The relationship between psychological and neurological diseases, the problem of diagnosis and treatment

Areas of knowledge

The first and most important thing in which they differ is the field of knowledge in which each of them is [under a successful combination of circumstances] a specialist. So, psychiatry. Firstly, it is part of medicine. Those. areas of knowledge and industry dedicated to diseases and their treatment, prevention, prevention and rehabilitation after. Psychiatry studies various types of mental disorders. She doesn't deal with the norm. Or rather, not like that: she deals with her in the sense that she tries to bring her patients to her, but if a person is mentally healthy and does not intend to lose this status, then she most likely will not be interested in him. Psychology is almost the complete opposite. Firstly, this is not a branch of medicine (yes, there is so-called medical psychology, but more about it below and separately). She studies the work of the psyche. A normal healthy psyche, for the most part (again, yes, there is pathopsychology, but we will also consider it separately). Those. For her, a healthy person, rejected by psychiatry because of his normality, will be interesting in practical and theoretical terms. But psychology does not deal with treatment. But he is engaged in increasing the level of adaptation, personal effectiveness, personal growth and other similar things. Psychotherapy. This is also part of medicine. In the sense that it considers, studies and practices the treatment of mental illness. But, at the same time, she can also deal with the normalization / solution of the problems of a healthy person. Those. in the field of problems being solved, this is a mixture of psychiatry and psychology.

Psychiatry refers to the branch of clinical medicine that studies mental disorders and also treats the soul using methods of diagnosis, prevention and treatment. Also, this term implies and includes a set of accredited non-state and government agencies that have the right to involuntary isolation of potentially dangerous individuals.

The German psychiatrist W. Griesinger received wide recognition thanks to a more precise definition of the concept of psychiatry, as the doctrine of the treatment and recognition of mental illnesses. Treatment includes therapy, organization of psychiatric care, rehabilitation, prevention, social aspects of psychiatry. Recognition includes diagnosis, study of the pathogenesis, etiology, course, and outcome of mental disorders. According to a common definition, mental illness refers to a change in consciousness that goes beyond the norm. Borderline states between pathology and normality are studied by clinical psychology. This direction is widely developing in the USA.

Psychiatry is divided into private and general.

In private psychiatry, the subject of study is individual diseases, and in general psychiatry, the subject of study is the general patterns of mental disorder. General psychiatry also includes general psychopathology, as well as pathopsychology. Private psychiatry is sometimes called private psychopathology. Signs of mental disorders are the subject of psychiatric semiotics. Clinical psychiatry studies the symptoms of mental illness, the biological essence, and the manifestations of pathological changes in the body that lead to mental disorders, and modern psychiatry studies the etiology, clinical picture, pathogenesis, diagnosis, prevention, treatment, examination and rehabilitation of mental disorders.

Expertise in psychiatry is divided into military psychiatric, forensic psychiatric, medical and social (labor). The main method of psychiatric examination is clinical research. A psychiatric diagnosis is established after obtaining clinical and laboratory research methods.

For several centuries and to this day, there has been a debate: psychiatry is a science or an art. The opinion of critics is that there is no real evidence of the scientific nature of psychiatry and the effectiveness of its methods.

Psychiatry at the end of the 19th and beginning of the 20th centuries was distinguished by two schools. The first included psychoanalysis, where Sigmund Freud laid the foundation with his works on the theory of the unconscious. According to his theory, the human brain secretes an area of ​​animal instincts. Freud believed that the “Id” is opposed to the personal “I,” and the “Super-Ego” is opposed to the dictates of society, which guides the individual and imposes certain norms of behavior. The unconscious, Freud believed, is a prison for forbidden desires, for example, erotic ones, which are repressed from it by consciousness. Due to the impossibility of completely destroying desire, consciousness offers a mechanism of sublimation - replacement through the implementation of creativity or religion.

In this case, a nervous disorder represents a failure of the program in the sublimation mechanism and the forbidden spills out of the patient through a painful reaction. Restoring normal functioning of the individual is carried out through a technique called psychoanalysis. This method involves returning the patient to childhood memories, as well as resolving the problem.

Freud was opposed by Emil Kraepelin with his school of positivist medicine. Kraepelin based his theory of mental disorder on progressive paralysis and developed a new form of studying the disease as a process that develops over time and then breaks down into certain stages, with certain symptoms. Positivist medicine explains mental illness as a destruction of brain tissue, a biological disorder caused by multiple causes.

However, none of the theories could claim to be substantiated by evidence. Freud built his theory about children's sexual desire on the psychoanalysis of adults, explaining that it was impossible to confirm it in children due to fear of a forbidden topic. Opponents reproached Kraepelin that in fact the theory of organic defeat leads to madness and emotional as well as mental degradation. At that time, curing a sick person was considered impossible, and the professional activity of a doctor was reduced to supervision, as well as stopping possible aggression. In addition, the positivist theory found it difficult to explain numerous cases of mental disorders.

Mental disorders are divided into two levels: psychotic and neurotic. This boundary is arbitrary and it is assumed that pronounced gross symptoms are a sign of psychosis. And the softness and smoothness of symptoms is characteristic of neurotic disorders.

Psychiatry is a field of human knowledge that studies the pathology of human mental activity. What is a pathology of mental activity? It is impossible to answer this question precisely. Where the norm is not defined, there can be no talk of pathology. At the same time, the manifestation of mental activity, which can be regarded as abnormal, is indisputable. This means the manifestation of a mental disorder that is both largely resistant and persistent. These include obsessions, delusions, phobias, mood pathologies (affect and manic states), and perception disorders (illusions, hallucinations, senestopathies).

Today, effective methods of therapy used by psychiatrists include blocking brain function (neuroleptics), pharmacotherapy - neuroleptics, brain destruction (electric shock - electroconvulsive therapy, lobotomy-psychosurgery).

Specialist education

A psychiatrist and psychotherapist are always specialists with higher specialized education. A psychologist (but not a medical psychologist) can (at least at the time of writing this post, until the law on providing psychological assistance has been adopted) be a person who has no formal education at all. Further, a psychiatrist and psychotherapist are doctors. Those. these are people who graduated from the Faculty of Medicine, completed residency/internship/practice as a GP/other formal stages - depending on how long the specialist’s training took: lately, officials like to change this medical bureaucracy quite often. An ordinary psychologist may not do any of this. There are psychologists with higher psychological education. And there are without it, but past profs. retraining or training at some MAAP or Gestalt institute. Those. formally this is not a higher education, but studying there is also long, expensive and very hardcore. A psychiatrist, psychotherapist and medical psychologist (but not just a psychologist, this does not apply to him) must undergo training and advanced training, otherwise their diploma / license loses its validity. Only a person who is already a psychiatrist (but not a psychologist!) can become a psychotherapist through additional training. After this, he receives the appropriate certificate and the right to be called a psychotherapist. You can retrain to become a psychologist relatively quickly (no more than 1,100 hours) and cheaply (from 15,000 rubles). Even clinical/medical (it's the same thing). This is done through professional retraining, on the basis of which a diploma is then awarded with a qualification. But there is no particular point in this - on the one hand, private practice can be conducted without a diploma at all, on the other, if the employer requires a higher education, then, most likely, a retraining diploma will not suit him. But, as I already said, this is not how you become a real clinical psychologist. What is the difference between real and fake? Because the real one has the right to work in a mental hospital, but the fake one does not. At the same time, he can work in the Ministry of Internal Affairs, the army, or a regular hospital, but not in a psychiatric hospital. There is an opinion that you can turn out and become a real clinical psychologist without first studying for it, if you get a higher education in psychology and then undergo retraining for clinical psychology (or graduate from the medical department and then retrain for clinical psychology), but I was not able to find out the reliability of this information . In different educational organizations and psychiatric hospitals I was given different answers.

Clinical Psychology and Psychiatry

The idea of ​​mental health arises in a person very early. “Crazy,” “crazy,” “abnormal” are epithets that are generously awarded to children of their peers and adults when faced with something unusual in their reasoning and actions. Adults also use similar expressions no less often, i.e., it seems that almost everyone can distinguish a mentally healthy person from a mentally ill person. But often the basis for making a “diagnosis” is the existing ideas in a given society about “correct” behavior. In accordance with these ideas, some people who are completely healthy by clinical standards, whose views and actions do not fit into the generally accepted framework, are often perceived as “abnormal.” However, not only ordinary people, but also specialists - psychologists and doctors - are not always unanimous in their approaches to assessing mental disorders.

The main sciences that study mental pathology are psychiatry and clinical (medical) psychology.

Clinical psychology studies:

— how various psychological factors influence the occurrence, development and treatment of diseases;

— how various diseases affect the human psyche and behavior;

— how the characteristics of the relationship between a sick person and medical personnel and the microenvironment around him influence the healing process.

The tasks of clinical psychology also include the development of principles and methods of psychological research in the clinic, the creation and study of psychological methods of influencing the human psyche for therapeutic and preventive purposes.

Psychiatry is a medical discipline, and therefore its main task is the treatment and prevention (prevention) of mental illness.

To this day, the issue of delimiting the subject of the theoretical sections of clinical psychology and psychiatry: pathopsychology and psychopathology remains debatable. Difficulties in such a distinction are inevitable, since both sciences deal with the same object - disorders of mental activity. The difference between psychopathology and pathopsychology can be seen in the fact that the first, being a clinical discipline, operates with medical categories (etiology, pathogenesis, symptom, syndrome), based mainly on the clinical method, while pathopsychology studies the patterns of mental disorders using psychological methods and concepts.

Currently, many works on psychiatry, psychotherapy, clinical psychology, including popular science publications, are being published. Many people, in an attempt to independently understand their own psychological problems or evaluate the behavior of someone from the environment from the point of view of “normality,” begin to read specialized literature. Sometimes this is useful, but it should be remembered that in the event of conditions that a person cannot cope with, it is necessary to contact a specialist - a psychiatrist or clinical psychologist.

Meanwhile, there is a persistent prejudice in society, a kind of fear of turning to a psychiatrist or psychologist, and this is partly due to the fact that certain mental disorders can serve as limitations in a person’s social functioning. It will be possible to overcome this fear with the growth of the general psychological culture of the population.

In modern psychiatry, there are different approaches to the diagnosis of mental illness, but on the one hand, there is a clear tendency towards integration, and on the other, there is a common system of terms and concepts, thanks to which psychiatrists and clinical psychologists of different theoretical directions understand each other.

Drug therapy

A psychologist does not write out or prescribe funny pills. And sad ones too. Even medical. If he recommends accepting something, then he goes beyond his formal rights. In current realities, this does not mean that he is necessarily wrong, but you must understand that he is exceeding his authority. On the contrary, both a psychiatrist and a psychotherapist have the right to prescribe pills. In practice, the former, as a rule, limit themselves to only this, while the latter often refuse this opportunity, preferring treatment with words. On the other hand, both a psychiatrist and a psychotherapist have the right to use non-drug methods of influence (the same therapeutic conversations in all their diversity).

Practical approach to work

In reality, things are often not as they really are. Therefore, there are no clear rules here, and everything very much depends on the specialist: I have seen psychologists illegally recommending drugs (very competently and successfully), and psychiatrists conducting openly psychotherapeutic sessions (which, in theory, is also haram), and psychotherapists refusing to combine psychiatry with pills. But these are exceptions, and we will look at the general trend. The psychiatrist will most likely feed you pills, give you injections and give you IVs. In most cases, he frankly doesn’t care about your rich inner world, he is interested in the absence of productive (delusions, hallucinations) and (less often) negative (emotional-volitional defect) symptoms. How well (subjectively) you will feel after life-giving haloperidol is of no concern to him (of course, there are good specialists who do not, but in my provincial sample there are vanishingly few of them). The psychologist will most likely talk to you. Ask something about your childhood, analyze your thoughts, feelings and somehow interpret them. In principle, all the psychologists I know (both personally, on the Internet, and in literature) have given up on the ban on engaging in psychotherapy and are actively pursuing it. The only “but” is that en masse they are afraid of real psychos. Those. If a psychologist is able to recognize a schizo, most likely he will refuse to work with him. No, no, if you have OCD, bipolar disorder, autism or something else, you shouldn’t rejoice - usually psychologists don’t really understand the types of psychos and are afraid of everyone the same. A clinical psychologist will work with you to diagnose, test and determine what and who you are. And, of course, psychocounseling. And even psychological correction (see below). And then, quite possibly, he will send you to a psychiatrist, psychologist or psychotherapist with specific recommendations, which can be very useful. A psychotherapist can feed you pills, and then, in fact, work either in the format of psychotherapy (word treatment) or psychology (increasing awareness, helping in self-knowledge and understanding of others). But in practice, they are still either psychiatrists at heart and base treatment on drug therapy, or psychologists (we remember that in reality psychologists do not hesitate to use psychotherapy methods, although, in theory, they should not).

The relationship between psychological and neurological diseases, the problem of diagnosis and treatment

 The problem of fragmented treatment of patients with diseases of a complex psychoneurological nature, the lack of specialized specialists in this context, and only the temporary effectiveness of treating patients with purely neurological means are analyzed. The influence of stressful conditions and negative psychological attitudes on the development of neurological symptoms and diseases is considered; methods of complex treatment.

Key words: psychology, psychiatry, psychologist, psychotherapist, neurology, neuropathology, diagnosis, treatment, psychosomatia, neurosis, VSD (vegetative-vascular dystonia), panic attacks, anxiety states, obsessive states.

The problem of fragmentation of treatment of patients with diseases of the complex psychoneurological nature, the lack of specialized specialists in this context, and only the temporal effectiveness of treatment of patients with exclusively neurological means are analyzed. The significance of stress states and negative psychological settings on the development of neurological symptoms and diseases is considered. Methods of complex treatment.

Keywords. psychology, psychiatry, psychologist, psychotherapist, neurology, neuropathology, diagnosis, treatment, psychosomatics, neurosis, vegetovascular dystonia, panic attacks, anxiety states, obsessive states.

Introduction. In practice, it often happens that a person is sick with certain nervous diseases, but cannot interpret them correctly. In our conservative society, most often he first turns to a neurologist or neuropathologist for help. From this doctor he receives a course of treatment (for example, standard Mexiprim, Lucetam, etc.), which most often helps only for a while. Due to internal attitudes, mainly experiences, diseases often return, and everything repeats itself in a circle.

Of course, a competent neurologist is interested in the patient’s lifestyle and thoughts, but due to an unprofessional approach, this happens superficially, often thanks to the doctor’s experience.

At the same time, psychotherapeutic doctors often remain on the sidelines or solve problems with their patients in the same isolation.

At the same time, doctors admit that, in layman's terms, some treat the “program”, while others repair the “technical equipment”, while one without the other in this context does not work.

The topic raised is the problem of the presence in medical practice of diagnostic doctors, which the average person is accustomed to seeing in the image of the omniscient Dr. House from the series of the same name. A functional diagnostician is a doctor whose specialty is conducting an in-depth comprehensive examination of the patient. In domestic medicine, less attention is paid to this practice. Psychoneurology fits perfectly into diagnostics as a complex problem. Psychoneurology is a branch of medicine that includes psychiatry and neurology and studies their border areas - neuroses, psychopathy, etc., as well as mental hygiene and psychoprophylaxis. There are also psychoneurological departments in hospitals. The main goal is to make the already proven relationships applicable to treatment in practice everywhere. Indeed, even in the pre-war years, V. M. Bekhterev created the Psychoneurological Institute, the problem was already considered comprehensively. At the beginning of the twentieth century, he organized a new scientific direction, which he called psychoneurology, which meets all the demands placed by science today on the interdisciplinary study of the patient’s nervous system.

According to Bekhterev, “neurology, understood in the broad meaning of this word that we give it at the present time, is closely related to those departments of knowledge that set as their task the study of the spiritual or inner world and its painful disorders. These branches of knowledge are known as psychology and psychiatry...” [3].

Thus, during a separate examination by a neurologist in the early stages of a disease, the tests may often show a relative norm, while the psychotherapist will notice deviations. Therefore, when combining psychology and neuroscience, we have excellent prognostic and preventive effects, not to mention more effective diagnosis and treatment.

However, before discussing this, let us trace the connection between the psychological and neurological components of the disease, and evaluate how often this can be traced.

The most popular are neuroses, dysfunctions of the autonomic nervous system (the term “vegetative-vascular dystonia” is outdated and commonplace, it is absent in the modern International Classification of Diseases, in this context it is considered a polyetiological syndrome) and in general any symptoms of a neurological profile [1].

Risk factors here are often chronic and acute stressful situations and depression. However, the standard recommendations of a neurologist regarding putting in order the daily routine, lifestyle and nutrition may not work: a person often suffers from debilitating obsessive states that do not let him go for completely different reasons. Thus, a change in lifestyle (which is also one of the main recommendations of a psychotherapist) may not help unless it is supported by additional psychological work with the patient. Some people are overly suspicious, others have a naturally weak nervous system, others have suffered great experiences in life (including about their health, the deterioration of which they are afraid of).

In this case, when a person experiences neurological symptoms (dizziness, tremors, numbness, unsteadiness of gait, slurred speech, feeling hot or cold, lethargy, decreased concentration, confusion, decreased vision) caused by experiences, because of this he begins to worry even more, which in turn again intensifies neurological symptoms. In this way, a person drives himself into a depressive neurological hole, which is accompanied by a decrease in productivity and general well-being, anxiety states of varying strength (up to panic attacks), failures of various body systems, for example vision, where the vegetative-vascular factor is of great importance.

The described picture is often characteristic of neuroses, which additionally include a whole complex of variations: neurasthenia, hysteria, obsessive states, etc. Neurosis is one of the most common neuropsychic diseases. The main cause of neuroses is mental trauma, the significance of which is determined not by physical impact, but by informational value. In other words, neurosis is a disease that develops as a result of exposure to information. Neuroses and neurotic conditions are considered reversible disorders of nervous activity. The prognosis for psychotherapy for neuroses is most often positive.

Often such diseases are accompanied by psychosomatic illnesses (the influence of psychological factors on the occurrence and course of physical diseases). These are the same neurological symptoms, but they have an even more pronounced psychological background, and variations in manifestations can be different. Among the common ones: a person may experience difficulty breathing, his heart may hurt, his head may hurt (localization, as a rule, affects the most important organ systems).

According to S. Freud, “if we drive some problem through the door, then it enters through the window in the form of a symptom of disease.”

A person will not avoid the disease if he avoids the problem itself. Here the mechanism of repression, a kind of psychological defense, is taken as a basis. A person throws away thoughts that are unpleasant to him, afraid to look at them directly, and therefore they simply move to another level without disappearing anywhere. All our problems are subsequently transformed from the social (that is, interpersonal relationships) or psychological level (unfulfilled desires, our dreams and desires, suppressed emotions, internal conflicts) to the physiological level [4].

The opposite picture also occurs, although less frequently, when it is not the psyche that provokes neurological problems, but vice versa. For example, with a lack of nutrition, the brain will signal about its problems with the help of alarms, etc. Many doctors note this effect for cervical osteochondrosis. However, as a rule, the development of the disease occurs simultaneously along two vectors.

It is worth mentioning separately the psychoneurological complex of disorders after some serious illnesses, damage to the vascular system, brain, etc.

There are also completely non-trivial reasons, such as the effects of toxic substances on the body. Thus, data from an experimental study revealed the effect of low concentrations of mercury on a decrease in auditory and visual memory, emotional instability and decreased control over emotions (107 people working under exposure to mercury vapor were examined directly at work) [2].

As we can see, the reasons may be different, but mental and neurological manifestations are very often noted together.

Treatment should be structured as follows: the patient, when going to a neurologist, undergoes treatment with medications (if necessary) and lifestyle adjustments, after which he is sent to a psychologist or psychotherapist, where, with the help of conversations, special tests and other techniques, the source of the problem is analyzed ( for example, systematic problems at work, fear of important tasks, putting them off and accumulating them, which is why even a simple task seems impossible to the patient). The correct attitude towards things is formed, the person understands that the source of fear is himself, that the fear of any diseases is groundless or exaggerated. (The main task of a psychotherapist is to combat irrational mental attitudes that run counter to common logic). Additionally, the recommendations previously given by the neurologist are adjusted taking into account mental hygiene and psychoprophylaxis; Specific methods can also be used: hypnosis, relaxation, meditation, special exercises.

At the same time, medicine does not stand still, and doctors who combine the two sides of the problem—psychiatric neurologists—are increasingly beginning to appear in the workplace.

A psychoneurologist is a doctor who understands both neurology and psychiatry. Firstly, any neurological disease always has a psychosomatic component, that is, internal discomfort, anxiety, fears, dysphoria (a form of pathological decline in mood, the antonym of the word “euphoria”). In the body, all these phenomena are embodied by completely material diseases - headaches, insomnia, various pain syndromes, etc. The doctor’s task is to see behind the mask of a somatic disease, for example gastritis, colitis, bronchial asthma, cystitis, migraine, vegetative-vascular dystonia or, for example, arterial hypertension, neurosis, hidden depression. Therefore, the psychoneurologist, in addition to the standard neurological status, takes into account information about the psychological state of the patient.

Conclusion. Even ancient philosophers focused on the connection between a healthy mind and a healthy body. People have noticed that a person who has been depressed for a long time subsequently begins to get sick often and “melt” physically and mentally. As we see, modern medicine confirms this phenomenon. And the task at this stage will be the comprehensive diagnosis and treatment of such diseases, the training of doctors who understand both manifestations of the problem - psychoneurologists, as well as the combination of drug and non-drug treatment and their phasing; dialogue between doctors of two profiles.

Literature:

1. Abdueva F. M., Kamenskaya E. P. Vegetative-vascular dystonia or somatoform dysfunction of the autonomic nervous system of the heart? // Bulletin of the V. N. Karazin Kharkov National University. Series "Medicine". - 2012. - No. 23 (998).

2. Gnelitsky G. I., Kaurov Ya. V., Artemenko A. G., Andryukhin V. I. Psychoneurological disorders during prolonged contact with low concentrations of mercury // Bulletin of Health and Education in the XXI Century. 2011. No. 9. URL: https://cyberleninka.ru/article/n/psihonevrologicheskie-narusheniya-pri-dlitelnom-kontakte-s-malymi-kontsentratsiyami-rtuti (access date: 01/26/2019).

3. Neznanov N. G. et al. School of V. M. Bekhterev: from psychoneurology to the biopsychosocial paradigm. St. Petersburg, 2007.

4. Topolyansky V.D., Strukovskaya M.V. Psychosomatic disorders. - M.: Medicine, 1986. 384 p.

Who to go to

To a good specialist. Seriously: a good specialist in the “wrong” (i.e., not the most suitable for your specific case) field is much better than a bad specialist in the right one. Simply because a good psychologist knows a good psychiatrist and will send you to the right address, if suddenly your misunderstanding with your wife is a manifestation of paranoid schiz, and you don’t have any wife. On the other hand, a good psychiatrist will prescribe you ascorbic acid and send you to a psychologist, if you are not a psychotic hypochondriac. But if you don’t know a good shrink, you can use the following diagram as a guide. 1. Go to a psychotherapist or medical (not ordinary!) psychologist. And require him to determine which area your problem belongs to. After this everything will become clear. 2. If this is not possible, and the choice is between a simple psychologist and a psychiatrist, then go to a psychiatrist. Simply because in this case the cost of a mistake is lower: it’s not as scary for a healthy person to take a course of some “Risperidone” as it is for a crazy person with delusions of jealousy to skip treatment and uselessly delve into why his wife doesn’t love him (paranoia is a scary thing!) . Personally, I worked with all these specialists, and ultimately came to the conclusion voiced in the first paragraph of this section.

Psychiatry

Psychiatry is a branch of clinical medicine that studies mental (mental) disorders, deals with their treatment, prevention and assistance to the mentally ill, as well as the isolation of persons with mental disorders and persons with behavioral disorders who pose a potential danger to themselves or others.

Medical descriptions of mental illnesses are contained in the works of the ancient Greek physician Hippocrates , the doctors of Ancient Rome Aretaeus, Soranus, Celsus, Galen . In the Middle Ages, Western Europe was dominated by mystical views on the nature of mental illness. Some Eastern doctors looked for natural causes of their occurrence; Thus, Ibn Sina (Avicenna) explained them by disturbances in the “juices” of the body. As cities grew, the need for isolation and care for the mentally ill became more acutely felt; Initially, these functions were carried out by monasteries (“houses of mercy”) and even prisons. Special institutions began to appear in the 13th–16th centuries. : Olomouc in the Czech Republic, Bedlam (Bethlehem) in London, etc. In Russia, the Council of the Hundred Heads (1551) developed a special provision on monastic assistance to those suffering from mental illness.

“psychiatry” itself was proposed in 1803 . German physician Johann Christian Reil .

There are still no clear criteria for distinguishing some mental illnesses from extreme manifestations of the norm. If you follow one of the most common definitions, mental illness is a change in consciousness that goes beyond the “norm of reaction.”

There are general and private psychiatry.

General psychiatry studies the basic properties of mental illnesses, patterns of their manifestation and development, causes, principles of classification, methods of research and treatment. In other words, general psychiatry (or general psychopathology) deals with the study of common features that characterize most mental illnesses or disorders. In this section, for example, disorders of mental processes (perception disorders - illusions, hallucinations; thinking disorders - delusions, etc.).

Private psychiatry (private psychopathology) studies individual mental illnesses, their etiology, pathogenesis, clinical picture, patterns of development, methods of treatment and restoration of disability. In private psychiatry, diseases such as:

• schizophrenia;
• epilepsy;
• affective insanity;
• personality disorders (psychopathy);
• and etc.

It should be noted that there are many different classifications of mental disorders, but none of them are based on any common criterion. Currently, the classification according to ICD-10 , despite the many shortcomings of this system. In addition, one of the most well-known systems is DSM-IV (Diagnostic and Statistical Manual of mental disorders) - a manual for the diagnosis and statistics of mental disorders adopted in the USA.

Various pharmacological drugs are used to treat mental illness. In addition, the use of psychotherapeutic methods , which, according to many authors, is the future of modern psychiatry.

How to understand if a given specialist is good

This section will be pure IMHO. The surest way: study yourself at least at an intermediate level in psychopharmacology, psychiatry, psychotherapy and psychology and talk to a specialist. Long, expensive, high quality. Attention : this method does not work for people with delusional concepts: if your reality testing is seriously impaired, then for you there is only one answer - nothing. If this is not possible, then there are a few simple rules: 1. Your specialist must have at least an approximate idea of ​​what evidence-based medicine is (even if he is just a psychologist), and how his methods are perceived by her. You can quite successfully work with a specialist who uses methods that do not have proven effectiveness (for example, psychoanalysis), but knowledge of what EBM is, why it is needed, why it is important is a certain general cultural level of a specialist, and if it is not there, talk about nothing. 2. Your specialist should not be intimidated by the words Pubmed and Cochrane. It’s even better if he knows what it is and why he needs it (or convincingly prove that he doesn’t need it, although there are possible options here). 3. Your specialist himself undergoes personal therapy. Even if he is a psychiatrist. Personal therapy is an awesome experience that cannot be replaced by anything. 4. Your specialist knows English at a level sufficient to read professional literature. Simply because all the most interesting and new things are published on it (or quickly translated into it), and if a specialist does not speak this language, he will be on the sidelines of progress. Titles, categories, diplomas, studies and the like don’t mean anything. Experience. Experience is a good thing, but it must be properly integrated and interpreted. And it’s not like “the same clinical mistakes repeated for 20 years.” Reviews... You need to be careful with reviews. This is an area where, in addition to the usual “everyone lies” glorified in House, there is also a lack of awareness. And one discreetly positive review from a schizoid can mean more than ten emotionally enthusiastic praises from a hysterical person (or it may not mean that). How to evaluate the quality of reviews? See the first sentence of the section.

Medical educational literature

According to myths, legends, and historical monuments, mental disorders were observed in very distant times. Thus, there is evidence that at the dawn of human existence, aggressive patients were considered possessed by spirits, while calm and quiet ones were considered to be under the protection of good gods. The latter were cared for and sometimes enjoyed special honor.

The first attempt to scientifically evaluate some mental disorders and explain their possible causes belongs to Hippocrates (460-370 BC). His books, as noted by the outstanding historian of psychiatry Yu. Kannabikh, naturally do not provide a complete presentation of psychiatry of that time. They contain many fragmentary observations and treatment recommendations, as well as contradictions. Nevertheless, it was Hippocrates who owned such terms as “melancholy”, “mania”, “phrenia”, “epilepsy”. They are still used today, although the content of some has changed somewhat. Hippocrates proposed the widely spread humoral theory of mental pathology.

During the times of Ancient Rome, the psychiatric views of Hippocrates found successors: new types of mental disorders were described and ideas about the temperaments identified by Hippocrates (choleric, sanguine, phlegmatic and melancholic) were fully formed. However, in general, psychiatry remained a largely naive area of ​​human knowledge, and assistance to patients was limited to isolating them from society.

The Middle Ages in Europe were marked by the dominance of religious dogmas in all spheres of social life, when many scientific ideas in medicine not only did not receive development, but were considered incompatible with the dogmas of the Holy Church. It is not surprising that the mentally ill were also persecuted at that time. Their statements and behavior were considered the result of a conspiracy with evil spirits. The mentally ill who were “caught” having connections with the devil were tortured and burned at the stake.

The following centuries, called the Renaissance, were characterized by geographical discoveries, the formation of new philosophical views, the development of art and many branches of science.

All this could not but affect the state of psychiatry: clinical descriptions of certain types of mental disorders continued to accumulate, and ideas appeared that mental disorders could be associated with abnormalities in brain activity. For example, Vettorn (1481 - 1561) and Trinkavella (1491 - 1563) believed that the cause of melancholy lies in some kind of substance that “darkens” the brain, and mania is caused by internal heat or fire.

The first attempt to create a classification of mental disorders, which belonged to F. Plater (1537-1614), a professor of medicine in Basel (Switzerland), dates back to this time. The starting point for this classification was the scientist’s idea that a person has two kinds of sensations - external (vision, hearing, touch, etc.) and internal (reason, imagination, memory), and the totality of all abilities constitutes consciousness. According to the professor, mental disorders are manifested by loss, weakening, strengthening and distortion of the listed functions. Plater also admitted the existence of internal and external causes of mental disorders, which essentially correspond to the division of mental illnesses into endogenous and exogenous, established in modern psychiatry. However, during the Renaissance, nothing changed in the provision of assistance to the mentally ill: they were still kept in specially adapted “shelters” in extremely cramped and unsanitary conditions, even subjected to physical punishment. Many patients were kept in chains.

Subsequently, the humanistic ideas of French educators played a major role in changing the worldview of society, including in relation to the mentally ill, and for psychiatry the reform of F. Pinel (1745-1826) was of exceptional importance, eliminating such measures as keeping patients on chains, thereby eliminating prison conditions for the mentally ill, although the straitjacket was retained. By the reform carried out in 1792, in the words of the domestic psychiatrist N. Bazhenov, “a madman was elevated to the rank of a patient.” The ideas and reforms of F. Pinel quickly spread to most European countries. The English psychiatrist J. Conolly (1828) went even further, advocating the complete abolition of all measures that restrained patients, which was called “no restraint.”

And in other European countries, the ideas of freedom were implemented at different rates. Their special development in Germany deserves attention. In this country in the first half of the 19th century. There were two psychiatric schools - psychics (Heinroth, 1773-1843) and somatics (Jacobi, 1775-1884), which took opposing positions in explaining the causes of mental disorders.

The first, believing that a person has free will in choosing God or the devil, considered mental disorders as “possession” of an evil will and used mainly mechanical measures of constraint and influence to treat them. The school of somatics considered mental disorders in relation to somatic pathology to be secondary, i.e. caused by certain diseases of the human body. But despite the apparent outward difference in views on the origin of mental disorders, in fact there was much in common in the ideas of psychics and somatics: the first, recognizing the presence of a divine soul, believed that it could be possessed by an evil will (the devil), others argued that only the body suffers, but the soul unable to get sick, she is likened to “a maestro who cannot play a damaged instrument,” i.e. the positions of these schools are reminiscent of medieval views on the mentally ill. It is no coincidence, apparently, that Jacobi considered it inappropriate to completely abandon physical measures of restraint.

In America in the VIII-XIX centuries. there was no independent school - mainly the ideas of European psychiatrists (primarily French and English) were widespread here. B. Rush is traditionally considered the founder of American psychiatry. In 1812, he published a textbook that remained the only American textbook on psychiatry for the next 70 years. A feature of psychiatry in this country has always been an increased interest in psychotherapeutic techniques and methods of social rehabilitation of patients. The works of the American doctor J.M. Bird (1880), who described a new type of neurosis - neurasthenia, also gained great popularity in Europe.

In Russia, psychiatry developed in its own, special way: the mentally ill were never persecuted, and the main place of their detention and charity was always monasteries. During the reign of Ivan the Terrible, the stay of the sick in monasteries was supported by a state act of 1554 (“Stoglavy Cathedral”), which indicated that sending the mentally ill to monasteries was necessary “so as not to be a hindrance and a scarecrow for the healthy, to give them the opportunity to receive admonition or bring them to the truth." The first institutions for the mentally ill in Russia were opened in Novgorod, Moscow and St. Petersburg at the end of the 18th century and were intended mainly to house the sick, but attempts were already being made to provide them with medical assistance.

Subsequently, the development of psychiatry in all countries was largely determined by the expansion of knowledge about the structure and functions of the brain, as well as the progress of such sciences as biochemistry, pharmacology and other fundamental areas of medicine, which made it possible to formulate a concept about the origin of mental disorders, to approach the development of methods for their treatment and organization of assistance, primarily hospital care. But all this already refers to the eventful 19th century, which can be considered the beginning of the development of clinical psychiatry in its modern understanding.

In 1882, the French psychiatrist A.L.J. Bayle described progressive paralysis, which marked the identification of the first independent mental illness. At this time, the basis of biological knowledge about mental illnesses was also formed. Thus, V. Griesinger argued that the anatomy and physiology of the nervous system form the basis of medical psychology, and mental disorder is associated with brain disease. Similar views were expressed by the domestic psychiatrist P.P. Malinovsky in the book “Insanity as it appears to the doctor in practice” (1843). Naturally, attempts have been made to find the neuroanatomical basis of psychosis. Neuroanatomy was given great attention by T. Meinert (1833-1892), K. Kleist (1848-1903), as well as K. Wernicke (1848-1905), who proposed a classification of mental disorders based on the location of brain lesions. F. Pinel's student J. Esquirol (1838) introduced the concept of remissions and intermissions, the idea of ​​predisposing and realizing factors of mental illness, defined the difference between illusions and hallucinations, etc.

Of the general theories about mental disorders, the concept of a single psychosis should be noted [Neuman N., 1814-1884; Zeller E.A., 1838] and ideas about degeneration (degeneration) [Morel E., 1859]. According to the first concept, various mental illnesses are considered as manifestations of a single psychosis. According to the concept of degeneration, mental disorders are determined by hereditary predisposition, and from generation to generation the corresponding disorders progress, leading to mental defects and dementia. J. Pritchard (1838) published a work on moral insanity, which dealt with persons lacking feelings of empathy, sympathy and compassion.

In search of the causes of mental disorders, psychiatrists of the 19th century. paid special attention to the study of the somatic sphere of patients. As an example, the book by I.P. Merzheevsky “Somatic studies of frantic patients” can be cited.

Psychiatry in many countries, including Russia, was first taught together with neurology, and their separation began only in the second half of the 19th century. This is clearly seen in the example of Russia: here, with the opening of a number of psychiatric hospitals in various cities, psychiatry began to emerge as an independent specialty. But only in 1867 was the first department of psychiatry established on the basis of the psychiatric clinic of the Military Medical Academy in St. Petersburg (the head of the department was Professor I.M. Balinsky). In 1885, V.M. Bekhterev was appointed professor of psychiatry. At Moscow University, the course of neurology and psychiatry was assigned to lecturer A.Ya. Kozhevnikov in 1869. In 1887, a psychiatry clinic was opened at Moscow University, and Prof. A.Ya.Kozhevnikova. The neurological clinic, on the basis of which teaching had previously been carried out, was located at a distance from the newly opened psychiatric clinic. At the suggestion of A.Ya. Kozhevnikov, the teaching of psychiatry was entrusted to the young private assistant professor S.S. Korsakov (1854-1900), who from 1893 became the official director of the psychiatric clinic, and after his death the name “Korsakov clinic” was assigned to it.

S.S. Korsakov, one of the outstanding Russian psychiatrists, in 1887 described polyneuritic alcoholic psychosis, which entered world psychiatry as “Korsakov psychosis.” In assessing the origin of mental disorders, the scientist attached particular importance to biochemical processes and therapeutic mechanisms operating on the principle of a complex reflex act. S.S. Korsakov is the founder of the school of Moscow psychiatrists. He actively implemented the ideas of a humanistic attitude towards the mentally ill. His works on the bed confinement of the mentally ill, on the organization of the regime and treatment of patients gained worldwide fame.

Subsequently, the Korsakov clinic was headed by P.B. Gannushkin (1875-1933), known for his work in the field of borderline mental disorders, especially psychopathy. Subsequently, the problems of borderline psychiatry were developed in the works of O.V. Kerbikov and his students.

Materials and observations of the experience of the Civil and Great Patriotic Wars made it possible to significantly enrich the description of the clinic of exogenous mental disorders (V.P. Osipov, S.N. Davidenkov, V.A. Gilyarovsky, etc.).

The research of domestic psychiatrists has always been distinguished by a high clinical level of description of mental disorders, not only statically, but also dynamically. A special place is occupied by the works of A.V. Snezhnevsky (1904-1986), who, in terms of changing psychopathological syndromes, substantiated the diagnosis, dynamics and prognosis of mental illnesses.

In foreign clinical psychiatry of the late XIX - early XX centuries. The names of the German psychiatrists E. Kraepelin and E. Bleuler stand out, who made a huge contribution to the study of endogenous psychoses, primarily schizophrenia, and had a huge influence on the development of all world psychiatry. It was E. Bleuler who introduced the concept of “schisis”, and in 1911 he published a well-known monograph in which early dementia was called “schizophrenia” (schizophrenia). E. Kraepelin established general patterns of the occurrence, course and outcomes of schizophrenia, manic-depressive and other psychoses, and his research in this area is still considered a reference for many modern studies. E. Kraepelin also made statements about the probable causes of the onset of dementia praecox, which he identified. The scientist believed that this could be autointoxication (self-poisoning). Autointoxication theories subsequently received great development, having undergone a significant transformation from ideas about the formation of toxic substances in the patient’s body to modern biochemical-receptor and molecular genetic views on the pathogenesis of endogenous psychoses.

In the 20th century, clinical psychiatry continued to develop. New directions have also emerged, among which the most important place is occupied by biological psychiatry, represented by a complex of studies (biochemical, genetic, immunological, etc.) aimed at studying the etiology and pathogenesis of mental illnesses. At the same time, significant progress has also been made in the psychological field.

In the field of biological psychiatry, a special place belongs to I.P. Pavlov (1849-1936). From the standpoint of the conditioned reflex theory, based on ideas about the processes of excitation and inhibition, their strength, mobility, the significance of the first and second signal systems, I.P. Pavlov and his students pathophysiologically explained a whole range of psychopathological phenomena.

Psychological concepts and related practices in psychiatry have a long history. According to the teachings of the ancient Greek philosopher Plato, the human soul is divided into 3 parts, which are similar to such personality structures identified by S. Freud as “Ego” and “Superego”. Several centuries later, Plato’s ideas were developed in depth psychology, which, together with psychodynamic (including psychoanalytic) postulates the existence of irrational forces in humans, conscious and unconscious, possessing a certain plasticity and autonomy both normally and during the development of mental disorders. Psychology played a major role in the development of psychotherapy, primarily Freud's psychoanalysis.

The most important achievements that provided completely new opportunities for modern psychiatry were the introduction into practice of methods of shock therapy for psychosis (insulin comas), electroconvulsive therapy, and especially the discovery in 1952 of the antipsychotic properties of aminazine, which became the first of the psychotropic drugs. Psychopharmacotherapy has decisively transformed the entire system of care for the mentally ill. It was with the widespread introduction of new treatment techniques into practice that psychiatry transformed from a descriptive and observational discipline into a full-fledged medical science. The use of psychotropic drugs has made it possible to find completely different approaches to studying the functioning of the brain and has given impetus to new achievements in both biological and psychological research.

As in any other area of ​​clinical medicine, the basis of diagnosis in psychiatry is the classification (systematics) of diseases. The diagnosis made in accordance with one or another classification determines the choice of treatment, the prognosis of the disease, as well as subsequent features of social rehabilitation measures. The most reliable classification should be based on etiological and pathogenetic principles; however, the current knowledge about the origin and mechanisms of development of mental illnesses is still insufficient for its construction. Therefore, all classifications of mental disorders have always been eclectic. Modern taxonomies are no exception, in the compilation of which various principles are used - etiological, clinical, age, etc. Classifications developed gradually, reflecting the characteristics of psychiatry in individual countries. But they could not help but be influenced by the achievements of world psychiatry.

The German psychiatrist E. Kraepelin made a great contribution to the development of psychiatric systematization. His classification, not without eclecticism, was based on the nosological principle, as it was focused on the medical model of the disease, i.e. it was assumed that each disease has its own etiology, clinical picture and outcome. However, E. Kraepelin’s nosological direction has not received recognition in other countries. In the USA, this trend was opposed by A. Meyer (1907), who believed that formal labels do not mean anything. In his opinion, mental disorders are the result of an individual’s reaction to various external harms. In other countries (France, Scandinavian countries, etc.), the nosological approach was partially accepted and is still used in this form, defining the features of existing national classifications.

Domestic psychiatrists accepted the classification of mental illnesses and the nosological direction in general, although with some criticism, in the first years of the 20th century. Within the framework of the nosological approach, the clinical features and prognosis of various mental illnesses were carefully developed.

Since the early 1960s, WHO has attempted to create an International Classification of Mental Disorders in order to unify, as far as possible, the assessment of mental illness by psychiatrists in different countries and to ensure the possibility of comparing the results of various studies in psychiatry. The classification of mental disorders is part of the International Classification of Diseases (ICD), which is systematically revised and improved. The creation of a classification of mental disorders under the auspices of the WHO served as a compromise between different national classifications. Currently, the International Classification of Diseases, 10th revision (ICD-10), has been adopted. The introduction of international classifications and unified criteria for assessing mental disorders made it possible to conduct not only clinical, but statistical and epidemiological studies at a new level.

This manual is based primarily on the diagnostic criteria of ICD-10, therefore the terms and codes of this classification are used in the text. At the same time, the presentation of clinical material reflects the traditional views and approaches of Russian psychiatry, supporting the continuity of Russian classical and modern psychiatry.

The textbook also reflects the traditional division of psychiatry into general and specific.

General psychiatry studies the general patterns of the formation of symptoms, syndromes of mental disorders, their dynamics and underlying pathogenetic mechanisms. It includes psychopathology and to some extent pathopsychology, especially when it comes to the assessment of cognitive impairment.

Private psychiatry describes the etiology, pathogenesis, clinical picture of individual diseases, their variants and treatment of patients with corresponding mental disorders.

Since the age factor has a great influence on the development, clinical picture and prognosis of mental disorders, psychiatry distinguishes such areas as child and adolescent psychiatry and gerontopsychiatry (psychiatry of late life).

Psychiatry is also called upon to perform a number of social functions, among which one of the most important is conducting examinations (labour, military and judicial). A labor examination determines the degree of disability in mentally ill patients; military examination determines the possibility of a conscript to remain in the Armed Forces and perform military duties; Forensic psychiatric examination evaluates the ability of mentally ill subjects to exercise civil rights and enjoy them fully, and in cases of committing offenses to bear the responsibility provided for by law.

This textbook covers all of the listed sections of psychiatry.

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About clinical/medical psychologists

I promised to write about them separately. First of all, they are the same thing. They are called clinical in their diploma, and medical in their work, when they work in a psychiatric hospital. They have some features that ordinary psychologists don’t have (or few of them): 1. They do study psychiatry. And psychotherapy too. 2. They study pathopsychology, so they can work with real psychos. 3. They carry out psychological correction - i.e. recovery using non-drug methods. How is this different from psychotherapy? Basically the name. And, yes, a real clinical psychologist studied in medical school. institute/university, just not at the medical department, but at the clinical psyche.

This article was published in the blog “A Psycho Consultant Writes,” 01/08/17.

Author: ya_schizotypic

What is fortitude for both men and women?

Strength of spirit is a special quality that distinguishes a purposeful person. People with this personality trait are able to overcome obstacles on the path to what they want without “breaking down.” An individual with fortitude shows perseverance when difficulties arise and often goes to the end in solving seemingly incomprehensible problems. Such people succeed where others fail.

What is the difference between strong and weak:

1. Doesn't look for excuses, doesn't whine - strong people, unlike weak ones, appreciate every moment and spend it wisely, without being scattered over trifles.
2. He knows who to let into his life and who not to.
3. Trusts himself, listens to intuition. A weak person is often captured by fears that prevent a rational analysis of the situation.
4. Knows how to control his emotions. A self-confident individual does not waste time on squabbles and does not conflict without good reason. It is quite difficult to drive such people into hysterics.
5. Doesn't have complexes. Weak people are most often latently dissatisfied with themselves, while they like to openly condemn other people. Such people also condemn themselves, but they place the blame for failures on fate and spiteful critics.
6. Knows how to act. When weak-spirited people hesitate, a strong person solves the problem without putting it off until tomorrow.
7. Does not depend on the opinions of others. Those who are strong in spirit do not pay attention to unfounded criticism, do not act to please others, ignoring their own desires.
8. Not amenable to manipulation. Weak people, on the contrary, are easily fooled by any psychological tricks.
9. Easily adapts to new conditions. Those who are strong in spirit quickly get used to it, which cannot be said about the weak.
10. Does not lose heart when faced with troubles. A strong person perceives a problem as a lesson, trying to learn it.

A strong-willed person takes action rather than making excuses.

Fortitude is a character trait in which a person goes towards his goal no matter what. And this is something that not everyone can boast of.

Zhanna Mulyshina, practicing psychologist-consultant

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