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MINISTRY OF HEALTH OF UKRAINE
BUKOVYNIAN STATE MEDICAL UNIVERSITY
“Approved”
on the methodical meeting
of the Department of neurology, psychiatry
and medical psychology nm. S.M.Savenko
“____” ___________ 2009 (Report № __).
Chief of the Department
_______________________
Professor V.M. Pashkovsky
METHODICAL INSTRUCTION
for 4-th year students of medical faculty №2
(the speciality “medical affair”)
for independent work during preparing to practical class
Theme 7: EMOTIONAL DISORDERS
MODULE 1. GENERAL QUESTIONS OF PSYCHIATRY AND NARCOLOGY.
GENERAL PSYCHOPATHOLOGY
TOPICAL MODULE 2. GENERAL PSYCHOPATHOLOGY
Сhernivtsi, 2009
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1. Actuality Aim
A man not only perceives surrounding the world, the nowaday represents him and past, she
thinks, thinks, draws conclusions, builds plans on the future. To the man peculiar certain attitude
toward surrounding environments, to itself, to the state, which shows up emotions and senses
which are determined as an affect sphere.
The state of affect sphere is the thin indicator of conduct of man which is specified on the
degree of useful effect of irritant for the vital functions of organism (emotions) and mutual relations
of personality and society (sense).
Intensity of destructive conduct and publicly dangerous features negatively influence on the
psychical health of people and an affect sphere is violated above all things.
Emotions and senses are violated not only in mentally patients but also for patients with any
somatic illness. Consequently, knowledge of clinic of disorders of affects is important for the
doctor of any profession. Inspecting a patient, already from the first minutes it is necessary to
estimate his emotional state. If a doctor diagnoses somatic pathology only, ignoring the emotional
state of patient, it not that other, how to explain the system of circulation of blood without taking
into account work of heart.
2. EDUCATIONAL PURPOSE
 determination of emotions and senses;
 classification of emotions and senses;
 classification of disorders of affects;
 clinic of maniac affect (crazes);
 signs of euphoria;
 clinic of the depressed affect (depressions);
 clinic of agitated depression;
 emotional decline (emotional devastation, emotional dullness, apathy);
 emotional labile;
 dysphory;
 anxiety and fear (phobias).
2.2. Able:
 to define the state of emotional sphere for patients;
 to find out disorders of emotions and senses;
 to define the clinical displays of the maniac state;
 to define the clinic of depression;
 able to diagnose agitated depression;
 able to find out emotional disorders;
 able to find out dysphory ;
 to find out an anxiety and phobias.
2.3. To capture practical skills:
 patients with have collection of anamnesis emotional disorders;
 to conduct in general lines the clinical and abnormal clinically-psychology inspection of
patients with emotional disorders;
 to diagnose emotional disorders;
 to diagnose a maniac syndrome;
 to diagnose the depressed syndrome;
 to define the types of depressions;
 to diagnose the dysphoric state;
 to diagnose anxious and phobias disorders;
 to design direction in psychiatric permanent establishment of patient with emotional
disorders.
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3. EDUCATE PURPOSE.
On practical employment a teacher notice for students that the thought develops in the
conditions of intercourse, studies, labour. It is underlined that thought and intellect disorders are
possible as a result of the negative factors carried in childhood, which result to organic changes in a
cerebrum, which, in the turn, result in thought and intellect disorders.
Come into special notice for students about development of clinical thought of doctor and his
value in a diagnostically-medical process.
4. INTERSUBJECT INTEGRATION (base level of preparation).
Names of previous disciplines
1. Anatomy.
2. Physiology.
3. General psychology.
Skills are got
1. To know an anatomy and topographical anatomy of
cerebrum.
2. To know the basic cork functions of cerebrum. Able
to define the type of higher nervous activity.
3. To know psychology of emotions.
5. CONTENTS OF THEME.
Affection refers to the way something affects the individual in consciousness and outward
expression. Affection (in the Western, especially American psychological literature) includes the
entire range of feelings and emotions.
Ukrainian psychologists, following the tradition of the former USSR psychological schools
(which to some extent differs from Western schools) prefer the following definitions:
Emotion: according to Ya. M. Kogan's definition is a special kind of mental reaction,
deprived of independence, that accompanies other mental processes and gives them a sensual tone.
Emotions can also be described as a living creature's peculiar appraisal al of environmental
circumstances or of its own internal state. Every fact in the reality can be estimated as comfortable,
useful, appropriate (feelings of pleasure) or inappropriate, uncomfortable, or even threatening
(feelings of displeasure).
Affect: in our tradition in most cases means a very intensiv emotion (passion — rage,
horror, agony, ecstasy).
American psychologists, on the contrary, prefer to speak of affective processes in a more
general sense, meaning normal reactions. They use the word emotion to define an acutely disturbe
affective process or state which originates in the psychological situation and which is revealed by
marked bodily changes in smooth muscles, glands, and gross behaviour. According to this
definition an emotion is a disturbance — a departure from the normal state of composure.
Mood: is a complicated, more or less stable emotional state, tone of feelings; this especially
concerns the subjective experience by an individual. It is the sum of different emotions the person
experiences simultaneously at a certain moment. Normal mood that changes according to the
situation in a healthy individual is called eutimic.
The popular term feeling has many meanings. It refers to tactual perception, cognitive belief,
emotion, and the simple experiences of pleasantness and unpleasantness.
Emotions have developed in living creatures long before cognitive processes. They
promoted the satisfaction of their fundamental drives. Among the characteristic features of the
"emotional mechanism" it is necessary to mark extremely high sensitivity, quickness and
univalence of estimation.
Emotions have the following properties: sensitivity (the threshold of excitation), mobility
(stability, time of existence), amplitude, rate of arousal (time that passes from the moment of
encounter with the cause of the emotion till it reaches its full intensity) and the content (Table 2).
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There are two aspects of all affective processes: (1) an acute, temporary event and (2) a
chronic, persisting state. The first aspect is revealed in experience and behaviour. The second aspect
is actually assumed. When we speak of "an emotionally disturbed child," "emotional development,"
"emotional maturity," "emotional balance," "emotional instability," we simply mean a persisting
state of maladjustment, conflict, frustration, or a stable attitude or disposition.
Changes in emotions and mood are the most common symptoms of psychiatric disorders.
They occur frequently among patients
Table 2. Classification of Emotional Disorders
According to Different Properties of Emotions
Properties
Features (symptoms)
According to sensitivity end intensity
Irritability
Sensitivity
Emotional coldness (blunting, flattening)
According to stability
Lability (emotional incontinence)
Explosion readiness
Rigidity
Distortion of emotions
Ambivalence
Parathymia
Pathologic affect
Mood disorders
Euphoria (mania)
Hyperthymia
Dysphoria
Anxiety
Depression (melancholy)
Apathy
with physical illness and also in healthy people at times of personal misfortune.
As we had mentioned before, an emotion is a reaction to an external or internal event.
Normal emotions are adequate to the situation. Their intensity, stability (duration) and content are
different. On one hand, they depend on the circumstances and their interpretation by the individual.
On the other hand, they depend on personality features (especially temperament). In mental
disorders emotions can change pathologically according to their sensitivity and intensity; stability,
and can be distorted.
Abnormal readiness to anger is called irritability. Sensitivity is a tendency to exaggerated
affective responsiveness. The opposite mental state, diminution of normal emotional
responsiveness, is called blunting or flattening of affect. When mood changes are marked, and one
emotion quickly changes the other (a patient laughs, and in some minutes begins to cry or gets
angry) the terms "emotional lability” or "incontinence" are used; this phenomenon sometimes
occurs after strokes or as part of dementia. Physiological emotional lability is characteristic of
children. Frequent angry and aggressive reactions, a tendency to bursting forth violently for no
serious reason is termed explosion readiness. When the emotions remain constant in the face of
circumstances that normally call for changes in affect, the condition is known and affective rigidity
(in patients with epilepsy or obsessive-compulsive disorder).
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Distortion of Emotions. Mood is normally consistent with thoughts and actions. Thus, a
person is likely to experience a mood of depression when recalling a sad event, or to experience a
mood of elation when recalling a happy event. Sometimes (mainly in schizophrenia) mood and
thinking are not consistent in this way; for example, the person may look and feel happy when
thinking about a sad event. This phenomenon is called incongruity of affect (parathymia). It has to
be distinguished carefully from apparent cheerfulness that hides embarrassment. Some patients with
depressive disorders fail to show the characteristic facial expression of depression even though their
mood is very low (sometimes this state is called "smiling depression"). If a patient experiences two
opposite feelings towards one object or circumstance (love and hate, for example), this phenomenon
is known as ambivalence.
Pathological Affect. As it was mentioned above, the term "affect" in our tradition means a
very intensive emotion (passion — rage, horror, agony, ecstasy). A physiological affect is usually
more or less adequate to the situation, and, although the feelings can be violent, the individual has a
command over his or her actions, can understand their consequences, and later remembers what has
happened during his/her state of affect. In a pathological affect , though, change (constriction) of
consciousness occurs in the subject. The twilight state of consciousness is one of distinguishing
features of pathologic affect. The intensity of emotions exceeds any reasonable reaction to the
situation, feelings become inadequate. In most cases the leading emotion is intensive anger, rage.
The person looses control over his/her actions and usually behaves violently, he/she can commit a
crime, including a murder. The behaviour often becomes not only aggressive, but senseless. The
subject can not assess the results of his/her actions. Wnen the pathological affect ends, the person
falls asleep. Later he/she forgets everything about the
episode.
Mood Disorders. Above we had discussed mostly short-term emotional disorders, lasting
from several minutes to hours. Speaking about mood disorders, we mean emotional states that last
much longer, for days, weeks, and even many months. They are very common in the mental health
practice. In healthy people mood varies from day to day, and depends on the circumstances. Such
mood is called euthymic. This normal variation may be disturbed in illness. Change of mood is the
prominent symptom of depressive and anxiety disorders but can also occur in every kind of
psychiatric disorder, and in the reactions of healthy people to stressful events and to physical
illness.
Anxiety and fear are normal affects, which appear in threatening situations and serve as an
adaptive mechanism. They increase the speed of response to danger and help organisms to survive.
In psychiatry, though, we encounter patients who experience these emotions in a wide range of
situations or even for no objective reason at all (free floating anxiety).
Anxiety is associated with a characteristic expression in which the brow is furrowed
horizontally, the posture is tense, eyes are widely open, and the person is restless and sometimes
tremulous. Often there are accompanying signs of autonomic (sympathetic) over-activity, such as
pale skin, dilated pupils and increased sweating of the hands, feet, and armpits. States of anxiety are
frequent in several mental disorders, especially neuroses.
The term phobia denotes the symptom of anxiety or fear arising in relation to a specific stimulus.
The association with a particular object, event, or situation defines the phobia as a separate
symptom. Phobic anxiety is associated with a tendency to avoid the stimuli that evoke anxiety. A
phobic person may experience anxiety when thinking about the stimulus but not in its presence
(anticipatory anxiety). Phobias are common in healthy people, for example phobias of spiders,
snakes, thunderstorms, and high places. Phobias of these and other kinds are the prominent
symptoms of phobic disorders and also occur as minor aspects of other anxiety disorders and of
depressive disorders. So-called obsessive phobias are different, they will be described in the lecture
on the odsessive-compulsive syndrome.
Syndromes of Mood Disorders
Depression. In psychiatry the classical (typical) depression is a clinical syndrome consisting
of lowering of mood-tone (feelings of painful dejection), difficulty in thinking (slowing down of
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thinkin), and psychomotor retardation (the so called depressive triad). Depressive patients
experience conscious psychic suffering, anguish, and sometimes feelings of boredom, despair, guilt
or other negative emotions. Some patients with depression complain of painful mental insensibility
(anesthesia psychica dolorosa) — lack of emotions, especially this concerns feelings of love
towards relations and other positive feelings. These experiences are associated with ideas of selfhumiliation, loss, or sinfulness. Patients with depression think that they are failures, that there was
nothing good in the lives in the past, nothing good occurs at present, and the future will bring them
only misfortune.
Depression of mood is associated with a characteristic expression in which the corners of the
mouth are turned down and the centre of the brow has vertical furrows. The head is inclined
forward with the gaze directed downwards, and the shoulders are bent. The patient's gestures are
reduced. If the psychomotor retardation is pronounced
Depressive stupor can occur, in which patients do not move at all. In some cases after a long
period of motor retardation a sudden episode of wild agitation and frenzy can occur. It is called
"raptus melancholicus." Patients in this state beat their heads against a wall, scratch their faces, they
can injure themselves seriously, or commit a suicidal attempt or suicide.
Depressive patients often have several physical complaints, although no organic changes in
their inner organs are found. Mood disorders, though, are in the majority of cases associated with
the autonomous nervous system dysfunction, such as tachicardia, dilation of pupils, and
constipation (Protopopov's triad); there are also dryness in the mouth and other symptoms. In
depression appetite is usually low, and decrease of weight is observed in the patients.
Non-typical depressions differ from the classical depressive syndrome in a number of ways.
In the cases of anxiety-depression, besides feelings of sadness or dejection, patients feel
intensive anxiety and agitation, associated with the expectation of some specific misfortune (death
of relations, loss of property, etc.). Such patients, instead of being retarded are restless and cannot
stay still even for a few minutes, they become fussy and often complain, ask other people for help,
tell them that something fatal has happened, or express their wish to die. If such state of excitement
grows very severe, long-termed, and patients go into a frenzy, the depression is called agitated.
Apathetic depression makes patients indifferent to their environment, to their own state and to their
relations, apathetic, inert, and listless. They do not want to communicate with other people, do not
complain, and their only wish is to be left alone.
Masked or somatized depression is manifested mainly in various physical complaints, such
as pains and aches in the chest, stomach, or other parts of the body, decrease of appetite,
disturbances of sleep, heart palpitations, headaches, etc. Patients do not feel anguish or despair, they
experience only boredom or sadness, but attribute these feelings to their physical problems. They
consult different physicians, but no somatic diseases are found in them. It usually takes a
considerable time to diagnose the masked depression.
Depressive states occur in different psychoses (maniac-depressive, or bipolar affective
disorder, involution melancholy, reactive states, neuroses and some others). Depression is one of
the most frequent syndromes in psychiatry.
The manic syndrome is characterised by: a) an elated or euphoric mood (hyperthymia); b)
increased psychomotor activity, restlessness; c) increased number of ideas, speed of thinking and
speech (manic triad). The intensity if these symptoms can be different. Elation of mood is
associated with a lively cheerful expression. Posture is normal. The patients speak very much and
fast, in a loud voice. Often they don't finish sentences. Their movements are quick and active.
The attention in the manic syndrome is unstable, patients are easily distracted and usually
don't finish the work they begin doing. Thus, they are extremely active, but not productive. Their
memory, on the contrary, increases (hypermnesia). These patien do not express any complaints,
they experience "moral elation” and increased physical powers. They tend to overestimate their
capacities and opportunities. For example, women find themselves extremely attractive, they think
that the male personnel of the hospital and the students are in love with them. They decorate their
hair and clothes with flowers or bright-coloured ribbons, and use cosmetics too much. Patients may
believe, that they are capable of attaining great social changes, or make an important scientific
discovery.
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Physical symptoms. Manic patients usually have increased appetite, but they do not gain
weigh, owing to their excessive activity. They sleep for only 3 or 4 hours at night (although this fact
does not disturb them). Their sexual activity grows.
Methods of Investigation. The main methods of diagnosing emotional and mood disorders
are observation and interview. These methods are combined in the initial interview: the psychiatrist
watches the patient's facial expression, gesticulation and posture while talking with him/her.
Loudness, intonation and other qualities of voice are even more important for understanding a
person's affective state, than the content of his/her speech. Inpatients' behaviour can be observed for
long enough periods of time by the personnel: affective states and mood disorders change behaviour
significantly. For instance, people with classic depression have a sad facial expression, look tired
and sometimes older than their age. They speak slowly and in a quiet, rather monotonous voice.
During the conversation their head is inclined, back bent, they move slowly and do not change
posture for long periods of time. At the inpatient department they spend most of the time in bed, are
withdrawn and don't communicate with others. They belong to the group of increased suicide risk.
Patients with the manic syndrome behave in an opposite way: their facial expression and
gesticulation are lively, speech is loud and fast, behaviour is overactive, and they are extremely
communicative.
In addition to these methods, psychological diagnostic methods (self-assessment scales and
psychological tests) can be used. They help to make the diagnosis more objective and precise.
Self assessment scales are clinical questionnaires that include direct statements or questions
concerning the patient's health, state of mind and behaviour (Beck's Depression Scale, Hopelessness
Scale, etc.). Clinical questionnaires are designed for diagnosing of mental disturbances, they are
formalized, but not all of them are standard.
Psychological tests are standardized instruments used for measurement or precise
assessment of psychological characteristics. They can be used both for healthy people and for
psychiatric patients. Among the tests that help in diagnosing affective disorders there are
questionnaires (Spilberger's Anxiety Inventory, Manifest Anxiety Scale, and many others) and
projective methods (Rorschach Test, Thematic Apperception Test, etc.). Projective methods help to
reveal hidden or subconscious emotions, they are also used to assess personality characteristics.
5.1. QUESTIONS OF CONTROLS:
1. Give determination of concept of «emotion» and «sense».
2. Conduct classification of emotions and senses.
3. Classify disorders of affects.
4. Describe the maniac state.
5. Describe depression.
6. Give description of agitated depression.
7. Describe emotional devastation and emotional dullness.
8. Describe the clinical picture of apathy.
9. Describe etiology and clinical picture of paralysis of emotions.
10. Describe the clinic of dysphory and its diagnostic value.
11. What is the concept of «anxiety» and «fear» and their diagnostic value.
6. MATERIALS OF METHODICAL PROVIDING OF EMPLOYMENT (MATERIALS OF
CONTROL OF BASE (INITIAL LEVEL) PREPARATION OF STUDENTS):
6.1. Additions. Facilities for control:
Questions of controls:
1. Determination of emotions and senses.
2. Classification of emotions and senses.
3. Classification of disorders of affects.
4. Gypertimya, euphoria, maniac state.
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5. Gypotimya, clinic of depression.
6. Clinical displays of agetated depression.
7. Emotional devastation and emotional dullness, their diagnostic value.
8. Apathy, clinical description.
9. Paralysis of emotions, etiology, clinic.
10. Emotional labile, diagnostic value.
11. Dysphory, clinic, diagnostics.
12. Anxiety and fear (phobias), clinic, diagnostic value.
Tests and tasks:
1. A male patient, 37 years old, became too cheerful for no particular rea-son, he has a subjective feeling of
high creative abilities, enthusiasm, elation and increased productivity, in spite of manifest disability to
concentrate (impaired attention); his speed of thinking processes is too high. He is uncritical to his state, and
finds it normal.
Name the syndrome:
A. Manic (non-psychotic) syndrome
B. Syndrome of dysphoria
C. Hypomanic (non-psychotic) syndrome
D. Obsessive syndrome
E. Depersonalization syndrome
2. A male patient 22 years old, complained of the decrease of physical and mental productivity, as well as
increased fatigue, weakness, increased need for rest after easy work. He became irritable, impatient and less
tolerate towards people, it is difficult for him to wait even for a short time; he often has headache, sweats
easily, feels prickling sensations in the heart re-gion when worries.
Name the syndrome:
A. Depressive syndrome
B. Hypochondriac syndrome
C. Asthenic syndrome
D. Paranoia syndrome
E. Obsessive syndrome
3. After a head injury that the patient had 5 years ago he developed affec-tive disturbances: suddenly and for
no serious reason he feels anger. His mood during these periods is characterised by tension, depression
combined with anger or even rage, high irritability with a tendency to aggressive actions.
Name the syndrome:
A. Phobic syndrome
B. Dysphoric syndrome
C. Depressive syndrome
D. Manic syndrome
E. Asthenic syndrome
4. At the inpatient department of a psychiatric hospital a female patient is passive, inert and is never involved
in any activities on her own accord. Does some primitive work (makes cardboard boxes), but constantly
needs inducement and activation. She is completely indifferent to the situation in the department, to the
members of her family and her own situation, does not care about being discharged from the hospital or left
at the department for a longer time.
Name the probable syndrome:
A. Asthenic syndrome
B. Apathetic and abulic syndrome
C. Organic brain syndrome
D. Encephalopathic syndrome
E. Depressive syndrome
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5. In a month after having flu the patient began to complain of persistent headaches, sleep and eating
disorders; other complaints were irritability for no serious reason and emotional instability. Gets exhausted
quickly, feels tired even after 20 or 30 minutes of conversation with the psychiatrist. Practically isn't able to
read books, because can not concentrate, is easily distracted to other subjects. Is critical to the state of his
health, understands that is ill and needs treatment.
Name the probable syndrome:
A. Apathetic syndrome
B. Neurotic syndrome
C. Hysterical syndrome
D. Asthenic syndrome
E. Organic syndrome
6. The observed patient's movements are retarded, she doesn't react to the attempts to contact her, answers no
questions. Sometimes she spontaneously stays in strange postures. It is possible to set (form) her body and
limbs into different positions artificially. For instance, if the psychiatrist lifts her arm or leg, so that she
remains standing on the other leg, the patient can stay in such an inconvenient position for quite a long time.
Name the probable syndrome:
A. Depressive stupor
B. Apathetic stupor
C. Psychogenic stupor
D. Catatonic stupor
E. Neurotic stupor
7. At the psychiatric department the patient monotonously walks along a corridor wall, doing a certain
number of paces. Then he stops, makes a decisive gesture with his hand, calls out a senseless phrase and
sharply turning round walks the same number of paces along the corridor and again repeats the same gesture
and phrase. He repeats this type of behavior several times, and it is impossible to stop him because he shows
resistance. Name the probable syndrome:
A. Catatonic syndrome
B. Manic syndrome
C. Hebephrenic syndrome
D. Heboid syndrome
E. Hysterical syndrome
8. At the psychiatric department the patient has no motivation, no incentive, and no wishes. She doesn't
speak to anybody, spends all her time in bed, fencing herself from others with a blanket. Eats only if she is
led to the table under compulsion and fed with a spoon. Often urinates in bed and has no initiative to ask
someone to change her bedclothes.
Name the probable syndrome:
A. Organic syndrome
B. Apathetic-abulic syndrome
C. Asthenic syndrome
D. Depressive syndrome
E. Catatonic syndrome
9. A male teenager (15 years old) with a normal level of intelligence and no conduct disorders before the age
of 14, is characterized by rudeness, negativism, perverted emotional reactions and drives with antisocial
tendencies. His attitude to others, especially members of his family, is often cruel, he seems to enjoy hurting
people. At school he sometimes bites or pinches girls painfully, and says that he does this because he "likes
them." He often offends and beats his grandmother and mother, when they "irritate" him.
Name the probable syndrome:
A. Hebephrenic syndrome
B. Hyperkinetic syndrome
C. "Wildness"
D. Alienation
E. Heboid syndrome
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10. A male patient, 51 years old, is sure that he has a serious incurable illness. He presents several
physical complaints (unpleasant feelings in his chest and stomach, constipation, etc.) and regularly consults
all the medical specialists in the outpatient department. He doesn't believe them, when they assure him that
the results of investigations are normal. The patient is sure that a horrible diagnosis is being concealed from
him. Demands more additional investigations and a professor's consultation.
Name the probable syndrome:
A. Hysterical syndrome
B. Hypochondriac syndrome
C. Depressive syndrome
D. Paranoia
E. Overvalued ideas
11. The patient consulted a psychiatrist with a complaint of being what he called "too pedantic." He told the
doctor that he simply couldn't begin doing any work without putting all his instruments symmetrically.
"Recently I had to repair my car, but was putting the wrenches and screw drivers sym metrically instead."
Conflicts often occurred in the family about trifles: the patient insisted that all the things had to lie
symmetrically. Otherwise he felt discomfort and nervous tension.
What is the probable syndromal diagnosis?
A. Depressive syndrome
B. Obsessive-compulsive syndrome
C. Asthenic syndrome
D. Cotard's syndrome
E. Dysmorphomanic syndrome
12. A 17-year-old girl, after her mother's serious illness became anxious and irritable. Waited impatiently for
the classes to be over, then ran home as fast as possible, imagining the horrible picture of her mother's death.
Her heart palpitated, she felt heaviness in the stomach and trembled all over. The girl got calm again only
when she saw that her mother was well.
What is the syndromal diagnosis?
A. Cotard's syndrome
B. Asthenic syndrome
C. Depressive syndrome
D. Obsessive-phobic syndrome
E. Syndrome of overvalued ideas
13. The patient had consulted the psychiatrist several times. During this visit the complaints were as follows:
the state occurred acutely, she felt that her body had changed "as if it was not hers", her voice became
"somehow different." As she stood at night near the window, she suddenly saw her body as if from aside, and
"felt the experiences and sensations of both bodies simultaneously." The patient told the psychiatrist that all
night she seamed to "live double life."
What is the syndromal diagnosis?
A. Apathetic syndrome
B. Derealisation syndrome
C. Depersonalisation syndrome
D. Paraphrenic syndrome
E. Visual hallucinosis syndrome
14. At the psychiatric department the patient is lively and cheerful, her eyes shine, and her mood is elevated
almost all the time. Her clothes look rather extraordinary: the slippers are decorated with bows and a lot of
cotton wool balls are sewn all over her jersey. Her hair is made into a strange coiffure, her lips are painted
with bright lipstick. The patient is excessively energetic and restless, she intrudes into every activity going
on at the department, dances, sings, makes sexually advances to male visitors of the department. Seems
never to get tired, sleeps only for 3 or 4 hours at night, her appetite is increased. Speaks very quickly, with no
pauses, can't keep one line of conversation, and constantly "skips" from one topic to another.
Name the syndromal diagnosis.
A. Catatonic excitation
B. Manic syndrome
C. Hebephrenic excitation
D. Hyperbulic syndrome
E. Hysterical syndrome
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15. The patient is excited and restless, incessantly walks around the room, wrings her hands, weeps and
groans. There is an expression of fear on her face. Asks the people around her to save her family, which is
sure to be in great danger. Promises to give the people much money for rescuing her relations. The personnel
can't dissuade her: the patient stays extremely anxious. Couldn't sleep for two nights, and hasn't eaten any
food for three days, saying, "How can I eat, when my dear ones are dying?" Tried to commit suicide.
Name the syndromal diagnosis.
A. Hypochondriac syndrome
B. Anxiety and depressive syndrome
C. Agitated depression syndrome
D. Masked depression syndrome
E. Catatonic syndrome
8. RECOMMENDED LITERATURE IS:
8.1. Basic:
1. Clinical Psychiatry from Synopsis of Psychiatry by H.I.Kaplan, B.J.Sadock. – New York:
Williams @ Wilkins. – 1997.
2. Psychiatry. Course of lectures. – Odessa: The Odessa State Medical University. – 2005. – 336
p.
3. Lectures.
4. Internet resource.
8.2. Additional:
1. Морозов Т.В., Шумский Н.Г. Введение в клиническую психиатрию. – Н.Новгород:
Изд-во НГМА, 1998.
2. Попов Ю.В., Вид В.Д. Современная клиническая психиатрия. – М., 1997.
3. Сонник Г.Т. Психіатрія: Підручник / Г.Т.Сонник, О.К.Напрєєнко, А.М.Скрипніков. –
К.: Здоров’я, 2006.
Prepared by assistant
S.D.Savka