained in old chronicles, we can get an idea of the diseases that determined the behavior of numerous "sorcerers" and "witches" condemned in those days. Most of the “witches” and their “assistants” who were burned at the stake suffered from schizophrenia, some from hysteria or dementia; Among them there were also neurotic individuals or simply dissidents. Schizophrenia is still the most serious mental illness today. The overwhelming number of psychiatric patients requiring hospitalization are people suffering from schizophrenia or related conditions. Many people today are ashamed that they themselves or their relatives have a mental illness. A visit to a psychiatrist or psychotherapist is often kept secret and can cause, at least in some people, a contemptuous attitude, expressed in such commonly used words as “nuts”, “crazy”, “crazy”, etc. Such attitudes show that the diagnosis of mental illness still remains a stigma, and reflects the hostility of the “healthy” and “normal” towards those considered “abnormal” and “crazy”. In this regard, further educational work is needed to explain the nature of mental illness and the nature of modern psychiatry. By their nature, people are irrational beings, or at least not only rational ones. Their preferences and prejudices, desires and sympathies, motivations and aspirations are determined not only by reason, but also by the struggle hidden in the depths of the personality, waged by internal, often unconscious forces. Our attitude towards strangers, towards parents, children, friends, teachers, competitors and our entire environment also depends not so much on reason and logic, but on feelings, emotions and experiences gained primarily in childhood. The normal functioning of the entire body, especially the brain, endocrine glands, gastrointestinal and cardiovascular systems also affects the course of these processes and helps maintain the balance of physical and mental strength, which is a condition for mental health. Thus, pathological, inappropriate human behavior (observed in various mental illnesses) can be explained by the influence of these underlying factors and psychological experience.
Mental disorders. One of the most common mental disorders is alcoholism. Psychological studies of the personality of alcoholics have shown that they are characterized by such traits as deep-seated, internal anxiety, quarrelsomeness, and a tendency to shift blame to others. It is becoming, however, increasingly obvious that these and other traits can be both the cause of alcoholism and its consequence, and the idea of the presence of the so-called. alcoholic personality traits remain unsaid. Currently, the development of alcoholism is associated not so much with a specific personality type, but with a combination of deep psychological, physiological and social factors. Moreover, the term “alcoholism” is used less and less by specialists, since it does not differentiate the various degrees of the disorder. For its most severe form, the term “alcohol dependence” is used; it should be distinguished from “drunkenness” and “alcohol abuse” as less severe disorders.
see also ALCOHOLISM. Addiction to other substances, such as drugs, hallucinogens, narcotics, or tobacco, can also be caused by a combination of psychological and social factors. The dangers associated with addiction and the severity of toxic complications depend on the chemical nature of the substances used. When using most of these drugs, there is a tendency to form mental dependence, i.e. habits only to the pleasure received, and not to the physical need for the drug.
see also DRUG ADDICTION. Schizophrenia (from the Greek schizein - splitting and phren - mind) is one of the “major” mental disorders. It is usually a chronic and gradually developing disease that often begins in adolescence or young adulthood. It has a wide variety of symptoms that gradually progress, increasingly limiting the patient’s capabilities until they finally affect his entire personality, affecting behavior, emotional reactions, thinking and life.
see also SCHIZOPHRENIA. Paranoia (delusional disorder). Previously, this condition was defined as a syndrome associated with schizophrenia, but now paranoia is considered as an independent type of mental disorder, which is characterized by a tendency to blame people and attribute malice to them. In many cases, unfounded suspicion, mistrust, jealousy and envy, suspiciousness, fear of persecution and ideas of grandeur prevail. These symptoms are often combined into a kind of delusional system.
see also PARANOIA. Manic-depressive psychosis is a severe mental illness that mainly affects the mood of patients. It is also called bipolar affective disorder. The disease is characterized by repeated attacks of manic agitation followed by periods of depression. Between these attacks, patients may return to normal. During the manic phase, the mood is so elevated that anxiety, insomnia, racing thoughts, increased aggressiveness and irritability occur. During the depressive phase, which can last for weeks and months, there is mental retardation, expressed in slower physical and intellectual activity, general fatigue, apathy, feelings of failure, hopelessness, personal sinfulness, as well as hypochondriacal ideas and ideas that life is leaving the body , health is forever lost, death is approaching. Depression is usually accompanied by a significant decrease in self-esteem. This is often noticeable in a person’s appearance and behavior. In severe depression, there is a constant risk of suicide as self-destructive tendencies spiral out of control.
Depressive disorder. Similar tendencies towards self-blame, self-deprecation, and often self-destructive behavior also prevail in another type of mental depression - recurrent (i.e., recurring) depressive disorder. This disease is also called unipolar depression, since it (unlike manic-depressive psychosis) does not cause manic episodes. It is most often observed between the ages of 25 and 45, although it can occur in adolescence. Women get sick twice as often as men. The advanced stage of depression is accompanied by painful and gloomy feelings. Family, friends, social activity, professional pursuits, hobbies, books, theater, company - all these diverse interests lose their attractiveness for the patient. He is overwhelmed by one feeling: “No one needs me, no one loves me.” Under the influence of this feeling, all ideas about life change. The present seems gloomy, the future devoid of hope. Life itself is perceived as a joyless burden. Everyday problems, once unnoticed or easily solved, grow to insurmountable proportions. Exhortations to “get rid of the bad mood” or “pull yourself together” are usually useless. The danger of suicide, as with manic-depressive psychosis, remains as long as the depressive state lasts. The old saying that people who threaten to commit suicide never do so does not apply in this case. No other disease has such a high percentage of patients attempting suicide. Organic psychoses are deep mental disorders caused by one or another damage to brain tissue. Both rapidly developing acute and quite severe mental disorders and chronic protracted disorders are possible. The differences between acute and chronic organic psychoses concern not only the nature, but also the prognosis, as well as treatment. The causes of organic psychoses can be infectious diseases, poisoning, hallucinogenic states (alcoholism or drug addiction), metabolic disorders, neurosyphilis, tumors and other brain diseases, and hormonal pathologies. These organic causes cause pronounced changes in the structure and function of brain tissue. Such changes, accompanied by damage to the blood vessels of the brain, can lead to mental disorders, which often resemble mental illnesses caused by psychological factors. Meanwhile, these two types of psychoses differ both in their origin and in the clinical picture of disease progression.
Causes of mental illness. Although the essence of “major” mental disorders still remains unclear, the causes of some mental illnesses have already been established, and specialists diagnose and clinically study them. First of all, this applies to mental disorders associated with organic diseases (such as traumatic brain injuries, infections or other brain disorders arising from concussions, syphilis, tumors, cerebral atherosclerosis), poisoning with toxic substances (alcohol, drugs, lead , mercury, etc.), deficiency of certain nutrients and vitamins (for example, with pellagra), endocrine and metabolic disorders, mental retardation, aging. This group also includes epidemic viral encephalitis, postencephalitic parkinsonism (shaking paralysis), as well as delirium (stupefaction with hallucinations, delirium and motor agitation) associated with alcoholism, acute infectious hepatitis, trichinosis, typhus and other diseases accompanied by high fever . Structural damage to the brain can cause epileptic seizures. In general, any damage to brain tissue can cause disruption of its functions, manifested by more or less pronounced disorders of thinking, emotions or behavior. The most important mental illnesses include psychoneuroses (such as hysteria or neurasthenia), psychosis, drug addiction and other types of pathological behavior. The significance of these disorders is determined by their extremely high prevalence and profound, often destructive impact on the personality and work ability of patients. Most of these conditions appear to be due to psychological rather than physical reasons. Even diseases such as alcoholism or drug addiction can be considered variants of emotional disorders and treated accordingly. At the same time, ideas have also been put forward about the contribution of biological factors to the development of some severe mental illnesses. Thus, in schizophrenia, disturbances in neurotransmitter processes in the brain have been found; Depression and anxiety may also be associated with similar disorders. In addition, with regard to schizophrenia, a family (genetic) predisposition to the disease has been identified, which, apparently, can be realized under the influence of unfavorable external circumstances. And yet, the origins of mental illness should often be sought in the patient’s early childhood, in the action of deep psychodynamic factors (usually unconscious), which can be identified using various methods of modern psychotherapy. The idea of the existence of unconscious processes in the human psyche can be found already in the works of St. Augustine, St. Thomas Aquinas, Schopenhauer and other thinkers. But only S. Freud was the first to develop in detail the doctrine of unconscious processes, creating a psychodynamic system (psychoanalysis) as a way of understanding mental disorders from the point of view of the patient’s individual experience and his relationships with other people. Many followers of Freud, in particular K. Horney, G. Sullivan, E. Erikson, enriched this understanding. The systematic study of both pathological and normal behavior initiated by Freud and his students showed that many of the adjustment difficulties, emotional problems, and mental manifestations found in adults are determined by the events and influences of early childhood. A mother's emotional relationship with her child is often the most important factor in determining whether a given person will be mentally healthy or ill. The contact between mother and child in the first years of life determines the atmosphere in which the child grows up and which will affect his future adult life: under the influence of maternal warmth, affection, approval, a feeling of security and inner strength is formed in the growing personality. Conversely, a mother’s refusal of a child, lack of love, and hostility cause feelings of defenselessness, fear, resentment, and emotional lability. These early experiences become deeply ingrained in the personality structure and predispose a person to emotional or mental disorders in adulthood. Of course, it is necessary to take into account the entire complex of psychological factors operating during the formation of personality: the influence of not only the mother, but also the father, brothers and sisters, other family members, social and economic status, situational conflicts, school, cultural factors, profession, internal and external pressure, i.e. frustrations of various types, originating from all kinds of sources. Thus, each mental disorder is a purely individual problem that can only be understood by revealing its deep dynamic sources. This procedure is difficult, and to find the causes of the disease, one must delve deeply into the life history and personality structure.
see also PSYCHOANALYSIS.
Psychiatric treatment. The most developed method of treating mental disorders offered by modern psychiatry is psychotherapy in its various forms. It is well known that with emotional disorders, a sick person thinks more about himself than a healthy person. He is constantly preoccupied (often excessively) with his troubles, anxieties, symptoms, various pains, real or imaginary, etc. Since this type of thinking is very difficult to change, and in modern society the diagnosis of mental illness still remains a stigma, the uninitiated person often does not understand the need for psychiatric treatment. Moreover, people with serious mental illnesses often do not know or deny that they are ill. Even highly intelligent non-psychotic patients suffering, for example, from neuroses, are skeptical about the advice to consult a psychotherapist; they immediately have a question: “What can a psychiatrist do? How can a conversation with him help my headaches or poor digestion, how will it relieve anxiety and depression, reduce painful feelings of inferiority or resolve sexual difficulties, relieve insomnia and relieve me of mental discord ?" The answer to these questions touches on the very nature of emotional illness, which is briefly outlined above. In the process of psychotherapy, a patient with a serious mental disorder primarily gains understanding, warmth and emotional support in the form of a therapeutic relationship between the doctor and the patient, i.e. between the one who listens and the one who is listened to, the one who wants to help and the one who needs help. Thus, treatment becomes for the patient an experience of relationship with another person, a psychotherapist, who specifically refrains from critical comments and evaluations and accepts everything that the patient feels, says, thinks or describes. Many mentally ill people are unfamiliar with such treatment - in life they are mercilessly criticized, attacked, ridiculed, they are intimidated by oppressive parents or other people in authority for them. And just the fact that they are listened to for long hours, weeks or months is extremely valuable. In addition, if patients see that the doctor is making a serious and honest effort to understand and help them understand their suffering, aspirations, internal conflicts, the results are very fruitful. With the help of psychotherapy, patients gradually increase their self-confidence, they are better aware of the limits of their own capabilities and accept the very fact of the existence of such boundaries, their sense of reality is strengthened. Certain types of psychiatric patients, especially those with strong antisocial tendencies, may benefit from group therapy. The group itself forms a special type of therapeutic community, of which each patient becomes an integral part. By participating in group therapy, patients not only overcome tendencies toward self-isolation and withdrawal, but also realize that others have the same difficulties and problems. This understanding, as well as the experience of communication in a favorable therapeutic environment and an atmosphere of mutual support, helps to improve the mental state of patients. When, thanks to group therapy, the patient feels more confident, he can be recommended individual psychotherapy, which provides not so much support as a deeper understanding of unconscious conflicts and driving forces.
see also
PSYCHOTHERAPY;
GROUP PSYCHOTHERAPY.
Electroshock therapy and psychosurgery. Until a few decades ago, treatment in a psychiatric hospital was limited to isolation, care and administrative measures. Today, active methods of physiotherapy have become available, such as electroshock, which, in combination with drug therapy (see below), improves the condition of patients and shortens their length of stay in the hospital. In this regard, hospitalization no longer looks as frightening and ominous as it did in those days when there was practically no hope for recovery. Through electroshock, drug therapy, or a combination of both, isolated schizophrenic patients who live outside reality in their inner world of strange fantasies and morbid delusions become available for psychotherapy or at least begin to respond to external stimuli. Electroshock has proven to be especially effective for depression - in some cases it saves patients' lives, bringing them out of deep depression and eliminating the danger of suicide. This initial success can be supported by active psychotherapy, which, depending on the severity of the condition, may be limited to supportive measures or include psychoanalytic techniques. In cases where these measures do not bring success and the patient’s condition continues to progressively deteriorate, psychosurgery is resorted to as a last resort. Instead of the previously used prefrontal lobotomy (in which nerve fibers in the frontal lobe were crossed), more targeted operations on the deep structures of the brain are now used. These operations are performed only in a very small part of cases - if patients, despite all therapeutic efforts, remain aggressive, destructive tendencies and excessive excitement.
Drug therapy. The therapeutic capabilities of psychiatrists have expanded significantly with the development of new psychotropic drugs, i.e. chemical compounds acting as “tranquilizers”, “antidepressants”, “psychostimulants”, “mood improvers”, etc. The achievements of the psychopharmacological approach to the treatment of mental illness have been recognized by both doctors and patients. The judicious use of appropriate remedies can eliminate or alleviate many severe mental symptoms: confusion, apathy, chronic fatigue, irritability, agitation, aggressive behavior, depression, fears. Psychotropic drugs are widely used in the treatment of patients with psychoses, neuroses, chronic alcoholism, drug addiction; They are prescribed to adolescents with antisocial behavior, persons suffering from manic agitation or delirium tremens, patients with persecutory delusions or thoughts of murder, mentally retarded children, elderly people with chronic diseases or senile behavioral disorders.
Rehabilitation. At the dawn of psychiatry, Freud once remarked: “Work connects a person with reality much more effectively than anything else; in the process of work a reliable connection is established with real life and human society.” Based on this premise and taking into account the importance of rehabilitation of mentally ill people, experts have developed programs that provide for the creation of help services - social (including assistance in choosing a profession) and psychiatric. The activities of these services include vocational training and retraining in hospital workshops, occupational therapy, psychosocial adaptation and counseling, acquisition of new skills or restoration of previously existing ones in a workshop environment where patients feel protected and where there is no competition. Thanks to the work of such services and with the support of such treatment methods as individual and group psychotherapy, as well as appropriate drug therapy, occupational rehabilitation has become possible for many patients, even with severe chronic psychoses. Such measures require a significant investment of effort, time and money, but their results are often encouraging and lasting.
Prevention. The importance of the problems facing modern psychiatry is easier to understand in the light of statistical data. In US psychiatric hospitals, the number of patients accounts for approximately a third of all hospitalized patients. However, this is only a small proportion of people with some kind of mental illness. The total number of mental patients in the United States reaches 8-9 million. Of these, 1.5 million suffer from severe, disabling forms of psychosis and neuroses. Mental disorders play an important role in the development of drug addiction, alcoholism, juvenile delinquency and other types of crime. In the United States, approximately 6 million people currently use cocaine, the vast majority of them under the age of 25. Cocaine addiction occurs in all levels of society. Its consequences are especially tragic for young and talented people. Alcoholism is also common among people of all social standings and all socioeconomic groups. There are approximately 9 million alcoholics in the United States, and millions more are close to becoming alcoholics.
see also DRUG ADDICTION. Methods for the prevention and control of mental illness involve action on many fronts and require the participation of officials and citizens at the national, regional and local levels. At the national level, efforts should be aimed at improving conditions in psychiatric hospitals and clinics, creating new hospitals and public health centers, training personnel (psychiatrists, psychiatric nurses, social workers, clinical psychologists), conducting research on the prevention and treatment of mental illness, and educating the population to erase the stigma associated with mental illness. In recent years, people have become increasingly aware that emotional disorders can be treated or prevented through special measures. This changing attitude is reflected not only in newspapers and other periodicals, but also in the adoption of large-scale mental hygiene programs by an increasing number of communities, public organizations, religious congregations, etc. To strengthen the mental health of the population, it is necessary to implement the following basic measures: 1) instructing parents and educators, aimed at early recognition and understanding of personality disorders in children; 2) development of mental health programs for schools, enterprises, cities and regions; 3) creation of children's clinics to provide assistance to children with emotional disorders and their parents; 4) familiarizing everyone involved in raising children, education or providing social, medical and legal assistance with the concepts and principles of psychology and mental hygiene and their practical application; 5) coordination of all social forces related to the protection of the health of children and youth in order to begin a new chapter in the history of psychiatry related to the prevention of mental illness. Since emotional disorders and, to a large extent, mental illness are associated with difficult experiences in childhood (abuse, social stress, physical and mental oppression, etc.), the success or failure of preventive efforts ultimately depends on the immediate environment of the children, i.e. . emotional climate in home, family, society.
see also
DISSOCIATIVE DISORDERS;
MENTAL HEALTH ;
PSYCHOSEXUAL DISORDERS;
ANXIETY DISORDERS.
Collier's Encyclopedia. - Open Society. 2000 .
Synonyms:See what "PSYCHIATRY" is in other dictionaries:
PSYCHIATRY- PSYCHIATRY, the science of mental illness, History of psychology. As a scientific discipline, psychology was formed only in the 19th century. , although the diseases it interprets began to attract the interest and attention of people at the earliest stages of human society.... ... Great Medical Encyclopedia
psychiatry- a field of medicine that studies the causes of mental illness, their manifestations, methods of treatment and prevention. The main method of psychiatry is clinical examination using neurophysiological, biochemical,... ... Great psychological encyclopedia
Greek, from psyche, and iatreia, treatment. Treatment of mental illness. Explanation of 25,000 foreign words that have come into use in the Russian language, with the meaning of their roots. Mikhelson A.D., 1865. PSYCHIATRY is the science of mental illness. Complete dictionary... ... Dictionary of foreign words of the Russian language
In the article we will consider the history of psychiatry, its main directions, and tasks.
The clinical discipline that studies the etiology, prevalence, diagnosis, pathogenesis, treatment, assessment, prognosis, prevention and rehabilitation of behavioral and mental disorders is psychiatry.
Subject and tasks
The subject of her study is the mental health of people.
The tasks of psychiatry are as follows:
- diagnosis of mental disorders;
- study of the course, etiopathogenesis, clinical picture and outcome of mental diseases;
- analysis of the epidemiology of mental disorders;
- studying the effect of drugs on the pathomorphosis of mental disorders;
- development of methods for treating mental disorders;
- development of rehabilitation methods for patients with mental illnesses;
- development of preventive methods for the development of mental illness in people;
- organizations providing assistance to the population in the psychiatric field.
The history of the development of psychiatry as a science will be briefly described below.
History of science
According to Yu. Kannabikh, the following stages are distinguished in the development of psychiatry:
- The pre-scientific period - from ancient times to the emergence of ancient medicine. Observations are accumulated haphazardly and recorded in mythology in figurative form. People endowed the surrounding phenomena and objects with a soul, which is called animism. Sleep and death were identified by primitive man. He believed that the soul leaves the body in a dream, sees various events, takes part in them, wanders, and all this is reflected in dreams. If a person’s soul left and never returned, then the person died.
- Ancient Greco-Roman medicine (7th century BC - 3rd century AD). Mental illnesses are viewed as natural phenomena that require appropriate action. The religious-magical understanding of pathologies has been replaced by a metaphysical and, to some extent, scientific-realistic one. Somatocentrism becomes predominant. On its basis, Hippocrates considered hysteria the result of pathologies of the uterus, melancholy (depression) - bile stagnation.
- The Middle Ages - the decline of human thought, scholasticism and mysticism. Practical medicine returns to mystical-religious and animistic approaches. At that time, demonic ideas about mental illness were winning.
- The Renaissance era - scientific thought is flourishing, and with it the history of psychiatry is developing.
- Second half of the 9th century. - 1890. At this time, the clinical direction of psychiatry was intensively developing. All clinical observations are being systematized, symptomatological psychiatry is being developed, and symptom complexes are described.
- The end of the 19th century (the last ten years) is a nosological stage in the development of science. At present, the history of psychiatry has stopped moving at this stage.
The boundaries of a number of nosological psychiatric forms are constantly revised as knowledge accumulates, until now, while most diseases are classified not according to etiological characteristics.
Below we consider the main areas of psychiatry.
Nosological direction
Its founder is Kraepellin, who believed that any individual disease - a nosological unit - must meet the following criteria: the same symptoms, the same cause, outcome, course, anatomical changes. His followers, Korsakov and Kandinsky, sought to make a descriptive classification of psychoses, and Baylem identified progressive paralysis. The descriptive method is the leading one.
Syndromological and eclectic directions
In the syndromological direction, mental illnesses are classified on the basis of psychopathological syndromes (depression, delirium).
The eclectic (atheoretical, pragmatic) direction became particularly widespread at the end of the 20th century. Its theoretical basis is constructed in such a way as to reflect the judgments of representatives of various directions and numerous schools of psychiatry. A disorder is identified according to a nosological principle if its cause is known, for example, alcoholism, drug addiction, senile dementia. If the cause is unclear, and characteristic organic transformations in the central nervous system have not been established, then they turn to the syndromological or psychoanalytic direction.
Psychoanalytic direction
The psychoanalytic direction is associated with the name of S. Freud, who put forward a concept for the study of human behavior, which is based on the position that psychological unconscious conflicts (mainly sexual) control behavior. The scientist believed that personality development coincides with children's psychosexual development. He proposed a psychoanalytic method for the treatment of neurotic disorders. Followers - A. Freud, M. Klein, E. Erikson, Jung, Adler, etc.
Antipsychiatric direction
Its founder is R. Laing. This movement is responsible for the elimination of psychiatric institutions as a way of social coercion of people who think differently. The main theses are the following: society itself is insane, suppressing the desire to go beyond ordinary ways of perception and thinking. Laing's interpretation of psychopathology was carried out in the context of changes in human existence. He believed that schizophrenia is a special strategy; an individual resorts to it to adapt to an unfavorable situation in life. Other representatives of the direction: F. Basaglio, D. Cooper.
Psychiatric Care Act
The current law on psychiatry is aimed at creating guarantees for the protection of the interests and rights of persons who suffer from mental disorders. This category of citizens is the most vulnerable and requires special attention to their needs from the state.
On July 2, 1992, the Federal Law “On Psychiatric Care and Guarantees of the Rights of Citizens in its Provision” No. 3185-1 came into force. This bill approves a list of economic and organizational norms that control the provision of psychiatric care to people whose mental state requires medical intervention.
The law contains six sections and fifty articles. They describe:
- general provisions telling about the rights of patients, about the examination for the court about the state of mind, the rules of care, etc.;
- state support and provision of mental health care;
- doctors and medical institutions that treat patients, their responsibilities and rights;
- types of assistance provided in psychiatry and the procedure for their implementation;
- challenging various actions of medical staff and medical institutions that provide such support;
- control by the prosecutor's office and the state over this procedure.
World famous psychiatrists
- Sigmund Freud was the first to explain human behavior in terms of psychology. The scientist’s findings created the first large-scale theory of personality in science, which was based not on speculative conclusions, but on observation.
- Carl Jung - his analytical psychology gained more followers among religious leaders and philosophers than among medical psychiatrists. The teleological approach suggests that a person should not be bound by his own past.
- Erich Fromm - philosopher, sociologist, psychoanalyst, social psychologist, one of the founders of Freudo-Marxism and neo-Freudianism. His humanistic psychoanalysis is a treatment aimed at revealing human individuality.
- Abraham Maslow is a famous American psychologist who founded humanistic psychology. He was one of the first to explore the positive aspects of human behavior.
- V. M. Bekhterev is a famous psychiatrist, psychologist, neurologist, founder of a scientific school. He created fundamental works on pathology, physiology and anatomy of the nervous system, works on child behavior at an early age, sex education and social psychology. He studied personality based on a comprehensive analysis of the brain using psychological, anatomical and physiological methods. He also founded reflexology.
- I. P. Pavlov is one of the most authoritative Russian scientists, psychologist, physiologist, creator of ideas about the processes of digestive regulation and the science of higher nervous activity; founder of the largest physiological school in Russia, winner of the Nobel Prize in physiology and medicine in 1904.
- I.M. Sechenov is a Russian physiologist who created the first physiological school in Russia, the founder of new psychology and the doctrine of mental regulation of behavior.
Books
Some popular books on psychiatry and psychology will be listed below.
- I. Yalom “Existential psychotherapy.” The book is dedicated to special existential givens, their place in psychotherapy and human life.
- K. Naranjo “Character and neurosis.” Nine personality types are described, and the most subtle aspects of internal dynamics are revealed.
- S. Grof “Beyond the Brain.” The author gives a description of expanded mental cartography, which includes not only the biographical level of S. Freud, but also the perinatal and transpersonal levels.
What other books on psychiatry are known?
- N. McWilliams “Psychoanalytic diagnostics.” In addition to detailed descriptions, the book includes specific recommendations for working with clients, including for complex cases.
- C. G. Jung “Memories, Dreams, Reflections.” An autobiography, but at the same time it is unusual. Focuses on events of inner life and stages of understanding one’s unconscious.
We reviewed the history of psychiatry, its main directions, famous scientists and useful literature on the topic.
Beginnings of Psychiatry.
Questions for the exam.
1. Psychiatry as a medical science. Position among other medical specialties. Prevalence of mental pathology.
Psychiatry- medical science that studies the clinical manifestations, diagnosis, treatment and prognosis of mental disorders, develops issues of restoration in the lives of patients with mental disorders. Concept "mental illness" is not limited to psychosis.
Psychiatry as a science
Psychiatry as a science was formed relatively recently - a little over 150 years ago, when the first scientifically based ideas about painful disorders of human mental activity appeared. However, it received recognition as a special branch of practical medicine much earlier. This was due to the need to provide assistance to people with mental disorders. At all stages of the formation and development of psychiatry, it was influenced to a greater extent than all other areas of medicine by the prevailing religious, philosophical, and worldview views. It is with this that its dramatic and sometimes tragic pages, the destinies and lives of the mentally ill, are connected. The fact is that during a mental illness, in some cases sharply, in others - gradually, the characteristic properties of a person’s personality can change, and many of his actions become incomprehensible, inappropriate, and sometimes even contradictory to the environment. As a result, the ability to work decreases, the sick person ceases to be necessary and useful to people. The attitude of healthy people towards such patients and their care always in one way or another reflect the humanity and degree of culture of society; they occupy not the last place in the fight against mental abnormality. Here, essentially, two periods can be distinguished. The first of them - pre-scientific - lasted for centuries and amounted only to getting rid of the sick (or, as paradoxical as it sounds now, to deification and worship of them). In the second period, advances in science made it possible to understand the essence of mental illness, their treatment, and contributed to the return to a full life of many people who had suffered psychosis.
Any doctor, no matter what field of medicine he works in, no matter what specialty he chooses, must certainly proceed from the fact that he is dealing primarily with a living person, a person with all his individual characteristics. In the most holistic understanding of the patient, the doctor will be helped by knowledge of psychiatry, especially borderline psychiatry.
Knowledge of psychiatry is necessary for every doctor: the overwhelming number of mentally ill patients first of all turn not to psychiatrists, but to representatives of another medical specialty, and a very significant period of time often passes before such a patient comes under the supervision of a psychiatrist.
Especially often, a general practitioner deals with persons suffering from neuroses and psychopathy - “minor” forms of mental disorders, which are dealt with by “minor”, or borderline, psychiatry.
Borderline psychiatry, noted the prominent Soviet psychiatrist O.V. Kerbikov, is precisely the area in which the psychiatrist’s contact with general practitioners, who, one might say, are at the forefront of protecting the mental health of the population, is most needed.
Knowledge of psychiatry in general and borderline psychiatry in particular will help the doctor avoid mistreatment of the patient, religiously follow the order with which Hippocrates addressed his colleagues: “Do no harm.” Improper treatment of a patient, which can be expressed not only in words that frighten the patient, but in facial expressions and gestures, can cause so-called iatrogeny - a disease involuntarily caused by a doctor. In this case, the most dangerous thing is that the doctor will not be able to draw conclusions from his mistakes, because “a patient who has been harmed by the doctor with his incorrect behavior will never turn to him again” (O. Bumke).
The doctor must not only behave correctly himself, but also monitor the behavior of his sister and teach her, since the disease can also be caused by a nurse (sorrorogeny) who does not follow the rules of deontology.
To avoid unnecessary trauma to the patient, the doctor must understand how his patient feels about his illness, what his reaction to it is (what is called the internal picture of the illness).
General practitioners are often the first to encounter psychoses in their very initial stages, when the painful manifestations are not yet very pronounced and not too noticeable.
A doctor of any profile may encounter the initial manifestations, especially if the initial psychopathology superficially resembles some kind of somatic disease. Moreover, sometimes pronounced mental disorders “stimulate” one or another somatic disease, which may relate, in particular, to various hypochondriacal symptoms (when the patient is firmly “convinced” that he has cancer, syphilis, some kind of disgraceful physical defect, and categorically requires appropriate special or surgical treatment), hysterical disorders (hysterical blindness, deafness, paralysis, etc.), latent (somatized, larved) depression occurring under the guise of a somatic illness, etc.
Any doctor, but much more often a general practitioner, can find himself in a situation where urgent (emergency) psychiatric care is required: to relieve a state of acute psychomotor agitation (for example, in a patient with delirium tremens), to do everything necessary when status epilepticus occurs, when trying to suicide, etc.
General practitioners, as well as each of the representatives of any other medical specialty, must be able to approach a mentally ill patient, get in touch with him for his somatic examination (neurological, surgical, ophthalmological or any other), which may be necessary for patient both in outpatient and inpatient settings. First of all, this concerns general therapeutic examination, which every newly admitted mentally ill patient must undergo; This must be done in the further dynamics of the disease.
Doctors of all profiles should be well aware of somatogenic mental disorders that arise in connection with the pathology of internal organs and systems, their initial manifestations, dynamics, possible dangerous consequences (sudden sharp excitement, attempts to jump out of a window, etc.).
Every doctor should also know that, in addition to somatogenic mental pathology, there are also psychosomatic disorders - somatic diseases caused by exposure to psychotraumatic factors.
Sufficient understanding of the mutual influence of mental and somatic diseases will undoubtedly contribute not only to accurate diagnosis, but also to the most adequate treatment.
Finally, the doctor must have sufficient knowledge to combat various kinds of harmful superstitions, the activities of medical charlatans, self-proclaimed “healers”, who often cause great harm to the patient, even leading to the occurrence of severe mental disorders. Knowledge of psychiatry will greatly help him in this.
The total volume of identified mental pathology in our sample (as in other similar studies) is measured in values of the order of many tens of percent. Indeed, if we are to believe case histories, which clinicians know are harder to falsify than raw numbers, there were 227 longer or shorter case histories or psychiatric biographies written among the 415 members of the sample that included infants. some of whom are classified as group “D” - that is, socially fully compensated, prosperous in everyday life. Let us present some summary data, recalculated for the then population of the capital's districts.
The total number of cases of mental illness (group A+B) is 55: 13.3%, or, in terms of the population, taking into account possible random fluctuations at our accepted level of statistical significance, 13.3 ± 3.3%. Of the patients, there were 26 people with psychoses, manifest and reduced: 6.2% (6.2±2.4%); with dementia, severe psychopathic or psychoorganic syndrome and severe mental retardation - 29 people: 7.0% (6.0±2.5%).
For individual nosological units or unities, in groups A, B and C:
Schizophrenia, including low-grade and controversial paranoids: 18 patients, or 5.5% (5.5 ± 2.2%). Conditions suspicious for “latent” schizophrenia (“pseudopsychopathy”, “complicated schizoidia”) in another 30 people: 7.2% (7.2±2.6%). Schizoid psychopathy (without persons suspected of having latent schizophrenia) - 35 people: 8.4% (8.4±2.7%). In general, the schizophrenic-schizoid group, where the connection of the condition with the original prototype was traced to one degree or another, amounts to 83 people, or 20.75% (in terms of the population of the districts 20.75 ± 4.0).
Other psychopathy of varying severity - 95 people: 22.9 (22.9±4.3%), of which “decompensated” cases - 19 people: 4.6% (4.6±2.2%).
Alcoholism without a degree of habitual drunkenness (subgroups 2 and 3) - 18 people: 4.3% (4.3±2.0%); the same with habitual drunkenness (with the 1st subgroup) - 45 people: 10.8% (10.8±3.0%).
The dispensary's reporting underestimated the prevalence of schizophrenia by at least 1.5 times, the total number of mental illnesses by 4 times, the prevalence of alcoholism by at least 2.5 times (the ratios are given at the lower limit of the indicators common to the population).
For various reasons, even a healthy person can develop a mental disorder, which is often called mental disorder. The clinical branch that studies them is called psychiatry. Specialists in this area know better than anyone how severe emotional disorders are treated, as well as what methods of their prevention exist. provide assistance to mentally ill people. Specialists have the right to isolate patients with severe mental disorder and unhealthy behavior who pose a potential threat to themselves and the surrounding population.
History of psychiatry
The path of development of psychiatry was very long and confusing. With the change of generations of scientists, the complete understanding of the subject of study and the actual goals changed.
- The most ancient society was very religious and believed in mysticism, which is why they associated mental disorders in people with possession by evil spirits, with a curse or the activities of dark forces. Any insanity was already associated with the brain, which is why craniotomy was performed, a procedure supposedly “rescuing” spirits from the patient’s head.
- The end of the nineteenth century becomes very intense in terms of psychiatric research. During this period, two completely opposite theories appeared, put forward by Sigmund Freud and Emil Kraepelin.
The first of them, together with his like-minded people, identified something that he called the “unconscious”. In his understanding, this meant that the minds of any person contain their own natural instincts, which are always in our heads (for the most part they have erotic overtones). But the imposed moral norms in society oppress these “desires,” which is why internal confrontation occurs. When instincts win, the forbidden appears outside, which is very painful for the person himself. Hence the psychiatric disorder.
E. Kraepelin found in this mental disorder paralysis, which leads to the destruction of brain tissue, which in turn is expressed by a number of symptoms.
But, due to constant disputes between opponents and the presence of some gaps, all this has remained at the theoretical level, although it still has few followers.
- A way out of the resulting impasse was found by E. Husserl, who laid the foundation for phenomenological psychiatry. It is based on a certain “phenomenon” that serves as an integral part of the mind of a healthy person. If a conflict develops between them, this leads to mental disorder.
- K. Jaspers continued this teaching and introduced the method of interviewing the patient in order to identify his own subconscious phenomena and classify them in order to make a correct diagnosis. Further, J. Minkowski and G. Ellenberg developed a special approach to the treatment of mental disorders, which is used in modern psychiatry.
Sections of psychiatry
Mental disorders can vary greatly in severity and severity of consequences. Therefore, psychiatry is usually divided into 2 sections:
- General psychiatry. Here the main mental illnesses, their properties, causes of development and patterns, classification of disorders, as well as research and therapeutic activities in relation to them are studied. Particular attention is paid to the common symptoms that are inherent in common mental illnesses: hallucinations, illusions and thinking disorders.
- Private psychiatry. Her interests include specific mental illnesses, their etiology with pathogenesis, clinical manifestations, methods of treatment and recovery. You will find out a little later what diseases she studies.
Features of diagnostics in psychiatry
Despite the technical and laboratory research methods that scientists have brought to a perfect level, their significance in psychiatry is not very great.
The following is used as an aid for examining brain activity:
- Electroencephalography;
- Radiography;
- Computed tomography;
- Magnetic resonance imaging;
- Rheoencephalography;
- Dopplerography;
- Lab tests.
But specialists obtain the main diagnostic data from the clinical method, which is based on interviewing the subject and observing him and his mental state. Professionals pay very special attention to the patient’s facial expressions and intonation, their changes during a conversation on certain topics and other external reactions.
In parallel with this, a conversation is also held with relatives, who sometimes help to clarify a more complete picture of the patient’s condition.
Modern psychiatry
The main methods of treatment used in modern psychiatry are based on the use of pharmacological drugs with appropriate action. But increasingly, experienced specialists are resorting to psychotherapeutic methods, which turn out to be more effective.
Mental illness
There is no age limit when it comes to mental disorders. People can face a “mental problem” both at a young age and at an older age. The culprit may be heredity, living environment, living conditions, alcoholism, infections, diseases, injuries, intrauterine development disorders (due to drunkenness of parents, especially the mother during pregnancy, as well as illnesses during pregnancy).
However, one should not perceive psychiatry as it was previously characterized, such as prison, bullying and torture. Nowadays, patients can undergo outpatient treatment, which is no less effective and humane.
Among the most famous mental illnesses in people are:
More about psychiatry