Research methods in clinical psychology. Psychological correction and psychotherapy. Methods for studying sensations and perception. Basic sensory disturbances
Clinical psychology is a branch of psychological science. Its data have theoretical and practical significance for both psychology and medicine.
In some countries, the concept of medical psychology is common, but in most countries the concept of “clinical psychology” is more commonly used.
In recent decades in Russia, the question of the rapprochement of domestic and world psychology has increasingly begun to arise, which required a revision of such concepts as medical and clinical psychology.
The change in the name of medical psychology to clinical psychology is due to the fact that in recent decades it has been integrated into world psychology.
Clinical psychology as an organization of researchers and practitioners has been represented by the American Association of Clinical Psychology since 1917, and in German-speaking countries since the mid-19th century.
The international manual on clinical psychology, edited by M. Perret and W. Baumann, provides the following definition: “Clinical psychology is a private psychological discipline, the subject of which is mental disorders and mental aspects of somatic disorders (diseases). It includes the following sections: etiology (analysis of the conditions for the occurrence of disorders), classification, diagnosis, epidemiology, intervention (prevention, psychotherapy, rehabilitation), health protection, outcome assessment.” In English-speaking countries, in addition to the term “clinical psychology,” the concept of “pathological psychology” – Abnormal Psychology – is used as a synonym. In addition to clinical psychology, medical psychology is also taught in many universities, mostly Western. The content of this discipline may vary. It includes:
1) application of the achievements of psychology in medical practice (primarily this concerns solving the problem of interaction between a doctor and a patient);
2) disease prevention (prophylaxis) and health protection;
3) mental aspects of somatic disorders, etc. In accordance with the state educational
The standard clinical psychology is a broad-profile specialty aimed at solving a set of problems in the healthcare and education systems. It is also noted that clinical psychology is interdisciplinary in nature.
Experts give different definitions of clinical psychology. But they all agree on one thing: clinical psychology examines the area bordering between medicine and psychology. This is a science that studies medical problems from a psychological point of view.
Leading Soviet psychiatrist A.V. Snezhnevsky believes that medical psychology is a branch of general psychology that studies the state and role of the psyche in the occurrence of human diseases, the characteristics of their manifestations, course, as well as outcome and recovery. In its research, medical psychology uses descriptive and experimental methods accepted in psychology.
2. Subject and object of research in clinical psychology
According to their focus, psychological research is divided into general (aimed at identifying general patterns) and specific (aimed at studying the characteristics of a particular patient). In accordance with this, we can distinguish general and specific clinical psychology.
The subject of general clinical psychology is:
1) the basic patterns of the psychology of the patient, the psychology of the medical worker, the psychological characteristics of communication between the patient and the doctor, as well as the influence of the psychological atmosphere of medical institutions on the human condition;
2) psychosomatic and somatopsychic interactions;
3) individuality (personality, character and temperament), human evolution, the passage of successive stages of development in the process of ontogenesis (childhood, adolescence, adolescence, maturity and late age), as well as emotional-volitional processes;
4) issues of medical duty, ethics, medical confidentiality;
5) mental hygiene (psychology of medical consultations, families), including mental hygiene of persons during crisis periods of their lives (puberty, menopause), psychology of sexual life;
6) general psychotherapy.
Private clinical psychology studies a specific patient, namely:
1) features of mental processes in mental patients;
2) the psyche of patients during preparation for surgical interventions and in the postoperative period;
3) mental characteristics of patients suffering from various diseases (cardiovascular, infectious, oncological, gynecological, skin, etc.);
4) the psyche of patients with defects in hearing, vision, etc.;
5) mental characteristics of patients during labor, military and forensic examinations;
6) the psyche of patients with alcoholism and drug addiction;
7) private psychotherapy.
B. D. Karvasarsky, as a subject of clinical psychology, singled out the characteristics of the patient’s mental activity in their significance for the pathogenetic and differential diagnosis of the disease, optimization of its treatment, as well as prevention and promotion of health.
What is the object of clinical psychology? B.D. Karvasarsky believes that the object of clinical psychology is a person with difficulties in adaptation and self-realization, which are associated with his physical, social and spiritual state.
3. Goals and structure of clinical psychology. Main sections and areas of their research
Clinical psychology as an independent science faces certain goals. In the 60s-70s. XX century the specific goals of clinical psychology were formulated as follows (M. S. Lebedinsky, V. N. Myasishchev, 1966; M. M. Kabanov, B. D. Karvasarsky, 1978):
1) study of mental factors influencing the development of diseases, their prevention and treatment;
2) studying the influence of certain diseases on the psyche;
3) study of mental manifestations of various diseases in their dynamics;
4) study of mental development disorders; studying the nature of the relationship of a sick person with medical personnel and the surrounding microenvironment;
5) development of principles and methods of psychological research in the clinic;
6) creation and study of psychological methods of influencing the human psyche for therapeutic and preventive purposes.
Such a formulation of the goals of clinical psychology corresponded to the growing tendency to use the ideas and methods of this science to improve the quality of the diagnostic and treatment process in various fields of medicine with all the difficulties inevitable at this stage due to the unequal degree of development of one or another of its sections.
It is possible to identify specific sections of medical psychology that find practical application of knowledge in the relevant clinics: in a psychiatric clinic - pathopsychology; in neurology – neuropsychology; in somatic – psychosomatics.
According to B.V. Zeigarnik, pathopsychology studies disorders of mental activity, patterns of mental disintegration in comparison with the norm. She notes that pathopsychology operates with the concepts of general and clinical psychology and uses psychological methods. Pathopsychology works both on the problems of general clinical psychology (when changes in the personality of mental patients and patterns of mental disintegration are studied), and private (when mental disorders of a particular patient are studied to clarify the diagnosis, conduct labor, forensic or military examinations).
The object of study of neuropsychology is diseases of the central nervous system (CNS), mainly local focal lesions of the brain.
Psychosomatics studies how changes in the psyche affect the occurrence of somatic diseases.
Pathopsychology should be distinguished from psychopathology (which will be discussed later). Now it is only worth noting that pathopsychology is part of psychiatry and studies the symptoms of mental illness using clinical methods, using medical concepts: diagnosis, etiology, pathogenesis, symptom, syndrome, etc. The main method of psychopathology is clinical descriptive.
4. The relationship of clinical psychology with other sciences
The basic sciences for clinical psychology are general psychology and psychiatry. The development of clinical psychology is also greatly influenced by neurology and neurosurgery.
Psychiatry is a medical science, but it is closely related to clinical psychology. These sciences have a common subject of scientific research - mental disorders. But besides this, clinical psychology deals with disorders that are not equivalent in significance to illness (for example, problems of marriage), as well as the mental aspects of somatic disorders. However, psychiatry as a private field of medicine takes more into account the somatic plane of mental disorders. Clinical psychology focuses on psychological aspects.
Clinical psychology is related to psychopharmacology: both study psychopathological disorders and methods of treating them. In addition, the use of drugs always has a positive or negative psychological effect on the patient.
Medical pedagogy is successfully developing - a field related to medicine, psychology and pedagogy, the tasks of which include the training, education and treatment of sick children.
Psychotherapy as an independent medical specialty is closely related to clinical psychology. Theoretical and practical problems of psychotherapy are developed based on the achievements of medical psychology.
In the West, psychotherapy is considered to be a special branch of clinical psychology, and thus the special closeness between psychology and psychotherapy is emphasized.
However, the position about the special closeness of psychotherapy and clinical psychology is often disputed. Many scientists believe that, from a scientific point of view, psychotherapy is closer to medicine. The following arguments are given:
1) treating patients is the task of medicine;
2) psychotherapy is the treatment of patients. It follows that psychotherapy is the task of medicine. This provision is based on the fact that in many countries only doctors receive the right to practice it.
Clinical psychology is also close to a number of other psychological and pedagogical sciences - experimental psychology, occupational therapy, oligophrenopedagogy, typhlopsychology, deaf psychology, etc.
Thus, it is obvious that in the process of work, a clinical psychologist needs to take an integrated approach.
5. The origin and development of clinical psychology
The emergence of clinical psychology as one of the main applied branches of psychological science is associated with the development of both psychology itself and medicine, biology, physiology, and anthropology.
The origin of clinical psychology dates back to ancient times, when psychological knowledge arose in the depths of philosophy and natural science.
The emergence of the first scientific ideas about the psyche, the identification of the science of the soul, the formation of empirical knowledge about mental processes and their disorders is associated with the development of ancient philosophy and the achievements of ancient doctors. Thus, Alkemon of Croton (VI century BC) for the first time in history put forward the position of the localization of thoughts in the brain. Hippocrates also attached great importance to the study of the brain as an organ of the psyche. He developed the doctrine of temperament and the first classification of human types. The Alexandrian doctors Herophilus and Erasistratus described the brain in detail; they paid attention to the cortex with its convolutions, which distinguished humans from animals in mental abilities.
The next stage in the development of clinical psychology was the Middle Ages. It was a rather long period, permeated with unbridled mysticism and religious dogmatism, persecution of naturalists and the fires of the Inquisition. At first, training was based on ancient philosophy and the natural science achievements of Hippocrates, Galen, and Aristotle. Then knowledge declines, alchemy flourishes, and until the 13th century. The “dark” years last. Psychology in the Middle Ages was based on philosophy
Thomas Aquinas. The development of ideas about the psyche at this stage slowed down sharply. An important role in the development of domestic clinical psychology was played by A.F. Lazursky, the organizer of his own psychological school.
Thanks to A.F. Lazursky, the natural experiment was introduced into clinical practice, although it was originally developed by him for educational psychology.
Most developed in the 60s. XX century There were the following sections of clinical psychology:
1) pathopsychology, which arose at the intersection of psychology, psychopathology and psychiatry (B.V. Zeigarnik, Yu.F. Polyakov, etc.);
2) neuropsychology, formed at the border of psychology, neurology and neurosurgery (A. R. Luria, E. D. Khomskaya, etc.).
There is an independent field of psychological knowledge, which has its own subject, its own research methods, its own theoretical and practical tasks - clinical psychology.
Currently, clinical psychology is one of the most popular applied branches of psychology and has great prospects for development both abroad and in Russia.
6. Practical tasks and functions of a clinical psychologist
A clinical psychologist in healthcare institutions is a specialist whose responsibilities include participation in psychodiagnostic and psychocorrectional activities, as well as in the treatment process as a whole. Medical assistance is provided by a team of specialists. This “team” model of medical care initially arose in psychotherapeutic and psychiatric services. The center of the team is the attending physician, working together with a psychotherapist, clinical psychologist and social work specialist. Each of them carries out their own diagnostic, treatment and rehabilitation plan under the guidance of the attending physician and in close cooperation with other specialists. But such a “team” model in healthcare is not yet widespread enough, and the speed of its spread depends on the availability of psychological personnel. But for now, unfortunately, the domestic healthcare system is ready for this moon.
The activities of a psychologist in a medical institution are aimed at:
1) increasing mental resources and adaptive capabilities of a person;
2) harmonization of mental development;
3) health protection;
4) prevention and psychological rehabilitation. Subject of activity of a clinical psychologist
Therefore, it is important to emphasize that a clinical psychologist is a specialist who can work not only in clinics, but also in institutions of other profiles: education, social protection, etc. These are institutions that require an in-depth study of a person’s personality and providing him with psychological assistance.
In the above areas, a clinical psychologist performs the following activities:
1) diagnostic;
2) expert;
3) correctional;
4) preventive;
5) rehabilitation;
6) advisory;
7) scientific research, etc.
7. Features and objectives of pathopsychological research
The main areas of work of a pathopsychologist are the following.
1. Solving problems of differential diagnostics.
Most often, such tasks arise when it is necessary to distinguish the initial manifestations of sluggish forms of schizophrenia from neuroses, psychopathy and organic diseases of the brain. Also, the need for a pathopsychological study may arise when recognizing erased or “masked” depression, dissimulated delusional experiences and some forms of late-life pathology.
2. Assessment of the structure and degree of neuropsychic disorders.
With the help of pathopsychological research, a psychologist can determine the severity and nature of violations of individual mental processes, the possibility of compensating for these violations, taking into account the psychological characteristics of a particular activity.
3. Diagnosis of mental development and choice of ways of training and retraining.
In children's institutions, the pathopsychologist plays a large role in solving diagnostic problems. An important task here is to determine anomalies of mental development, to identify the degree and structure of various forms of mental development disorders. Pathopsychological research contributes to a better understanding of the nature of mental development anomalies, and also serves as the basis for the development of psychocorrectional programs for further work with the child.
4. Study of the patient’s personality and social environment.
In this case, the psychological experiment is based on the principle of modeling a certain objective activity. At the same time, the peculiarities of the patients’ psyche, mental processes and personality traits are revealed, which play an important role in social and professional adaptation. The pathopsychologist must establish which functions are affected and which are preserved, and determine methods of compensation in various types of activities.
5. Assessment of the dynamics of mental disorders. Psychological methods are effective
to identify changes in the system of relationships and in the social position of the patient in connection with the psychocorrectional work being carried out. It is important to note that when assessing the dynamics of the patient’s condition, a repeated psychological examination is always carried out.
6. Expert work.
Pathopsychological research is an important element of medical-labor, military-medical, medical-pedagogical and forensic-psychiatric examinations. In addition, in judicial practice, a psychological examination can act as independent evidence. The objectives of the study are determined by the type of examination, as well as the questions that the psychologist must answer during the experiment.
8. Methods of pathopsychological research
Methods used for pathopsychological research can be divided into standardized and non-standardized.
Non-standardized methods are aimed at identifying specific mental disorders and are compiled individually for each patient.
Non-standardized methods of pathopsychological research include:
1) the method of “formation of artificial concepts” by L. S. Vygotsky, which is used to identify the characteristics of conceptual thinking in various mental illnesses, primarily in schizophrenia and some organic brain lesions;
2) Goldstein’s “classification of objects” method, which is used to analyze various violations of the processes of abstraction and generalization;
3) methods of “classification”, “subject pictures”, “exclusion of objects”, “exclusion of concepts”, “interpretation of proverbs” and other methods of studying thinking;
4) the method of “proofreading tests” by Anfimov-Burdon and the method of “black-red digital tables” by Schulte-Gorbov (for studying attention and memory), as well as the methods of typing syllables and words, the methods of Kraepelin and Ebbinghaus are used to study short-term memory;
5) method of “unfinished sentences”;
6) method of “paired profiles”;
7) thematic apperception test (TAT) and other methods for personality research.
The main principle when using non-standardized research methods is the principle of modeling certain situations in which certain types of mental activity of the patient are manifested. The pathopsychologist's conclusion is based on an assessment of the final result of the patient's activity, as well as on an analysis of the characteristics of the process of performing tasks, which allows not only to identify violations, but also to compare the disturbed and intact aspects of mental activity.
Standardized methods are widely used in diagnostic work. In this case, specially selected tasks are presented in the same form to each subject. Thus, it becomes possible to compare the methods and levels of task performance by the test subject and other persons.
Almost all non-standardized methods can be standardized. It should be noted that for a qualitative analysis of the characteristics of mental activity, most of the subtests included in the standardized methods can be used in a non-standardized version.
B.V. Zeigarnik believes that the pathopsychological experiment is aimed at:
1) to study real human activity;
2) for a qualitative analysis of various forms of mental disintegration;
3) to reveal the mechanisms of disrupted activity and the possibility of its restoration.
9. Procedure for conducting a pathopsychological examination
Pathopsychological examination includes the following stages.
1. Studying the medical history, talking with a doctor and setting the task of a pathopsychological study.
The attending physician must inform the pathopsychologist about the basic clinical data about the patient and set the psychologist the tasks of pathopsychological research. The psychologist specifies the research task for himself, selects the necessary methods and establishes the order of their presentation to the patient. The doctor must explain to the patient the goals of the pathopsychological study and thereby contribute to the development of positive motivation in him.
2. Conducting a pathopsychological examination.
First of all, the psychologist needs to establish contact with the patient. The reliability of the results obtained during the pathopsychological study largely depends on the success of establishing psychological contact between the pathopsychologist and the subject. Before starting the experiment, it is necessary to make sure that contact with the patients has been established and the patient understands the purpose of the study. The instructions must be formulated clearly and accessible to the patient.
M. M. Kostereva identifies several types of patient relationships to pathopsychological research:
1) active (patients are involved in the experiment with interest, react adequately to both success and failure, and are interested in the results of the study);
2) wary (at first, patients treat the study with suspicion, irony, or even fear it, but during the experiment, uncertainty disappears, the patient begins to show accuracy and diligence; with this type of attitude, a “delayed form of response” should be noted when discrepancies between subjective experiences are observed the subject and the external expressive component of behavior);
3) formally responsible (patients comply with the psychologist’s requirements without personal interest and are not interested in the results of the study);
4) passive (the patient requires additional motivation; the attitude towards examination is absent or extremely unstable);
5) negative or inadequate (patients refuse to participate in the study, perform tasks inconsistently, and do not follow instructions).
When making conclusions, the pathopsychologist must take into account all factors, including the patient’s education, his attitude towards the study, as well as his condition during the study.
3. Description of the results, drawing up a conclusion based on the results of the study - the limits of the competence of a psychologist.
But based on the results of the study, a conclusion is drawn up, which consistently sets out the conclusions.
10. Violation of mediation and hierarchy of motives
One of the types of personality development disorders is changes in the motivational sphere. A. N. Leontiev argued that the analysis of activity should be carried out through an analysis of changes in motives. Psychological analysis of changes in motives is one of the ways to study the personality of a sick person, including the characteristics of his activities. In addition, as B.V. Zeigarnik notes, “pathological material in some cases makes it possible not only to analyze changes in motives and needs, but also to trace the process of formation of these changes.”
The main characteristics of motives include:
1) the indirect nature of motives;
2) hierarchical structure of motives.
In children, the hierarchical construction of motives and their mediation begins to emerge even before school. Then, throughout life, motives become more complex. Some motives are subordinate to others: any one general motive (for example, to master a certain profession) includes a number of private motives (to acquire the necessary knowledge, to acquire certain skills, etc.). Thus, human activity is always stimulated by several motives and meets not one, but several needs. But in a specific activity it is always possible to identify one leading motive, which gives a certain meaning to all human behavior. Additional motives are necessary because they directly stimulate human behavior. The content of any activity loses its personal meaning if there are no leading motives that make it possible to mediate motives in their hierarchical structure.
B. S. Bratus points out that changes occur primarily in the motivational sphere (as an example, a narrowing of the range of interests). During the pathopsychological study, no gross changes in cognitive processes are detected, but when performing some tasks (especially those that require long-term concentration of attention, quick orientation in new material), the patient does not always notice the mistakes he has made (non-criticality), does not respond to the experimenter’s comments and is not guided by them in the future. The patient also exhibits inflated self-esteem.
So, we see how, under the influence of this patient’s alcoholism, the previous hierarchy of motives is destroyed. Sometimes he has some desires (for example, to get a job), and the patient takes some actions, guided by the previous hierarchy of motives. However, all these motivations are not permanent. The main (meaning-forming) motive that controls the patient’s activity, as a result, is the satisfaction of the need for alcohol.
So, based on the analysis of changes in mediation and hierarchy of motives, the following conclusions can be drawn:
1) these changes are not derived directly from brain disorders;
2) they go through a complex and lengthy path of formation;
3) during the formation of changes, mechanisms similar to the mechanisms of normal development of motives operate.
11. Violation of the meaning-forming and incentive functions of the motive
Now let us consider the pathology of the meaning-forming and incentive functions of motives.
Only when these two functions of motive are merged can we talk about consciously regulated activity. Due to the weakening and distortion of these functions, serious disruption occurs.
These disorders were examined by M. M. Kochenov using the example of patients with schizophrenia. He conducted a study that consisted of barely: the subject must complete three tasks of his own choice out of nine proposed to him by the experimenter, spending no more than 7 minutes on it. The tasks were:
1) draw one hundred crosses;
2) complete twelve lines of proofreading (according to Bourdon);
3) complete eight lines of counting (according to Kraepelin);
4) fold one of the ornaments of the Braid technique;
5) build a “well” from matches;
6) make a chain from paper clips;
7) solve three different puzzles.
Thus, the patient had to choose those actions that were most appropriate to achieve the main goal (complete a certain number of tasks in a certain time).
Conducting this study on healthy subjects, M. M. Kochenov came to the conclusion that in order to achieve the goal, an orientation stage (active orientation in the material) is necessary, which was present in all representatives of this group of subjects.
All subjects were guided by the degree of difficulty of the tasks and chose those that would take less time to complete, as they tried to complete them within the seven minutes allotted to them.
Thus, in healthy subjects in this situation, individual actions are structured into goal-directed behavior.
When conducting an experiment among patients with schizophrenia, different results were obtained:
1) the patients did not have an orientation stage;
2) they did not choose easy tasks and often took on tasks that were clearly impossible to complete within the allotted time;
3) sometimes patients performed tasks with great interest and with special care, without noticing that the time had already expired.
Let us note that all the patients also knew that they had to meet the allotted time, but this did not become a regulator of their behavior. During the experiment, they were able to spontaneously repeat “I have to do it in 7 minutes” without changing the way they performed the task.
So, the research of M. M. Kochenov showed that the disruption of the activities of patients with schizophrenia was due to a change in the motivation of the sphere. Their motive turned into simply “knowledge” and thus lost its functions – meaning-forming and motivating.
It was the displacement of the meaning-forming function of motives that was the cause of disruption of the patients’ activities, changes in their behavior and personality degradation.
12. Violation of controllability and criticality of behavior
Failure to control behavior is one of the images of personality disorder. It is expressed in the patient’s incorrect assessment of his actions, in a lack of criticality towards his painful experiences. Investigating violations of criticism in mentally ill people, I. I. Kozhukhovskaya showed that non-criticism in any form indicates a violation of activity in general. Criticality, according to Kozhukhovskaya, is “the pinnacle of a person’s personal qualities.”
As an example of such a violation, consider extracts from the medical history given by B.V. Zeigarnik:
Patient M.
Year of birth: 1890.
Diagnosis: progressive paralysis.
Disease history. In childhood, he developed normally. He graduated from the Faculty of Medicine and worked as a surgeon.
At the age of 47, the first signs of mental illness appeared. While performing the operation, he made a grave mistake, which led to the death of the patient.
Mental state: correctly oriented, verbose. He knows about his illness, but treats it with great ease. Recalling his surgical mistake, he says with a smile that “everyone has accidents.” At the moment he considers himself as healthy as a bull. I am convinced that I can work as a surgeon and chief physician of a hospital.
When performing even simple tasks, the patient makes many serious mistakes.
Without listening to the instructions, he tries to approach the object classification task like a game of dominoes, and asks: “How can you find out who won?” When the instructions are read to him a second time, he completes the task correctly.
When completing the task “establishing the sequence of events,” he tries to simply explain each picture. But when the experimenter interrupts his reasoning and asks him to put the pictures in the right order, the patient completes the task correctly.
When performing the task “correlating phrases with proverbs,” the patient correctly explains the sayings “Measure twice, cut once” and “All that glitters is not gold.” But he incorrectly refers to them with the phrase “Gold is heavier than iron.”
Using the pictogram technique, the following results were obtained: the patient forms connections of a fairly general order (to remember the phrase “merry holiday” he draws a flag, “dark night” he shades a square). The patient is often distracted from the task.
When checking, it is discovered that the patient remembered only 5 words out of 14. When the experimenter told him that this was very little, the patient replied with a smile that he would remember more next time.
Thus, we see that patients do not have a motive for the sake of which they perform this or that activity, perform this or that task.
Their actions are completely unmotivated; patients are not aware of their actions or their statements.
The loss of the ability to adequately assess their behavior and the behavior of others led to the destruction of the activities of these patients and a deep personal disturbance.
13. Violation of the operational side of thinking. Methods of its research
Violation of the operational side of thinking occurs in two categories:
1) reduction in the level of generalization;
2) distortion of the generalization process.
Generalization refers to the basic mental operations.
There are four levels of the generalization process:
2) functional – belonging to a group based on functional characteristics;
3) specific – belonging to a group based on specific characteristics;
4) zero – listing of objects or their functions, no attempts to generalize objects.
Before we begin to consider the types of violations of the operational side of thinking, we list the main methods that are used to diagnose the pathology of mental activity.
1. Methodology “Classification of objects” The test subject’s task is to classify
objects to a particular group (for example, “people”, “animals”, “clothing”, etc.). Then the subject is asked to expand the groups he has formed (for example, “living” and “non-living”). If at the last stage a person identifies two or three groups, we can say that he has a high level of generalization.
2. Method “Elimination of the superfluous” The subject is presented with four cards. Three of them depict objects that have something in common; the fourth item should be excluded.
The selection of overly generalized features and the inability to exclude an unnecessary item indicate a distortion of the generalization process.
3. Methodology “Formation of analogies” The subject is presented with pairs of words between which there are certain semantic relationships. The subject’s task is to identify a couple of words by analogy.
4. Methodology “Comparison and definition of concepts”
Stimulus material represents homogeneous and heterogeneous concepts. This technique is used to investigate bias in the generalization process.
5. Interpretation of the figurative meaning of proverbs and metaphors
There are two variants of this technique. In the first case, the subject is asked to simply explain the figurative meaning of proverbs and metaphors. The second option is that for each proverb you need to find a phrase corresponding in meaning.
6. Pictogram technique
The test subject’s task is to remember 15 words and phrases. To do this, he needs to draw a light picture in order to remember all the phrases or words. Then the nature of the drawings performed is analyzed. Attention is drawn to the presence of connections between the stimulus word and the subject’s drawing.
14. Reducing the level of generalization
With a decrease in the level of generalization in patients, direct ideas about objects and phenomena predominate, i.e., instead of identifying general characteristics, patients establish specific situational connections between objects and phenomena. They have difficulty abstracting from specific details.
B.V. Zeigarnik gives examples of the performance of the “classification of objects” task by patients with a reduced level of generalization: “... one of the described patients refuses to combine a goat with a wolf into one group, “because they are at enmity”; another patient does not unite the cat and the beetle, because “the cat lives in the house, but the beetle flies.” The particular signs “lives in the forest”, “flies” determine the judgments of patients more than the general sign “animals”. With a pronounced decrease in the level of generalization, the classification task is generally inaccessible to patients; for the subjects, the objects turn out to be so different in their specific properties that they cannot be combined. Even a table and a chair cannot be classified in the same group, since “they sit on the chair, and work and eat on the table...”.
Let us give examples of responses from patients with a reduced level of generalization in the “subject exclusion” experiment. Patients are presented with pictures of “kerosene lamp”, “candle”, “electric light bulb”, “sun” and asked what needs to be removed. The experimenter receives the following answers.
1. “We need to remove the candle. It’s not needed, there’s a light bulb.”
2. “You don’t need a candle, it burns out quickly, it’s not profitable, and then you can fall asleep, it might catch fire.”
3. “You don’t need a kerosene lamp, now there is electricity everywhere.”
4. “If it’s during the day, then you need to remove the sun - and without it it’s light.” Pictures of “scales”, “clock”, “thermometer”, “glasses” are presented:
1) the patient removes the thermometer, explaining that “it is only needed in the hospital”;
2) the patient removes the scales, since “they are needed in the store when they need to be hung”;
3) the patient cannot rule out anything: he says that the watch is needed “for time”, and the thermometer is “to measure the temperature”; He cannot remove his glasses, because “if a person is short-sighted, then he needs them,” and scales “are not always needed, but they are also useful in the household.”
So, we see that patients often approach presented objects from the point of view of their suitability in life. They do not understand the convention that is hidden in the task assigned to them.
15. Distortion of the generalization process. Violation of the dynamics of thinking
Patients with a distortion of the generalization process are usually guided by overly generalized features. In such patients, random associations predominate.
For example: the patient classifies a shoe and a pencil into the same group because “they leave marks.”
Distortion of the generalization process occurs in patients with schizophrenia.
The main difference between the distortion of the generalization process and the reduction of its level was most clearly described by B.V. Zeigarnik. She noted that if for patients with a reduced level of generalization, drawing up pictograms is difficult due to the fact that they are not able to distract themselves from some specific meanings of the word, then patients with a distortion of the generalization process easily complete this task, since they can form any association unrelated to the task assigned to them.
For example: a patient draws two circles and two triangles, respectively, to remember the phrases “happy holiday” and “warm wind,” and draws a bow to remember the word “separation.”
Let's consider how a patient with a distortion of the generalization process (in schizophrenia) performs the task “classification of objects”:
1) combines a cabinet and a pan into one group, since “both items have a hole”;
2) identifies the group of objects “pig, goat, butterfly” because “they are hairy”;
3) a car, a spoon and a cart belong to the same group “according to the principle of movement (the spoon is also moved towards the mouth)”;
4) combines a watch and a bicycle into one group, because “a watch measures time, and when riding a bicycle, space is measured”;
5) a shovel and a beetle belong to the same group, since “they dig the ground with a shovel, the beetle also digs in the ground”;
6) combines a flower, a shovel and a spoon into one group, because “these are objects elongated in length.”
Violation of the dynamics of thinking occurs quite often.
There are several types of disturbances in the dynamics of thinking.
1. Inconsistency of judgments.
2. Lability of thinking.
3. Inertia of thinking.
The study of the dynamics of thinking is carried out using techniques used to study violations of the operational side of thinking. But with this type of violation, you must first of all pay attention to:
1) features of the subject’s switching from one type of activity to another;
2) excessive thoroughness of judgment;
3) a penchant for detail;
4) inability to maintain focused judgments.
16. Inconsistency of judgment
A characteristic feature of patients with inconsistency of judgment is the instability of the way they complete a task. The level of generalization in such patients is usually reduced. They quite successfully complete generalization and comparison tasks. However, correct decisions in such patients alternate with specific situational association of objects into a group and with decisions based on random connections.
Let us consider the actions of patients with inconsistency of judgments when performing the “classification of objects” task. Such patients correctly assimilate the instructions, use an adequate method to complete the task, and select pictures based on a generalized feature. However, after some time, patients change the correct path of decision to the path of incorrect random associations. Several features are noted:
1) alternation of generalized (correct) and specific situational combinations;
2) logical connections are replaced by random combinations (for example, patients classify objects as belonging to the same group because the cards are nearby);
3) the formation of groups of the same name (for example, the patient identifies a group of people “child, doctor, cleaning lady” and a second group of the same name “sailor, skier”).
This disturbance in the dynamics of thinking is characterized by the alternation of adequate and inadequate decisions. Lability does not lead to gross disturbances in the structure of thinking, but only for some time distorts the correct course of judgment of patients. It is a violation of the mental performance of patients.
Sometimes lability of thinking is persistent. Such constant, persistent lability occurs in patients with MDP in the manic phase.
Often a word evokes a chain of associations in such patients, and they begin to give examples from their lives. For example, explaining the meaning of the proverb “All that glitters is not gold,” a patient in the manic phase of MDP says: “Gold is a wonderful gold watch that my brother gave me, it’s a very good one. My brother loved the theater very much...”, etc.
In addition, patients with manifestations of lability of thinking exhibit “responsiveness”: they begin to weave into their reasoning any random stimulus from the external environment. If this happens while performing a task, patients are distracted, violate instructions, and lose the focus of their actions.
17. Inertia of thinking
Inertia of thinking is characterized by pronounced difficulty switching from one type of activity to another. This thinking disorder is the antipode of lability of mental activity. In this case, patients cannot change the course of their judgments. Such switching difficulties are usually accompanied by a decrease in the level of generalization and distraction. Stiffness of thinking leads to the fact that subjects cannot cope even with simple tasks that require switching (mediation tasks).
Inertia of thinking occurs in patients:
1) epilepsy (most often);
2) with brain injuries;
3) with mental retardation.
To illustrate the inertia of thinking, let’s give an example: “Patient B-n (epilepsy). Closet. “This is an object in which something is stored... But dishes and food are also stored in the buffet, and dresses are stored in the closet, although food is often stored in the closet. If the room is small and a buffet does not fit in it, or if there is simply no buffet, then dishes are stored in the closet. Here we have a closet; on the right there is a large empty space, and on the left there are 4 shelves; there are dishes and food. This, of course, is uncivilized; bread often smells of mothballs - this is moth powder. Again, there are bookcases, they are not so deep. There are already shelves of them, a lot of shelves. Now the cabinets are built into the walls, but it’s still a cabinet.”
The inertia of mental activity is also revealed in an associative experiment. The instructions state that the subject must respond to the experimenter with a word of the opposite meaning.
The data obtained showed that the latent period in such patients averages 6.5 s, and in some patients it reaches 20–30 s.
In subjects with inertia of thinking, a large number of delayed responses were noted. In this case, patients respond to a previously presented word, and not to the one that is presented at the moment. Let's look at examples of such delayed responses:
1) the patient responds with the word “silence” to the word “singing”, and responds to the next word “wheel” with the word “silence”;
2) having answered the word “deception” with the word “faith”, the patient answers the next word “voices” with the word “lie”.
Delayed responses from patients are a significant deviation from the normal course of the associative process. They show that the trace stimulus for such patients has a much greater signaling value than the actual one.
18. Violation of the motivational (personal) side of thinking. Diversity of thinking
Thinking is determined by the set goal, task. When a person loses the purposefulness of mental activity, thinking ceases to be a regulator of human actions.
Violations of the motivational component of thinking include:
1) diversity;
2) reasoning.
Diversity of thinking is characterized by the absence of logical connections between different thoughts. Patients' judgments about this or that phenomenon seem to proceed on different planes. They can accurately understand the instructions and generalize the proposed objects based on the essential properties of the objects. However, they cannot complete tasks in the right direction.
When performing the “classification of objects” task, patients can combine objects either on the basis of the properties of the objects themselves, or on the basis of their own attitudes and tastes.
Let's look at a few examples of diversity of thinking.
1. The patient identifies a group of objects “cabinet, table, bookcase, cleaning lady, shovel,” since this is “a group that sweeps out the bad from life,” and adds that “a shovel is an emblem of labor, and labor is incompatible with cheating.”
2. The patient identifies the group of objects “elephant, skier”, since these are “objects for spectacles. People tend to desire bread and circuses, the ancient Romans knew this.”
3. The patient identifies a group of objects “flower, bed, pan, cleaning lady, saw, cherry” because these are “objects painted red and blue.”
Here are examples of how one of the patients with diversity of thought performed the “elimination of objects” task:
1) pictures of “kerosene lamp”, “sun”, “light bulb”, “candle” are presented; the patient excludes the sun, since “it is a natural luminary, the rest is artificial lighting”;
2) pictures of “scales”, “clock”, “thermometer”, “glasses” are presented; the patient decides to remove the glasses: “I’ll separate the glasses, I don’t like glasses, I love pince-nez, why don’t they wear them. Chekhov wore it”;
3) pictures of “drum”, “revolver”, “military cap”, “umbrella” are presented; the patient removes the umbrella: “There is no need for an umbrella, now they wear raincoats.”
As we see, the patient can generalize: she excludes the sun, since it is a natural luminary. But then she singles out glasses based on personal taste (because "she doesn't like them," not because they aren't a measuring device). On the same basis, she identifies an umbrella.
19. Reasoning. Classification of thinking disorders by form and content
Reasoning is a tendency to unproductive verbose reasoning, a tendency to so-called “sterile philosophizing.” The judgments of such patients are caused not so much by a violation of intellectual activity as by increased affectivity. They strive to bring any phenomenon (even absolutely insignificant) under some concept.
Affectivity is manifested in the very form of the statement (the patient speaks loudly, with inappropriate pathos). Sometimes the patient’s intonation alone indicates that the statement is “reasonable.”
In addition to the considered classification of thinking disorders, there is another classification, according to which thinking disorders are divided into two groups:
1) in form;
Thinking disorders according to their form are in turn divided into:
1) tempo violations:
a) acceleration (a jump in ideas, which is usually observed in the manic phase in MDP; mentism, or manticism, is an influx of thoughts that occurs against the will of the patient in schizophrenia, in MDP);
b) slowing down – inhibition and poverty of associations, which usually occurs during the depressive phase in MDP;
2) violations of harmony:
a) discontinuity—violation of logical connections between members of a sentence (while maintaining the grammatical component);
b) incoherence is a violation in the field of speech, its semantic and syntactic components; c) verbigeration - stereotypical repetition in speech of individual words and phrases that are similar in consonance;
3) violations by purpose:
a) reasoning;
b) pathological thoroughness of thinking;
c) perseveration.
Thinking disorders according to their content are divided into:
1) obsessive states - various involuntarily arising thoughts that a person cannot get rid of, maintaining a critical attitude towards them;
2) highly valuable ideas - emotionally rich and plausible beliefs and ideas;
3) delusional ideas - false judgments and conclusions:
a) paranoid delusion - a systematic and plausible delusion that occurs without disturbances of sensations and perception;
b) paranoid delusion – delusion that usually does not have a sufficiently coherent system, most often occurring with disturbances of sensations and perception;
c) paraphrenic delusion – systematized delirium with disturbances in the associative process, occurring against the background of elevated mood.
20. Techniques used to study memory
The following techniques are used to study memory.
1. Ten words
Ten simple words are read to the subject, after which he must repeat them in any order 5 times. The experimenter enters the results obtained into the table. After 20–30 minutes, the subject is again asked to reproduce these words. The results are also entered into the table.
Example: water, forest, table, mountain, clock, cat, mushroom, book, brother, window.
2. Pictogram method
The subject is presented with 15 words to memorize. To facilitate this task, he should make sketches in pencil. No entries or letter designations are allowed. The subject is asked to repeat the words after finishing the work, and then again after 20–30 minutes. When analyzing the characteristics of memorization, attention is paid to how many words are reproduced accurately, close in meaning, incorrectly, and how many are not reproduced at all. A modification of this method can be A. N. Leontiev’s test. This method does not involve drawing, but choosing an object from the proposed ready-made pictures. The technique has several series, varying in degree of complexity. A. N. Leontiev’s test can be used to study memory in children, as well as in people with a low level of intelligence.
3. Reproduction of stories The subject is read a story (sometimes the story is given for independent reading). Then he must reproduce the story orally or in writing. When analyzing the results, the experimenter must take into account whether all semantic links have been reproduced by the subject, and whether he has observed confabulations (filling gaps in memory with non-existent events).
Examples of stories for memorization: “The Jackdaw and the Doves”, “The Eternal King”, “Logic”, “The Ant and the Dove”, etc.
4. Study of visual memory (A. L. Benton test).
This test uses five series of drawings. At the same time, three series offer 10 cards of equal complexity, two series offer 15 cards each. The subject is shown a card for 10 seconds, and then he must reproduce the figures he saw on paper. The analysis of the obtained data is carried out using special Benton tables. This test allows you to obtain additional data on the presence of organic brain diseases.
When conducting a pathopsychological experiment aimed at studying memory disorders, features of direct and indirect memory are usually revealed.
21. Impaired immediate memory
Immediate memory is the ability to reproduce information immediately after the action of a particular stimulus.
Some of the most common types of immediate memory disorders are:
1) Korsakoff syndrome;
2) progressive amnesia.
Korsakov's syndrome is a disorder of memory for current events with relative preservation of memory for past events. This syndrome was described by the domestic psychiatrist S. S. Korsakov.
Korsakov's syndrome can manifest itself in insufficiently accurate reproduction of what is seen or heard, as well as inaccurate orientation. Often patients themselves notice defects in their memory and try to fill in the gaps with fictitious versions of events. Real events are either clearly reflected in the patient’s consciousness, or intricately intertwined with events that never existed. The inability to remember current events leads to the inability to organize the future.
With progressive amnesia, memory disorders extend to both current events and past events. Patients confuse the past with the present and distort the sequence of events. With progressive amnesia, the following signs are noted:
1. Interfering effect - the imposition of events of the past on events of the present, and vice versa.
2. Disorientation in space and time. Example: the patient seems to live in the early twentieth century; she thinks that the October Revolution has recently begun.
Such memory impairments are often observed in late-life mental illnesses. First, patients’ ability to remember current events decreases, then the events of recent years are erased from memory. At the same time, events from the distant past preserved in memory acquire special relevance in the patient’s mind. The patient does not live in the present, but in fragments of situations and actions that occurred in the distant past.
To illustrate such memory impairments, we give examples taken from the results of an experimental study of one of the patients:
1) explaining the meaning of the proverb “Don’t get into your own sleigh,” he says: “Don’t be so impudent, impolite, a hooligan. Don’t go where you don’t need to”;
2) the meaning of the proverb “Strike while the iron is hot” is explained as follows: “Work, be hardworking, cultured, polite. Do everything quickly, okay. Love the person. Do everything for him."
Thus, understanding the figurative meaning of the proverb, the patient cannot remember it and is distracted. The patient's judgments are characterized by instability; correct judgments alternate with incorrect ones.
22. Violation of mediated memory
Indirect memorization is memorization using an intermediate (mediating) link in order to improve reproduction.
Violation of mediated memory in various groups of patients was studied by S. V. Loginova and G. V. Birenbaum. The works of A. N. Leontyev show that introducing the factor of mediation improves the reproduction of words. But despite the fact that normally the mediating factor improves memorization, it turned out that in some patients the introduction of a mediating link often does not improve, and even worsens, the ability to reproduce.
Patients with mediated memory disorders remember words worse when they try to use a mediating link. Mediation also does not help those patients who try to establish too formal connections (for example, for the word “doubt” the patient drew a catfish fish because the first syllable coincided, and for the word “friendship” - two triangles).
When analyzing memory impairments, the personal-motivational component should be taken into account.
To study the violation of the motivational component of mnestic activity, experimental studies were carried out. The subject was presented with about twenty tasks that he had to complete. This new motive acted as a meaning-forming and motivating motive (the subject set himself a specific goal - to reproduce as many actions as possible).
The fact that mnestic activity is motivated can also be seen in the example of pathology.
The same experiments were conducted in patients with various forms of motivational disorders. It turned out that:
1) in patients with schizophrenia there was no effect of better reproduction of unfinished tasks compared to completed ones;
2) patients with rigid emotional attitudes (for example, with epilepsy) were much more likely to reproduce unfinished actions compared to completed ones.
To summarize, let us compare the results obtained in the study of healthy subjects and subjects with various mental illnesses.
1. In healthy subjects, VN/VZ = 1.9.
2. In patients with schizophrenia (simple form) VN/VZ = 1.1.
3. In patients with epilepsy, VN/VZ = 1.8.
4. In patients with asthenic syndrome, VN/VZ = 1.2.
So, a comparison of the results of reproducing unfinished actions in patients with various disorders of the motivational sphere indicates the important role of the motivational component in mnestic activity.
23. Methods used to study attention
The following methods are distinguished that are used in the study of attention.
1. Corrective test. It is used to study the stability of attention and the ability to concentrate. Forms are used with images of rows of letters that are arranged randomly. The subject must cross out one or two letters at the experimenter's discretion. A stopwatch is required to conduct the study. Sometimes the position of the subject's pencil is noted every 30–60 s. The experimenter pays attention to the number of errors made, the pace at which the patient performed the task, as well as the distribution of errors during the experiment and their nature (crossing out other letters, omitting individual letters or lines, etc.).
2. Account according to Kraepelin. This technique was proposed by E. Kraepelin in 1895. It is used to study the characteristics of switching attention and study performance. The subject is presented with forms with columns of numbers on them. You need to add or subtract these numbers in your head and write down the results on the form.
After completing the task, the experimenter makes a conclusion about performance (exhaustion, ability to work) and notes the presence or absence of attention disorders.
3. Finding numbers on Schulte tables. For the study, special tables are used, where numbers are arranged in random order (from 1 to 25). The test subject must use a pointer to show the numbers in order and name them. The experimenter takes into account the time it takes to complete the task. Research using Schulte tables helps to identify features of attention switching, exhaustion, processing, as well as concentration or distractibility.
4. Modified Schulte table. To study attention switching, a modified red-black Shul-te table is often used, which contains 49 numbers (of which 25 are black and 24 are red). The subject must show the numbers in turn: black - in ascending order, red - in descending order. This table is used to study the dynamics of mental activity and the ability to quickly switch attention from one object to another.
5. Countdown. The subject must count from one hundred a certain number (the same number). At the same time, the experimenter notes pauses. When processing the results, the following is examined:
1) the nature of the errors;
2) following instructions;
3) switching;
4) concentration;
5) exhaustion of attention.
24. Feelings. Their classification
Sensation is the simplest mental process, consisting of the reflection of individual properties, objects and phenomena of the external world, as well as internal states of the body under the direct influence of stimuli on the corresponding receptors.
The main properties of sensations include:
1) modality and quality;
2) intensity;
3) time characteristics (duration);
4) spatial characteristics.
Feelings can be both conscious and unconscious.
An important characteristic of sensations is the threshold of sensation - the magnitude of the stimulus that can cause a sensation.
Let's look at some classifications of sensations.
V. M. Wundt proposed dividing sensations into three groups (depending on what characteristics of the external environment are reflected):
1) spatial;
2) temporary;
3) spatiotemporal.
A. A. Ukhtomsky proposed dividing all sensations into 2 groups:
1. Higher (those types of sensations that provide the most subtle and varied differentiated analysis, for example visual and auditory).
2. Lower (those types of sensations that are characterized by less differentiated sensitivity, for example pain and tactile).
Currently, the generally accepted and most widespread classification is Sherrington, who proposed dividing sensations into three groups depending on the location of the receptor and the location of the source of irritation:
1) exteroceptors - receptors of the external environment (vision, hearing, smell, taste, tactile, temperature, pain sensations);
2) proprioceptors - receptors that reflect the movement and position of the body in space (muscular-articular, or kinesthetic, vibration, vestibular);
3) interoreceptors - receptors located in the internal organs (they, in turn, are divided into chemoreceptors, thermoreceptors, pain receptors and mechanoreceptors, reflecting changes in pressure in the internal organs and bloodstream).
25. Methods for studying sensations and perception. Basic sensory disturbances
Perception research is carried out:
1) clinical methods;
2) experimental psychological methods. The clinical method is usually used in the following cases:
1) studies of tactile and pain sensitivity;
2) study of temperature sensitivity;
3) study of hearing and vision disorders.
4) study of thresholds of auditory sensitivity and speech perception.
Experimental psychological methods are usually used to study more complex auditory and visual functions. Thus, E.F. Bazhin proposed a set of techniques, which includes:
1) techniques for studying simple aspects of the activity of analyzers;
2) techniques for studying more complex complex activities.
The following methods are also used:
1) the “Classification of Objects” technique – to identify visual agnosia;
2) Poppelreiter tables, which are images superimposed on each other and are needed to identify visual agnosia;
3) Raven tables - for studying visual perception;
4) tables proposed by M.F. Lukyanova (moving squares, wavy background) - for the study of sensory excitability (for organic disorders of the brain);
5) tachistoscopic method (identification of listened to tape recordings with various sounds: clinking glass, murmur of water, whispering, whistling, etc.) - for the study of auditory perception.
1. Anesthesia, or loss of sensitivity, can involve both individual types of sensitivity (partial anesthesia) and all types of sensitivity (total anesthesia).
2. The so-called hysterical anesthesia is quite common - loss of sensitivity in patients with hysterical neurotic disorders (for example, hysterical deafness).
3. Hyperesthesia usually affects all areas (the most common are visual and acoustic). For example, such patients cannot tolerate sound at normal volume or not very bright light.
4. With hypoesthesia, the patient seems to vaguely perceive the world around him (for example, with visual hypoesthesia, objects for him are devoid of color, look shapeless and blurry).
5. With paresthesia, patients experience anxiety and fussiness, as well as increased sensitivity to skin contact with bedding, clothing, etc.
A type of paresthesia is senestopathy - the appearance of rather ridiculous unpleasant sensations in various parts of the body (for example, a feeling of “transfusion” inside organs). Such disorders usually occur in schizophrenia.
26. Definition and types of perception
Now let's look at the main perception disorders. But first, let’s define how perception differs from sensations. Perception is based on sensations, arises from them, but has certain characteristics.
What is common to sensations and perception is that they begin to function only with the direct impact of irritation on the sense organs.
Perception is not reduced to the sum of individual sensations, but is a qualitatively new stage of cognition.
The following are considered the basic principles of the perception of objects.
1. The principle of proximity (the closer to each other in the visual field the elements are located, the more likely they are to be combined into a single image).
2. The principle of similarity (similar elements tend to unite).
3. The principle of “natural continuation” (elements that act as parts of familiar figures, contours and forms are more likely to be combined into precisely these figures, contours and forms).
4. The principle of closure (elements of the visual field tend to create a closed, integral image).
The above principles determine the basic properties of perception:
1) objectivity – the ability to perceive the world in the form of separate objects that have certain properties;
2) integrity - the ability to mentally complete a perceived object to a holistic form if it is represented by an incomplete set of elements;
3) constancy - the ability to perceive objects as constant in shape, color, consistency and size, regardless of the conditions of perception;
The main types of perception are distinguished depending on the sense organ (as well as sensations):
1) visual;
2) auditory;
3) taste;
4) tactile;
5) olfactory.
One of the most significant types of perception in clinical psychology is a person’s perception of time (it can change significantly under the influence of various diseases). Great importance is also attached to disturbances in the perception of one’s own body and its parts.
27. Basic perception disorders
The main perception disorders include:
1. Illusions are a distorted perception of a real object. For example, illusions can be auditory, visual, olfactory, etc.
Based on the nature of their occurrence, there are three types of illusions:
1) physical;
2) physiological;
3) mental.
2. Hallucinations are disturbances of perception that occur without the presence of a real object and are accompanied by the belief that this object really exists at a given time and place.
Visual and auditory hallucinations are usually divided into two groups:
1. Simple. These include:
a) photopsia - perception of bright flashes of light, circles, stars;
b) acoasms - perception of sounds, noise, crackling, whistling, crying.
2. Complex. These include, for example, auditory hallucinations, which have the appearance of articulate phrasal speech and are usually of a commanding or threatening nature.
3. Eidetism is a disorder of perception in which a trace of just ended excitation in some analyzer remains in the form of a clear and vivid image.
4. Depersonalization is a distorted perception of both one’s own personality as a whole and individual qualities and parts of the body. Based on this, two types of depersonalization are distinguished:
1) partial (impaired perception of individual parts of the body); 2) total (impaired perception of the whole body).
5. Derealization is a distorted perception of the surrounding world. An example of derealization is the symptom of “already seen” (de ja vu).
6. Agnosia refers to impaired recognition of objects, as well as parts of one’s own body, but at the same time consciousness and self-awareness are preserved.
The following types of agnosia are distinguished:
1. Visual agnosia – disorders of recognition of objects and their images while maintaining sufficient visual acuity. Are divided into:
a) object agnosia;
b) agnosia for colors and fonts;
c) optical-spatial agnosia (patients cannot convey the spatial characteristics of an object in a drawing: further - closer, more - less, higher - lower, etc.).
2. Auditory agnosia – impaired ability to distinguish speech sounds in the absence of hearing impairment;
3. Tactile agnosia - disorders characterized by failure to recognize objects by feeling them while maintaining tactile sensitivity.
28. Stress. A crisis
The concept of stress was introduced by the Canadian pathophysiologist and endocrinologist G. Selye. Stress is the body’s standard response to any factor that affects it from the outside. Characterized by affects - expressed emotional experiences.
Stress can be of different types:
1) distress is negative;
2) eustress is positive and mobilizing in nature.
G. Selye identified two reactions to harmful environmental influences:
1. Specific – a specific disease with specific symptoms.
2. Nonspecific (manifests itself in the general adaptation syndrome).
A nonspecific reaction consists of three phases:
1) anxiety reaction (under the influence of a stressful situation, the body changes its characteristics; if the stressor is very strong, stress can occur at this stage);
2) resistance reaction (if the action of the stressor is compatible with the body’s capabilities, the body resists; anxiety almost disappears, the level of body resistance increases significantly);
3) exhaustion reaction (if a stressor acts for a long time, the body’s strength is gradually depleted; anxiety reappears, but now irreversible; the stage of distress begins).
The concept of crises originated and developed in the United States. According to this concept, “the risk of mental disorders reaches its highest point and materializes in a specific crisis situation.”
“A crisis is a condition that occurs when a person is faced with an obstacle to vital goals, which for some time is insurmountable using habitual methods of solving problems. A period of disorganization and frustration arises, during which many different abortive attempts at resolution are made. Eventually some form of adaptation is achieved which may or may not be in the best interests of the person and his or her loved ones.” 1 .
The following types of crises are distinguished:
1) developmental crises (for example, a child entering kindergarten, school, marriage, retirement, etc.);
2) random crises (for example, unemployment, natural disaster, etc.);
3) typical crises (for example, the death of a loved one, the appearance of a child in the family, etc.).
29. Frustration. Fear
“Frustration (English frustration - “upset, disruption of plans, collapse”) is a specific emotional state that arises in cases where an obstacle and resistance arises on the way to achieving a goal, which are either really insurmountable or are perceived as such.”
The following signs are characteristic of the state of frustration:
1) presence of motive;
2) presence of need;
3) presence of a goal;
4) availability of an initial action plan;
5) the presence of resistance to an obstacle that is frustrating (resistance can be passive and active, external and internal).
In situations of frustration, a person behaves either as an infantile or as a mature person. In case of frustration, the infantile personality is characterized by unconstructive behavior, which is expressed in aggression or avoidance of resolving a difficult situation.
A mature personality, on the contrary, is characterized by constructive behavior, which manifests itself in the fact that a person strengthens motivation, increases the level of activity to achieve a goal, while maintaining the goal itself.
The most common symptom of emotional disturbance is fear. However, fears can be an adequate mobilizing reaction to a real threat. Many people are not even aware that they have any type of fear until they are faced with a corresponding situation.
To assess the degree of pathologicality of fears, the following parameters are used.
1. Adequacy (validity) – correspondence of the intensity of fear to the degree of real danger that comes from a given situation or from surrounding people.
2. Intensity - the degree of disorganization of the activity and well-being of a person gripped by a feeling of fear.
3. Duration – duration of fear in time.
4. The degree of controllability of a person’s feeling of fear – the ability to overcome one’s own feeling of fear.
A phobia is a fear that is experienced frequently, is obsessive, poorly controlled, and significantly disrupts a person’s functioning and well-being.
The most common types of phobias are:
1) agoraphobia – fear of open spaces;
2) claustrophobia - fear of closed spaces. Social phobia is a fairly common phenomenon - obsessive fears that are associated with the fear of a person being judged by others for any actions.
30. Violations of the volitional sphere
The concept of will is inextricably linked with the concept of motivation. Motivation is a process of purposeful, organized, sustainable activity (the main goal is to satisfy needs).
Motives and needs are expressed in desires and intentions. Interest, which plays the most important role in the acquisition of new knowledge, can also be a stimulus for human cognitive activity.
Motivation and activity are closely related to motor processes, therefore the volitional sphere is sometimes referred to as motor-volitional.
Disorders of volitional activity include:
1) violation of the structure of the hierarchy of motives - deviation of the formation of the hierarchy of motives from the natural and age-related characteristics of a person;
2) parabulia – the formation of pathological needs and motives;
3) hyperbulia – behavioral disorder in the form of motor disinhibition (excitement);
4) hypobulia – behavioral disorder in the form of motor retardation (stupor).
One of the most striking clinical syndromes of the motor-volitional sphere is catatonic syndrome, which includes the following symptoms:
1) stereotypies - frequent rhythmic repetition of the same movements;
2) impulsive actions - sudden, senseless and absurd motor acts without sufficient critical assessment;
3) negativism - an unreasonable negative attitude towards any external influences in the form of resistance and refusal;
4) echolalia and echopraxia - the patient’s repetition of individual words or actions that he hears or sees at the moment; 5) catalepsy (symptom of “waxy flexibility”) – the patient freezes in one position and maintains this position for a long time. The following pathological symptoms are special types of disorders of the will:
1) a symptom of autism;
2) a symptom of automatisms.
A symptom of autism is that patients lose the need to communicate with others. They develop pathological isolation, unsociability and isolation.
Automatisms are the spontaneous and uncontrolled implementation of a number of functions, regardless of the presence of incentive impulses from the outside. The following types of automatisms are distinguished.
1. Outpatient (occurs in patients with epilepsy and consists in the fact that the patient performs externally ordered and purposeful actions, which he completely forgets about after an epileptic seizure).
2. Somnambulistic (the patient is either in a hypnotic trance or in a state between sleep and wakefulness).
3. Associative.
4. Senestopathic.
5. Kinesthetic.
The last three types of automatisms are observed in Kandinsky-Clerambault mental automatism syndrome.
31. Disorders of consciousness and self-awareness
Before we begin to consider violations, let us define consciousness.
“Consciousness is the highest form of reflection of reality, a way of relating to objective laws.”
To determine disturbances of consciousness, it is important to take into account that the presence of one of the above signs does not indicate confusion of consciousness, therefore it is necessary to establish the totality of all these signs.
Disturbances of consciousness are divided into two groups.
1. States of switched off consciousness:
2. States of upset consciousness:
a) delirium;
b) oneiroid;
c) twilight disorder of consciousness. States of switched off consciousness are characterized by a sharp increase in the threshold for all external stimuli. Patients' movements slow down and they are indifferent to their surroundings.
Delirium is characterized by a violation of orientation in space and time (not just disorientation occurs, but false orientation) with complete preservation of orientation in one’s own personality. In this case, scene-like hallucinations arise, usually of a frightening nature. As a rule, delirium occurs in the evening and intensifies at night.
Oneiroid is characterized by disorientation (or false orientation) in space, in time and partially in one’s own personality. In this case, patients experience hallucinations of a fantastic nature.
After emerging from the oneiric state, patients usually cannot remember what really happened in that situation, but only remember the content of their dreams.
The twilight state of consciousness is characterized by disorientation in space, time and one’s own personality. This condition begins suddenly and ends just as suddenly. A characteristic feature of the twilight state of consciousness is subsequent amnesia - the absence of memories of the period of darkness. Often, in a twilight state of consciousness, patients experience hallucinations and delusions.
One type of twilight state is “outpatient automatism” (occurs without delirium or hallucinations). Such patients, having left home for a specific purpose, unexpectedly find themselves at the other end of the city (or even in another city). At the same time, they mechanically cross streets, ride in public transport, etc.
32. Aphasia
Aphasias are systemic speech disorders that appear as a result of global injuries to the left hemisphere cortex (in right-handed people). The term “aphasia” was proposed in 1864 by A. Trousseau.
Let's consider the classification of speech disorders proposed by A. R. Luria. He identified seven forms of aphasia.
1. Sensory aphasia is characterized by a violation of phonemic hearing. In this case, patients either do not understand speech addressed to them at all, or (in less severe cases) do not understand speech in complicated conditions (for example, speaking too quickly); they have severe difficulty in writing from dictation, repeating words heard, and reading (from - for the inability to monitor the correctness of one’s speech).
2. Acoustic-mnestic aphasia (violation of auditory-speech memory) is expressed in the fact that the patient understands spoken speech, but is not able to remember even small speech material (while phonemic hearing remains preserved). Such a violation of auditory-verbal memory leads to a misunderstanding of long phrases and oral speech in general.
3. Optical-mnestic aphasia is expressed in the fact that patients cannot correctly name an object, but try to describe the object and its functional purpose. Patients cannot draw even elementary objects, although their graphic movements remain preserved.
4. Afferent motor aphasia is associated with a disruption in the transmission of sensations from the articulatory apparatus to the cerebral cortex during speech. Patients have pronunciation problems.
5. Semantic aphasia is characterized by a violation of the understanding of prepositions, words and phrases that reflect spatial relationships. Patients with semantic aphasia exhibit disturbances in visual-figurative thinking.
6. Motor efferent aphasia is expressed in the fact that the patient cannot utter a word (only inarticulate sounds) or in the patient’s oral speech there remains one word, which is used as a replacement for all other words. At the same time, the patient retains the ability to understand speech addressed to him (to some extent).
7. Dynamic aphasia manifests itself in the poverty of speech utterances, the absence of independent statements and monosyllabic answers to questions (patients are not able to form even the simplest phrase, they cannot answer even basic questions in detail).
Note that of the types of speech disorders discussed above, the first five are interconnected with the loss of the auditory, visual, and kinesthetic parts of speech, which are otherwise called afferent parts. The remaining two types of aphasia are associated with loss of the efferent link.
33. Poverty of vocabulary of speech
Poor vocabulary is usually observed in mental retardation, as well as in cerebral atherosclerosis. Let us consider the types of mental pathology that can be considered both as derivatives of speech disorders and as a result of disorders of the gnostic brain apparatus.
1. Dyslexia (Alexia) is a reading disorder.
In children, dyslexia manifests itself in the inability to master the skill of reading (with a normal level of intellectual and speech development, in optimal learning conditions, in the absence of hearing and vision impairments).
2. Agraphia (dysgraphia) is a violation of the ability to write correctly in form and meaning.
3. Acalculia is a disorder characterized by a violation of counting operations.
Let us dwell on the definition of other speech disorders encountered in clinical practice.
Verbal paraphasia is the use of others instead of some words that are not related to the meaning of the speech utterance.
Literal paraphasia is when some sounds are replaced by others that are not present in a given word, or certain syllables and sounds are rearranged in a word.
Verbigeration is the repeated repetition of individual words or syllables.
Bradyphasia is slow speech.
Dysarthria is slurred, as if “stumbling” speech.
Dyslalia (tongue-tied) is a speech disorder that is characterized by incorrect pronunciation of individual sounds (for example, skipping sounds or replacing one sound with another).
Stuttering is a violation of the fluency of speech, which manifests itself in the form of convulsive speech coordination disorder, repetition of individual syllables with obvious difficulties in pronouncing them.
Logoclony is the spastic repetition of certain syllables of a spoken word.
An increase in the volume of speech (up to screaming) is a disorder that manifests itself in the fact that, as a result of overexertion, the voice of such patients becomes hoarse or disappears completely (noted in patients in a manic state).
Changes in speech modulation - pomposity, pathos, or colorlessness and monotony of speech (loss of speech melody).
Incoherence is a meaningless collection of words that are not combined into grammatically correct sentences.
Oligophasia is a significant decrease in the number of words used in speech, impoverishment of vocabulary.
Schizophasia is a meaningless collection of individual words that are combined into grammatically correct sentences.
Symbolic speech is giving words and expressions a special meaning (instead of the generally accepted one), understandable only to the patient himself.
Cryptolalia is the creation of one’s own language or a special cipher called cryptography.
34. Violations of voluntary movements and actions
There are two types of disorders of voluntary movements and actions:
1. Disturbances of voluntary movements and actions that are associated with disruption of efferent (executive) mechanisms.
2. Disorders of voluntary movements and actions that are associated with disruption of the afferent mechanisms of motor acts (more complex disorders).
Efferent disorders.
1. Paresis - weakening of muscle movements (a person after brain damage cannot actively act with the opposite limb; however, movements of other parts of the body may remain preserved).
2. Hemiplegia - paralysis (a person completely loses the ability to move; motor function can be restored during the treatment process).
There are two types of hemiplegia:
1) dynamic hemiplegia (there are no voluntary movements, but there are violent ones);
2) static hemiplegia (no voluntary movements or amia).
Afferent disorders.
1. Apraxia is a disorder that is characterized by the fact that an action that requires afferent reinforcement and organization of a motor act is not performed, although the efferent sphere remains preserved.
2. Catatonic disorders.
With catatonic disorders, pointless chaotic motor activity of the patient is observed (up to and including causing injury to oneself and others). Currently, this condition is treated pharmacologically. Catatonic disorders are expressed in aimless thrashing of the patient.
One form of catatonic disorder is stupor (freezing). The following forms of stupor are distinguished:
1) negativistic (resistance to movements);
2) with numbness (the patient cannot be moved from his place).
3. Violent actions.
This disorder of voluntary movements and actions manifests itself in the fact that patients, in addition to their own desire, perform various motor acts (for example, crying, laughing, swearing, etc.).
35. Intellectual impairment
Intelligence is the system of all cognitive abilities of an individual (in particular, the ability to learn and solve problems that determine the success of any activity).
For the quantitative analysis of intelligence, the concept of IQ is used - mental development coefficient.
There are three forms of intelligence:
1) verbal intelligence (vocabulary, erudition, ability to understand what is read);
2) ability to solve problems;
3) practical intelligence (the ability to adapt to the environment).
The structure of practical intelligence includes:
1. Processes of adequate perception and understanding of ongoing events.
3. The ability to act rationally in a new environment.
The intellectual sphere includes some cognitive processes, but intelligence is not just the sum of these cognitive processes. The prerequisites for intelligence are attention and memory, but they do not exhaust the understanding of the essence of intellectual activity.
There are three forms of organization of intelligence, which reflect different ways of knowing objective reality, in particular in the sphere of interpersonal contacts.
1. Common sense is the process of adequately reflecting reality, based on an analysis of the essential motives of the behavior of people around us and using a rational way of thinking.
2. Reason - the process of cognition of reality and a method of activity based on the use of formalized knowledge, interpretations of the motives of the activities of communication participants.
3. Reason is the highest form of organization of intellectual activity, in which the thought process contributes to the formation of theoretical knowledge and the creative transformation of reality.
Intellectual cognition can use the following methods:
1) rational (requires the application of formal logical laws, the formulation of hypotheses and their confirmation);
2) irrational (based on unconscious factors, does not have a strictly defined sequence, does not require the use of logical laws to prove the truth).
The following concepts are closely related to the concept of intelligence:
1) anticipatory abilities - the ability to anticipate the course of events and plan one’s activities in such a way as to avoid undesirable consequences and experiences;
2) reflection—creating an idea of the true attitude towards the subject on the part of others.
36. The problem of cerebral localization of mental functions
The problem of localization of mental functions is one of the main research problems in neuropsychology. Initially, this problem was literally: how various mental processes and morphological zones of the brain are interconnected. But no clear matches were found. There are two points of view on this issue:
1) localizationism;
2) anti-localizationism. Localizationism connects every mental
a process involving the functioning of a specific part of the brain. Narrow localizationism considers mental functions as indecomposable into their component parts and realized through the work of narrowly localized areas of the cerebral cortex.
The following facts speak against the concept of narrow localization:
1) when different areas of the brain are damaged, the same mental function is disrupted;
2) the result of damage to a certain area of the brain can be a violation of several different mental functions;
3) impaired mental functions can be restored after damage without morphological restoration of the injured area of the brain.
According to the concept of anti-localizationism:
1) the brain is a single whole, and its work contributes to the development of the functioning of all mental processes equally;
2) with damage to any part of the brain, a general decrease in mental functions is observed (the degree of decrease depends on the volume of the affected brain).
According to the concept of equipotentiality of brain regions, all areas of the brain are equally involved in the implementation of mental functions. Thus, in all cases, restoration of the mental process is possible, unless the quantitative characteristics of the damage exceed some critical values. However, not always and not all functions can be restored (even if the amount of damage is small).
Currently, the main direction in solving this problem is determined by the concept of systemic dynamic localization of mental processes and functions, which was developed by L. S. Vygotsky and A. R. Luria. According to this theory:
1) human mental functions are systemic formations that are formed throughout life, are voluntary and mediated by speech;
2) the physiological basis of mental functions are considered to be functional systems that are interconnected with specific brain structures and consist of afferent and efferent interchangeable links.
37. Functional blocks of the brain
A. R. Luria developed a general structural and functional model of the brain, according to which the entire brain can be divided into three main blocks. Each block has its own structure and plays a specific role in mental functioning.
1st block – a block for regulating the level of general and selective brain activation, an energy block that includes:
1) reticular formation of the brain stem;
2) diencephalic sections;
3) nonspecific structures of the midbrain;
4) limbic system;
5) mediobasal parts of the cortex of the frontal and temporal lobes.
2nd block - the block for receiving, processing and storing exteroceptive information, includes the central parts of the main analyzer systems, the cortical zones of which are located in the occipital, parietal and temporal lobes of the brain.
The work of the second block is subject to three laws.
1. The law of hierarchical structure (primary zones are phylo- and ontogenetically earlier, from which two principles follow: the “bottom-up” principle – underdevelopment of the primary fields in a child leads to the loss of later functions; the “top-down” principle – in an adult with complete Due to the established psychological system, the tertiary zones control the work of the secondary zones subordinate to them and, if the latter are damaged, have a compensating effect on their work).
2. Law of decreasing specificity (primary zones are the most modally specific, and tertiary zones are generally supramodal).
3. The law of progressive lateralization (as you ascend from primary to tertiary zones, the differentiation of the functions of the left and right hemispheres increases).
3rd block - the block of programming, regulation and control over the course of mental activity), consists of the motor, premotor and prefrontal sections of the cerebral cortex. When this part of the brain is damaged, the functioning of the musculoskeletal system is disrupted.
38. Concepts of neuropsychological factor, symptom and syndrome
“Neuropsychological factor is the principle of physiological activity of a certain brain structure. It is a connecting concept between mental functions and the working brain.
A tool for identifying neuropsychological factors is syndromic analysis, which includes:
1) qualitative qualification of mental function disorders with an explanation of the reasons for the changes;
2) analysis and comparison of primary and secondary disorders, i.e., establishing cause-and-effect relationships between the direct source of pathology and emerging disorders;
3) study of the composition of preserved higher mental functions.
Let us list the main neuropsychological factors:
1) modal-nonspecific (energy) factor;
2) kinetic factor;
3) modality-specific factor;
4) kinesthetic factor (a special case of a modality-specific factor);
5) factor of voluntary-involuntary regulation of mental activity;
6) factor of awareness-unconsciousness of mental functions and states;
7) factor of successivity (consistency) of the organization of higher mental functions;
8) factor of simultaneity (simultaneity) of the organization of higher mental functions;
9) factor of interhemispheric interaction;
10) general cerebral factor; 11) factor of the work of deep subcortical structures.
Neuropsychological symptom is a violation of mental functions as a result of local brain lesions.
A syndrome is a natural combination of symptoms, the basis of which is a neuropsychological factor, i.e., certain physiological patterns of the functioning of areas of the brain, the violation of which is the cause of the occurrence of neuropsychological symptoms.
Neuropsychological syndrome is a fusion of neuropsychological symptoms associated with the loss of one or more factors.
Syndromic analysis is the analysis of neuropsychological symptoms, the main goal of which is to find a common factor that fully explains the appearance of different neuropsychological symptoms. Syndromic analysis includes the following stages: first, the signs of pathology of various mental functions are determined, and then the symptoms are qualified.
39. Methods of neuropsychological research. Restoration of higher mental functions
One of the most common methods for assessing syndromes in neuropsychology is the system proposed by A. R. Luria. It includes:
1) a formal description of the patient, his medical history;
2) a general description of the patient’s mental status (state of consciousness, ability to navigate place and time, level of criticism, etc.);
3) studies of voluntary and involuntary attention;
4) studies of emotional reactions;
5) studies of visual gnosis (using real objects, contour images, etc.);
6) studies of somatosensory gnosis (recognition of objects by touch, by touch);
7) studies of auditory gnosis (recognition of melodies, repetition of rhythms);
8) studies of movements and actions (assessment of coordination, drawing results, object actions, etc.);
9) speech research;
10) studies of writing (letters, words and phrases);
11) reading studies;
12) memory studies;
13) research into the counting system;
14) research of intellectual processes. One of the important branches of neuropsychology studies the mechanisms and methods of restoring higher mental functions impaired as a result of local pathologies of the brain. A position was put forward about the possibility of restoring damaged mental functions through the restructuring of functional systems that determine the implementation of higher mental functions.
In the works of A.R. Luria and his students, mechanisms for restoring higher mental functions were identified:
1) transferring the process to a higher conscious level;
2) replacing the missing link of the functional system with a new one.
Let us list the principles of restorative training:
1) neuropsychological qualification of the defect;
2) reliance on preserved forms of activity;
3) external programming of the restored function.
The practice of treating the wounded during the Great Patriotic War proved the effectiveness of these ideas. Subsequently, neuropsychological methods began to be used in conjunction with medications.
The development of ideas about the functional asymmetry of the human brain in the history of neuropsychology is associated with the name of the French doctor M. Dax, who in 1836, speaking at a medical society, presented the results of observations of 40 patients. He observed patients with brain damage accompanied by a decrease or loss of speech, and came to the conclusion that the disorders were caused only by defects in the left hemisphere.
40. Schizophrenia
Schizophrenia (from the Greek shiso - “split”, frenio - “soul”) is “a mental illness that occurs with rapidly or slowly developing personality changes of a special type (decreased energy potential, progressive introversion, emotional impoverishment, distortion of mental processes).”
Often the result of this disease is a break in the patient’s previous social relationships and significant disadaptation of patients in society.
Schizophrenia is considered almost the most famous mental illness.
There are several forms of schizophrenia:
1) continuous schizophrenia;
2) paroxysmal-progressive (fur-like);
3) recurrent (periodic flow).
According to the pace of the process, the following types of schizophrenia are distinguished:
1) low-progressive;
2) average progressive;
3) malignant.
There are various forms of schizophrenia, for example:
1) schizophrenia with obsessions;
2) paranoid schizophrenia (delusions of persecution, jealousy, invention, etc. are noted);
3) schizophrenia with asthenohypochondriacal manifestations (mental weakness with painful fixation on health);
4) simple;
5) hallucinatory-paranoid;
6) hebephrenic (stupid motor and speech agitation, elevated mood, confused thinking are noted);
7) catatonic (characterized by a predominance of motor disorders). The following features are characteristic of patients with schizophrenia.
1. Severe disturbances in perception, thinking, emotional-volitional sphere.
2. Decreased emotionality.
3. Loss of differentiation of emotional reactions.
4. State of apathy.
5. Indifferent attitude towards family members.
6. Loss of interest in the environment.
8. Decrease in volitional effort from insignificant to pronounced lack of will (abulia).
41. Manic-depressive psychosis
Manic-depressive psychosis (MDP) is a disease characterized by the presence of depressive and manic phases. The phases are separated by periods with the complete disappearance of mental disorders - intermissions.
It should be noted that manic-depressive psychosis is much more common in women than in men.
As mentioned earlier, the disease occurs in the form of phases - manic and depressive. Moreover, depressive phases are several times more frequent than manic phases.
The following symptoms are characteristic of the depressive phase:
1) depressed mood (depressive affect);
2) intellectual inhibition (slowness of thought processes);
3) psychomotor and speech inhibition.
The manic phase is characterized by the following symptoms.
1. Elevated mood (manic affect).
2. Intellectual excitement (accelerated thought processes).
3. Psychomotor and speech stimulation. Sometimes depression can only be identified
through psychological research.
Manifestations of manic-depressive psychosis can occur in childhood, adolescence and young adulthood. At each age, MDP has its own characteristics.
In children under 10 years of age in the depressive phase, the following features are noted:
1) lethargy;
2) slowness;
3) lack of talkativeness;
4) passivity;
5) confusion;
6) tired and unhealthy appearance;
7) complaints of weakness, pain in the head, stomach, legs;
8) low academic performance;
9) difficulties in communication;
10) disturbances of appetite and sleep.
Children in the manic phase experience:
1) ease of laughter;
2) insolence in communication;
3) increased initiative;
4) no signs of fatigue;
5) mobility.
In adolescence and adolescence, a depressive state manifests itself in the following features: inhibition of motor skills and speech; decreased initiative; passivity; loss of vividness of reactions; feeling of melancholy, apathy, boredom, anxiety; forgetfulness; tendency to self-examination; heightened sensitivity to attitudes from peers; suicidal thoughts and attempts.
42. Epilepsy
Epilepsy is characterized by the presence of frequent disturbances in consciousness and mood in the patient.
This disease gradually leads to personal changes.
It is believed that hereditary factors, as well as exogenous factors (for example, intrauterine organic damage to the brain) play a large role in the origin of epilepsy. One of the characteristic signs of epilepsy is a seizure, which usually begins suddenly.
Sometimes, a few days before a seizure, warning signs appear:
1) feeling unwell;
2) irritability;
3) headache.
The seizure usually lasts about three minutes. After it, the patient feels lethargic and drowsy. Seizures may recur with varying frequency (from daily to several per year).
Patients have atypical seizures.
1. Minor seizures (loss of consciousness for several minutes without falling).
2. Twilight state of consciousness.
3. Outpatient automatisms, including somnambulism (sleepwalking).
Patients have the following symptoms:
1) stiffness, slowness of all mental processes;
2) thoroughness of thinking;
3) tendency to get stuck on details;
4) the inability to distinguish the main from the secondary;
5) dysphoria (tendency to an angry-sad mood). Characteristic features of patients with epilepsy are:
1) a combination of affective viscosity and explosiveness (explosiveness);
2) pedantry regarding clothing, order in the house;
3) infantilism (immaturity of judgment);
4) sweetness, exaggerated politeness;
5) a combination of increased sensitivity and vulnerability with malice.
The face of patients with epilepsy is inactive, unexpressive, and there is restraint in gestures.
When examining patients with epilepsy, the psychologist primarily studies thinking, memory and attention.
The following methods are commonly used to study patients with epilepsy.
1. Schulte tables.
2. Elimination of items.
3. Classification of objects.
Methodology and methods of clinical psychology
Methodology is a system of principles and methods of organizing and constructing theoretical and practical activities, united by the doctrine of this system. It has different levels: philosophical, general scientific, specific scientific, which are interconnected and should be considered systematically. Methodology is closely related to worldview, since its system presupposes a worldview interpretation of the foundations of the study and its results. The methodology of clinical psychology itself is determined by the specific scientific level and is associated with the ideological position of the researcher (for example, focused on a dynamic, cognitive-behavioral, humanistic or dialectical-materialistic understanding of personality, behavior, psychopathology).
The methodology includes specific scientific research techniques: observation, experiment, modeling, etc. They, in turn, are implemented in special procedures - methods for obtaining scientific data. As a psychological discipline, clinical psychology is based on the methodology and methods of general psychology. Methods, that is, ways of cognition, are the ways by which the subject of science is learned.
Methodology in psychology is implemented through the following provisions (principles).
1. The psyche and consciousness are studied in the unity of internal and external manifestations. The relationship between the psyche and behavior, consciousness and activity in its specific, changing forms is not only an object, but also a means of psychological research.
2. The solution to a psychophysical problem asserts the unity, but not the identity of the mental and the physical, therefore psychological research presupposes and often includes a physiological analysis of psychological (psychophysiological) processes.
3. The methodology of psychological research should be based on a socio-historical analysis of human activity.
4. The goal of psychological research should be to reveal specific psychological patterns (the principle of individualization of research).
5. Psychological patterns are revealed in the process of development (genetic principle).
6. The principle of pedagogization of the psychological study of the child. It does not mean the abandonment of experimental research in favor of pedagogical practice, but the inclusion of the principles of pedagogical work in the experiment itself.
7. The use of products of activity in the methodology of psychological research, since they materialize the conscious activity of a person (the principle of studying a specific person in a specific situation).
According to Platonov, for medical (clinical) psychology the principles similar to those presented above are of greatest importance: determinism, unity of consciousness and activity, reflex, historicism, development, structure, personal approach. Only a few of them probably require explanation, in particular the last three principles.
Development principle. In clinical psychology, this principle can be specified as the etiology and pathogenesis of psychopathological disorders in their direct (disease development) and reverse (remission, recovery) development. A special category is specific - pathological development of personality.
The principle of structure. In philosophy, structure is understood as the unity of elements, their connections and integrity. In general psychology, they study the structures of consciousness, activity, personality, etc. Pavlov gave the following definition of the method of structural analysis: “The method of studying a human system is the same as any other system: decomposition into parts, studying the meaning of each part, studying the parts, studying the relationship with environment and an understanding from all this of its general working and management, if it is within human means.” The task of clinical psychology is to bring the particular structures of various psychopathological phenomena into a single system and harmonize it with the general structure of a healthy and sick personality.
The principle of a personal approach. In clinical psychology, a personal approach means treating a patient or a person under study as a whole person, taking into account all its complexity and all individual characteristics. It is necessary to distinguish between personal and individual approaches. The latter is taking into account the specific characteristics inherent in a given person under given conditions. It can be implemented as a personal approach or as the study of individual individual psychological or somatic qualities.
Methods of medical (clinical) psychology are divided into:
Clinical and psychological methods of personality research:
2) Interview
3) Anamnestic method
4) Observation
5) Study of products of activity
Experimental psychological methods:
1) Non-standardized (qualitative methods) - represented primarily by a set of so-called pathopsychological methods (Zeigarnik, S. Ya. Rubinstein, Polyakov), are distinguished by their “targeting”, focus on certain types of mental pathology, and their selection is carried out individually for a particular subject. These methods are created to study specific types of mental disorders. In the conditions of a psychological experiment, they are selectively used to identify the characteristics of mental processes in accordance with the task, in particular differential diagnosis. The psychological conclusion is based not so much on taking into account the final result (effect) of the patient’s activity, but on a qualitative, meaningful analysis of the methods of activity characteristic features of the process of performing work as a whole, and not individual tasks. It is important to take into account the patient’s attitude to the study, the dependence of the form of presentation of the task on the condition of the subject and the level of his development. Only with this design of the experiment can the requirement for psychological research be fully realized - identifying and comparing the structure of both changed and remaining intact forms of mental activity.
2) Standardized (quantitative) - In this case, groups of appropriately selected and structured tasks are presented in the same form to each subject in order to compare the method and level of their performance by the subject and other persons. Standardized methods can be defined as tests broadly understood, including tests for the study of mental processes, mental states and personality. In the case of using standardized methods, the method of analyzing the results of each individual technique is based primarily on a quantitative assessment, which is compared with assessments previously obtained from a corresponding sample of patients and healthy subjects. Standardized methods are inferior in their diagnostic value to non-standardized ones; their use in the clinic usually has an auxiliary value, often as a supplement to non-standardized methods. It is adequate to use them during mass examinations, when group assessment of subjects is necessary, for indicative express diagnostics in conditions of time shortage.
Projective methods– addressed to the unconscious psyche. Disguised testing, the subject does not know what the research is aimed at and therefore cannot distort the results. The only strictly psychological research method. Projection is a normal psychological process of assimilation.
Clinical psychology as a scientific discipline. History of development, current state, content, subject, tasks
List of topics
- Subject, tasks and features of modern natural science.
- Structure and methods of natural science knowledge.
- Physical concepts of natural science.
- Astrophysical concepts of natural science and space.
- Chemical concepts in natural science.
- Geoscience concepts.
- Biological concepts of natural science.
- Ecological picture of the world.
- Anthropological concepts.
- Synergetics as a promising direction of science.
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Clinical psychology is a broad-based specialty that is intersectoral in nature and involved in solving a set of problems in the healthcare system, public education and social assistance to the population. The work of a clinical psychologist is aimed at increasing a person’s psychological resources and adaptive capabilities, harmonizing mental development, protecting health, preventing and overcoming illnesses, and psychological rehabilitation.
Becoming clinical psychology as one of the main applied branches of psychological science is inextricably linked with the development of both psychology itself and medicine, physiology, biology, anthropology; its history begins in ancient times, when psychological knowledge arose in the depths of philosophy and natural science.
Late XVIII - early XIX centuries. development of psychological ideas about the decomposability of mental processes into certain initial mental “abilities”, doctors of that time began to look for the brain substrate of these “abilities”. Thus, the locationist theory began, which tries to illuminate the “brain-psyche” problem. Beginning of the 19th century Hall (Austrian anatomist) - an attempt to localize the moral and intellectual qualities of a person in different parts of the brain; he suggested that the development of individual areas of the cortex, sulci and the brain as a whole supposedly affects the shape of the skull and therefore the study of its surface makes it possible to diagnose individual personality traits.
By the middle of the 19th century. (thanks to the works of M. Hall and Müller, Steinbuch and Bell, Weber, Fechner, Helmholtz), the psyche began to be recognized as a reality woven into a complex system of interaction between stimuli from the external world and the response activity of the body, and the possibility arose of developing methods capable of translating this reality into scientific concepts and models. At the same time, Sechenov gave a significant impetus to the development of the reflex concept after his discovery of the mechanisms of central inhibition. This discovery led him to the most important conclusion about the reflex nature of the psyche.
In the middle of the 19th century. Thanks to the concept of the founder of modern pathological anatomy, the German scientist Virchow, various studies of the cellular structure of the brain and cerebral cortex begin. In 1861, the French anatomist and surgeon Broca drew attention to the connection between loss of speech and damage to the inferior frontal gyrus of the left hemisphere. These observations stimulated research into the localization of functions in the cerebral cortex, including those associated with irritation of certain parts of the brain with electricity. Thanks to Brock's work, a clinical method for studying the structure of the brain emerged. In 1874, the German psychiatrist Wernicke described 10 patients with impaired understanding of spoken speech, with the localization of the lesion in the posterior parts of the superior temporal gyrus, also in the left hemisphere. The end of the 19th century was marked by other successes of localizationists, who believed that a limited area of the brain could be the “brain center” of any mental function.
Development of science in the mid-19th century. led to rapid changes in ideas about living nature, about the functions of the body, including mental ones, both normally and in pathology. These changes in psychology in general and in the emerging scientific medical psychology in particular were also facilitated by global scientific discoveries in Europe: Darwin's theory in England, which revealed the laws of evolution; Bernard's doctrine of self-regulation mechanisms in France, which defined the concept of homeostasis; the achievements of the physicochemical school in Germany, which presented the foundations of life in a new way; the discovery of the mechanism of central inhibition by Sechenov in Russia, which radically changed the overall picture of the dynamics of processes of higher nervous activity.
The impetus for the development of psychology, and clinical psychology, in particular, was the opening in Leipzig by Wundt of the world's first experimental psychological laboratory (1879). Wundt became the founder of psychology as a formal academic discipline. He founded his own scientific school, where later famous scientists studied and worked - Kraepelin, Münsterberg, Külpe, Kirschman, Meisman, Marbe, Lipps, Kruger (Germany), Titchener (England), Skripchur, Angell, G. S. Hall, Whitmer (USA), Bekhterev, Chizh, Lange (Russia) - many of whom are considered the founders of clinical psychology. First of all it should be mentioned Whitmer, who introduced the concept clinical psychology. Having organized a psychological clinic for retarded and mentally ill children at the University of Pennsylvania, he developed a course of lectures on this problem. In 1907, Whitmer founded the journal Psychological Clinic, in the first issue of which he proposed a new specialization for psychologists - clinical psychology. Although Whitmer contributed to the development of clinical psychology and used this term quite legitimately, in fact this field was much broader than what he did. Many psychologists followed Whitmer's example. By 1914, almost two dozen psychological clinics similar to Whitmer’s were operating in the United States. Whitmer's followers applied his clinical approach to the diagnosis and treatment of disorders in adults.
Development of clinical psychology abroad associated with such personalities as Kraepelin, Bleier, Kretschmer, Binet, Ribot, Freud.
Read more: In Germany, Kraepelin introduced a psychological experiment into a psychiatric clinic already in the early 90s. The association experiment was widely used for diagnostic purposes by the Swiss psychiatrist Bleuler, thanks to which Bleuler identified a new form of thinking - autistic thinking. The German psychiatrist Kretschmer developed the doctrine of the difference between progressive processes and constitutional states. In 1922, he published the first textbook entitled “Medical Psychology,” which laid out the methodological foundations for the use of psychology in medical practice. In France, Binet, in addition to experimental studies of thinking, studied people with extraordinary abilities, as well as imagination, memory and intelligence in children. In 1896, he developed a series of personality tests. His real fame came from the metric scale of intellectual development, developed in 1905 together with the doctor Simon for the purpose of selecting mentally retarded children from a normal school. Much of the credit goes to Ribot, the founder of modern experimental psychology in France. He called pathopsychology a natural experiment of nature itself. Many of his works were devoted to the study of diseases of memory, personality, and feelings. Ribot noted that psychology should study specific facts of mental life in their dynamics. Ribot's ideas were further developed in the works of his student Janet. He considered clinical observation to be the main method of psychology.
Freud's psychoanalysis, which emerged in the early 90s, made a huge contribution to the development of clinical psychology. XIX century from the medical practice of treating patients with functional mental disorders, which significantly advanced the psychological theory of the emergence of mental disorders, and also opened the way for psychoanalytic treatment for psychologists and doctors.
Development of clinical psychology in Russia: associated with the names of Bekhterev, Lazursky, Pavlov
In Russia, the impetus for the development of clinical psychology was the opening of experimental psychological laboratories at psychiatric clinics and universities. Bekhterev (Kazan, St. Petersburg), Korsakov and Tokarsky (Moscow). Sikorsky (Kyiv), Chizh (Tartu). The employees of these laboratories developed methods for experimental psychological research of mentally ill patients, carried out developments to study the mechanisms and disorders of memory and thinking, developed and tested research methods for solving psychological, physiological, and psychiatric problems.
Bekhterev's colleague Lazursky expanded the use of the experiment, extending it to the study of personality. He developed a method of natural experiment, which, along with laboratory techniques, made it possible to study a person’s personality, interests and character.
Rossolimo, a famous pediatric neurologist, developed his own method of experimental personality study - the method of psychological profiles, which had great diagnostic significance for determining personality defects.
A significant contribution to research on the problem of localization of mental functions was made by Pavlov, who developed the doctrine of dynamic localization of functions, the formation of “dynamic stereotypes” in the cerebral cortex, and brain variability in the spatial timing of excitatory and inhibitory processes. In his works, ideas about the first and second signaling systems are formulated and justified, the concept of analyzers, their nuclear and peripheral parts is put forward and developed. The experimental study of higher nervous activity in Pavlov's laboratories, the identification of types of nervous activity (the physiological equivalent of temperament), and the relationships between the first and second signaling systems led to a theoretical justification for experimental neuroses, which Pavlov transferred to the clinic. Thus, the methodological foundation of the pathophysiological theory of neuroses (F40-F48) and their psychotherapy was laid. This direction was called Pavlovian psychotherapy, which used in practice experimental data on the emergence and inhibition of conditioned reflexes, the concepts of inhibition, irradiation, induction, and phase states.
In the first third of the 20th century in psychology (due to the gap between empirical and applied research and theoretical and methodological foundations), independent directions began to emerge that claimed to create a new psychological theory. Each of them relied on its own theoretical ideas about the nature of mental processes, had its own theory of personality in normal and pathological conditions, and developed the foundations of psychological influence on a person. But despite all the differences in views on the object and subject of research in medical psychology, the scope and tasks reflected in the literature of this period, its analysis indicates a convergence of at least some positions. First of all, this concerned medical psychology itself, the recognition of its right to be distinguished as an independent science at the interface between medicine and psychology. At the same time, it was obvious that the further development of many sections of modern medicine: the doctrine of psychogenic and psychosomatic diseases, psychotherapy and rehabilitation, mental hygiene and psychoprophylaxis was hardly possible without psychological science participating in the development of their theoretical foundations.
This is how I saw it medical psychology at this time (1972) the leading Soviet psychiatrist Snezhnevsky: “ Medical psychology is a branch of general psychology that studies the state and role of the mental sphere in the occurrence of human diseases, the characteristics of their manifestations, course, outcome and recovery. Medical psychology in its research uses descriptive and experimental methods accepted in psychology. It, in turn, contains the following branches: a) pathopsychology, which studies mental disorders using psychological methods; b) neuropsychology, which studies focal brain lesions using psychological methods; c) deontology; d) psychological foundations of mental hygiene - general and special; e) psychological foundations of occupational therapy; f) psychological foundations for organizing patient care in hospitals, outpatient clinics, and sanatoriums. Other industries are possible».
Specific goals medical psychology were formulated as follows (Lebedinsky; Myasishchev, Kabanov, Karvasarsky):
Study of mental factors influencing the development of diseases, their prevention and treatment;
Studying the influence of certain diseases on the psyche;
Study of mental manifestations of various diseases in their dynamics;
Study of mental development disorders; studying the nature of the relationship of a sick person with medical personnel and the surrounding microenvironment;
Development of principles and methods of psychological research in the clinic;
Creation and study of psychological methods of influencing the human psyche for therapeutic and preventive purposes.
In accordance with the specified purposes as subject Medical psychology considered (Karvasarsky) the features of the patient’s mental activity in their significance for the pathogenetic and differential diagnosis of the disease, optimization of its treatment and prevention (preservation and promotion of health).
The most developed branches of medical psychology at this time were: pathopsychology, which arose at the intersection of psychology, psychopathology and psychiatry (Zeigarnik, Polyakov, etc.), and neuropsychology, formed at the border of psychology, neurology and neurosurgery (Luria, Chomsky, etc.). Pathopsychology, according to Zeigarnik, studies the patterns of disintegration of mental activity and personality traits in comparison with the patterns of the formation and course of mental processes in the norm. The task of neuropsychology, according to the views of Luria, the founder of this branch of psychology, is to study the brain mechanisms of human mental activity using new psychological methods for topical diagnosis of local brain lesions.
In addition, research was conducted to build the most effective psychotherapeutic and rehabilitation programs.
The development of medical psychology was influenced by research on theory and practice rehabilitation. Kabanov understood the rehabilitation process as a systemic activity aimed at restoring the personal and social status of the patient (full or partial) using a special method, the main content of which is the mediation of therapeutic and restorative effects and measures through the individual.
A set of problems related to the study of the nature, methods of treatment and prevention of the so-called psychosomatic disorders, the importance of which in the structure of population morbidity has constantly increased. Gubachev, Zaitsev, Goshtautas, Solozhenkin, Berezin and others devoted their monographic works to psychosomatic research using psychological methods.
In the 60s In connection with brain research, interest in the problem of consciousness and its role in behavior. In neurophysiology, Nobel laureate Sperry views consciousness as an active force. In our country, neuropsychology is being developed in the works of Luria and his students - Chomskaya, Akhutina, Tsvetkova, Simernitskaya, Korsakova, Lebedinsky, etc. They have accumulated and systematized a huge amount of factual material about the role of the frontal lobes and other brain structures in the organization of mental processes, and summarized numerous previous research and continued study of violations of individual mental functions - memory, speech, intellectual processes, voluntary movements and actions in case of local brain lesions, and the features of their recovery were analyzed. Assimilation of the experience of domestic and foreign authors in the development of neuropsychological research techniques allowed Luria to create a set of methods for clinical research of individuals with brain lesions. One of the results of the theoretical generalization of clinical experience was the concept he formulated of the three-block structure of the functional organization of the brain. A large place in Luria’s work was occupied by issues of neurolinguistics, developed in inextricable connection with problems of aphasiology. These numerous studies in the field of neuropsychology created the prerequisites for separating this science into an independent discipline.
Current state : In connection with socio-political changes in Russia and the elimination of ideological barriers in the last decade, the question arose about the rapprochement of domestic and world psychology, which required, in particular, a revision of the concepts of “medical” and “clinical” psychology. Clinical psychology as an organization of researchers and practitioners has been represented by the American Association of Clinical Psychology since 1917, and in German-speaking countries since the mid-19th century. In our country, the specialty “clinical psychology” (022700) was approved by the Ministry of Education of the Russian Federation in 2000 (order No. 686). In accordance with the state educational standard clinical psychology- a broad-profile specialty that is intersectoral in nature and involved in solving a set of problems in the healthcare system, public education and social assistance to the population. The activities of a clinical psychologist are aimed at increasing a person’s mental resources and adaptive capabilities, harmonizing mental development, health care, prevention and psychological rehabilitation.
Object clinical psychology is a person with difficulties of adaptation and self-realization associated with his physical, social and spiritual condition.
Subject The professional activities of a clinical psychologist are mental processes and states, individual and interpersonal characteristics, socio-psychological phenomena that manifest themselves in various areas of human activity.
A clinical psychologist in the above areas performs the following: activities: diagnostic, expert, correctional, preventive, rehabilitation, advisory, research and some others.
The relationship of clinical psychology with other sciences: Any science develops in interaction with other sciences and under their influence. The basic sciences for clinical psychology are general psychology and psychiatry. Psychiatry belongs to medicine, but is closely related to clinical psychology. The subject of scientific research in both clinical psychology and psychiatry is mental disorders, and clinical psychology, in addition, deals with disorders that are not equivalent in significance to illness (for example, problems of marriage and partnership), as well as the mental aspects of somatic disorders. Psychiatry, as a private field of medicine, takes more into account the somatic plane of mental disorders; in clinical psychology, the main ones are psychological aspects. A comprehensive understanding of mental disorders is only possible with comprehensive biopsychosocial models. Therefore, the approaches being developed sometimes do not have pronounced differences and are often implemented in joint research.
Clinical psychology influences the development of the theory and practice of psychiatry, neurology, neurosurgery, internal medicine and other medical disciplines.
Methodology is a system of principles and methods of organizing and constructing theoretical and practical activities, united by the doctrine of this system. It has different levels: philosophical, general scientific, specific scientific, which are interconnected and should be considered systematically. Methodology is closely related to worldview, since its system presupposes a worldview interpretation of the foundations of the study and its results. The methodology of clinical psychology itself is determined by the specific scientific level and is associated with the ideological position of the researcher (for example, focused on a dynamic, cognitive-behavioral, humanistic or dialectical-materialistic understanding of personality, behavior, psychopathology).
The methodology includes specific scientific research techniques: observation, experiment, modeling, etc. They, in turn, are implemented in special procedures - methods for obtaining scientific data. As a psychological discipline, clinical psychology is based on the methodology and methods of general psychology. Methods, that is, ways of cognition, are the ways by which the subject of science is learned.
Methodology in psychology is implemented through the following provisions (principles).
1. The psyche and consciousness are studied in the unity of internal and external manifestations. The relationship between the psyche and behavior, consciousness and activity in its specific, changing forms is not only an object, but also a means of psychological research.
2. The solution to a psychophysical problem asserts the unity, but not the identity of the mental and the physical, therefore psychological research presupposes and often includes a physiological analysis of psychological (psychophysiological) processes.
3. The methodology of psychological research should be based on a socio-historical analysis of human activity.
4. The goal of psychological research should be to reveal specific psychological patterns (the principle of individualization of research).
5. Psychological patterns are revealed in the process of development (genetic principle).
6. The principle of pedagogization of the psychological study of the child. It does not mean the abandonment of experimental research in favor of pedagogical practice, but the inclusion of the principles of pedagogical work in the experiment itself.
7. The use of products of activity in the methodology of psychological research, since they materialize the conscious activity of a person (the principle of studying a specific person in a specific situation).
According to Platonov, for medical (clinical) psychology the principles similar to those presented above are of greatest importance: determinism, unity of consciousness and activity, reflex, historicism, development, structure, personal approach. Only a few of them probably require explanation, in particular the last three principles.
Development principle. In clinical psychology, this principle can be specified as the etiology and pathogenesis of psychopathological disorders in their direct (disease development) and reverse (remission, recovery) development. A special category is specific - pathological development of personality.
The principle of structure. In philosophy, structure is understood as the unity of elements, their connections and integrity. In general psychology, they study the structures of consciousness, activity, personality, etc. Pavlov gave the following definition of the method of structural analysis: “The method of studying a human system is the same as any other system: decomposition into parts, studying the meaning of each part, studying the parts, studying the relationship with environment and an understanding from all this of its general working and management, if it is within human means.” The task of clinical psychology is to bring the particular structures of various psychopathological phenomena into a single system and harmonize it with the general structure of a healthy and sick personality.
The principle of a personal approach. In clinical psychology, a personal approach means treating a patient or a person under study as a whole person, taking into account all its complexity and all individual characteristics. It is necessary to distinguish between personal and individual approaches. The latter is taking into account the specific characteristics inherent in a given person under given conditions. It can be implemented as a personal approach or as the study of individual individual psychological or somatic qualities.
Methods of medical (clinical) psychology are divided into:
Clinical and psychological methods of personality research:
2) Interview
3) Anamnestic method
4) Observation
5) Study of products of activity
Experimental psychological methods:
1) Non-standardized (qualitative methods) - represented primarily by a set of so-called pathopsychological methods (Zeigarnik, S. Ya. Rubinstein, Polyakov), are distinguished by their “targeting”, focus on certain types of mental pathology, and their selection is carried out individually for a particular subject. These methods are created to study specific types of mental disorders. In the conditions of a psychological experiment, they are selectively used to identify the characteristics of mental processes in accordance with the task, in particular differential diagnosis. The psychological conclusion is based not so much on taking into account the final result (effect) of the patient’s activity, but on a qualitative, meaningful analysis of the methods of activity characteristic features of the process of performing work as a whole, and not individual tasks. It is important to take into account the patient’s attitude to the study, the dependence of the form of presentation of the task on the condition of the subject and the level of his development. Only with this design of the experiment can the requirement for psychological research be fully realized - identifying and comparing the structure of both changed and remaining intact forms of mental activity.
2) Standardized (quantitative) - In this case, groups of appropriately selected and structured tasks are presented in the same form to each subject in order to compare the method and level of their performance by the subject and other persons. Standardized methods can be defined as tests broadly understood, including tests for the study of mental processes, mental states and personality. In the case of using standardized methods, the method of analyzing the results of each individual technique is based primarily on a quantitative assessment, which is compared with assessments previously obtained from a corresponding sample of patients and healthy subjects. Standardized methods are inferior in their diagnostic value to non-standardized ones; their use in the clinic usually has an auxiliary value, often as a supplement to non-standardized methods. It is adequate to use them during mass examinations, when group assessment of subjects is necessary, for indicative express diagnostics in conditions of time shortage.
Projective methods– addressed to the unconscious psyche. Disguised testing, the subject does not know what the research is aimed at and therefore cannot distort the results. The only strictly psychological research method. Projection is a normal psychological process of assimilation.
Research methods in medical (clinical) psychology
When choosing research methods, clinical psychology is guided by tasks arising from professional responsibilities: participation in solving differential diagnostic problems, analyzing the structure and establishing the degree of mental disorders, diagnosing mental development, characterizing the individual and the system of his relationships, assessing the dynamics of neuropsychic disorders and taking into account the effectiveness of therapy , solving expert problems.
The diagnostic task dictates the use of psychological techniques that are capable of assessing the activity of individual mental functions, as well as differentiating psychological phenomena and psychopathological symptoms and syndromes. The task of psychocorrection involves the use of various scales to analyze the effectiveness of the applied psychocorrection and psychotherapeutic techniques.
When selecting methods, a clinical psychologist takes into account, first of all, the goals of the psychological examination, as well as the somatic state of the subject, his age, profession and level of education, the time and place of the study.
V.D. Mendeleviya divides all research methods in clinical psychology into three groups: 1) clinical interviewing, 2) experimental psychological research methods and 3) assessing the effectiveness of psychocorrectional influences. For the most part, these methods are borrowed from general psychology, while some were created in medical psychology and are intended to solve specific problems in the work of a clinical psychologist.
There is another classification of medical psychology methods - a conditional division into non-standardized and standardized methods. Non-standardized methods are represented by a set of so-called psychological techniques (B.V. Zeigarnik, 1976, S.Ya. Rubinstein, 1970). These methods are aimed at identifying certain types of mental pathology. Their selection is carried out individually for a particular subject, mainly for the purpose of differential diagnosis. The psychological conclusion is based not so much on a quantitative analysis of the final result of the patient’s activity, but on a qualitative analysis of the methods of activity, the characteristic features of the process of performing the task itself.
In the case of using standardized methods, the method of analyzing the results is based primarily on a quantitative assessment, which is compared with estimates obtained on corresponding samples of sick and healthy subjects.
Clinical interviewing. The term "interview" has recently come into use by clinical psychologists. We used to talk about clinical questioning or conversation. We find some recommendations for conducting such a conversation in the works of B.V. Zeigarnik, S.Ya. Rubinstein.
The main goals of clinical interviewing are to assess the individual psychological characteristics of the client, ranking the identified characteristics by quality, strength and severity, classifying them as psychological phenomena or psychopathological symptoms. A clinical interview is a method of obtaining information about the individual psychological properties of a person, psychological phenomena and psychopathological symptoms and syndromes, the internal picture of the patient’s illness and the structure of the client’s problem, as well as a method of psychological influence on a person, carried out directly on the basis of personal contact between the psychologist and the client (V. D. Mendelevich, 1998).
The interview is aimed not only at the complaints that the person actively makes, but also at identifying the hidden motives of the person’s behavior and helping him to understand the internal reasons for the altered mental state. Psychological support is an essential aspect of the interview.
The clinical interview is based on the following principles:
- unambiguity, accuracy and accessibility of formulations and questions;
- adequacy and consistency;
- flexibility, impartiality of the survey;
- verifiability of the information received.
The principle of unambiguity and accuracy concerns the correct and precise formulation of questions asked to the client (patient). The principle of accessibility is that the speech of a clinical psychologist should be understandable to the client, close to his colloquial speech, and should not contain special terms.
Consistency in conducting interviews is another principle, which boils down to the fact that the first group of phenomena or symptoms is formed first. This follows from the analysis of the patient’s complaints, stories from his relatives or observation of his behavior. The survey identifies phenomena, symptoms, syndromes that are combined with those already identified. Then the type of formation (endo-, psycho- or exogenous) and the level of disorders, as well as etiological factors are determined.
The principle of verifiability and adequacy of a psychological interview implies clarification of the congruence of concepts and the correct interpretation of the patient’s answers. The principle of impartiality is not to impose on the patient his own idea of the presence of psychopathological symptoms. When supported by practical procedures, these principles become effective.
There are various methodological approaches to conducting interviews. Some scientists believe that 50 min. - this is the optimal duration of the first interview; subsequent interviews with the same client (patient) may be shorter. V.D. Mendelevich proposes the following structure of a clinical interview, consisting of four phases:
- 1) establishing a trust distance; situational support, provision of confidentiality guarantees; determining the leading motives for conducting interviews;
- 2) identification of complaints (passive and active interviews), assessment of the internal picture - the concept of the disease; structuring the problem;
- 3) assessment of the desired outcome of the interview and therapy, determination of the patient’s subjective model of health and preferred mental status;
- 4) assessment of the patient’s anticipatory abilities; discussion of possible options for the outcome of the disease (if it is detected) and therapy; anticipatory training.
This scheme can be used in every conversation, but the time and effort allocated to one or another stage vary depending on the order of meetings, the effectiveness of therapy, etc.
The clinical interview consists of verbal and non-verbal methods. The client's nonverbal expressions allow us to recognize a lot of important information. Eye contact, body language, intonation and pace of speech, and sentence structure can be indicators of conflict in a person. The use of verbal and nonverbal communication contributes to a more accurate understanding of the client's problems and creates a favorable situation during the clinical interview.
Experimental psychological methods for studying mental processes and states.Methods for studying sensations and perception. The study of tactile and pain sensitivity is usually carried out using the clinical Frey method using a set of specially selected graduated hairs and bristles attached at right angles to the handle. Skin discrimination sensitivity is determined using a Weber compass.
To determine general pain sensitivity, the sensography technique of A.K. is most often used. Sangailo. When studying disorders of the functions of the organs of vision and hearing, questioning and observation of the patient, as well as special techniques are important: projection perimeter, tables by E.B. Rabkina, adaptometer, audiometers.
Particularly difficult in clinical practice is the diagnosis and differential diagnosis of psychogenic disorders of the functions of the sense organs, especially vision and hearing. This requires a comprehensive study of the patient’s sensory sphere. It is partially carried out by neurologists, ophthalmologists, and otiatrists. More complex programs for studying the characteristics of sensory processes are carried out by psychologists using psychological and pathopsychological techniques (noise tests, comparative assessment of paired stimuli, tests with included images, tachistoscopic method).
Memory research methods. The most frequently used method for assessing mnestic disorders is the method of memorizing ten words. It is aimed at studying the ability to direct short-term or long-term, voluntary and involuntary memorization. To study mediated memorization, the techniques proposed by L.S. are used. Vygotsky, A.N. Leontyev and A.R. Luria. These techniques are based on the combined presentation to the subject of a stimulus series of words and auxiliary visual material, one way or another connected in meaning with verbal material. For the same purpose, the pictogram method is used.
When studying immediate memory disorders, tests for memorizing artificial sound combinations and numbers can be used. By changing the method of presentation (written on cards or spoken out loud), you can study the characteristics of different types of memory.
Methods for studying attention. When identifying individual properties of attention - volume, switchability, stability, concentration and selectivity, the following techniques are used:
- Schulte tables and tachistoscopic method (attention span);
- red-black Schulte-Gorbov table (switchability of attention);
- proofreading test, Burdon-Anfimov tables (sustainability of attention);
- Thorndike technique (concentration);
- Münsterberg technique (selectivity of attention).
Using each of these techniques, broader characteristics of attention can be obtained. Thus, the tachistoscopic technique reveals not only the volume, but also the stability and switchability of attention. Thus, it is more correct to talk about the primary focus of one or another technique on certain properties of attention.
The Kraepelin counting technique is used mainly to study fatigue.
Methods for studying thinking and intelligence. To study intelligence, a number of standardized methods are used - Binet-Simon, Wexler, Raven, etc. Thanks to testing on a large number of subjects, standardized methods make it possible to subject the results not only to qualitative, but also to quantitative analysis, based on a statistically based idea of how these tasks are performed normally .
There are a large number of experimental psychological methods for studying thinking disorders. This is the so-called set of pathopsychological techniques: classification, exclusion of objects, exclusion of concepts, identification of essential features, Ebbinghaus technique, associative experiment, simple analogies, complex analogies, comparison of concepts, pictograms, Vygotsky-Sakharov technique.
An idea of the characteristics of thinking and intelligence can be obtained during a conversation with the patient. You need to pay attention to the pace and activity of mental operations. If the patient’s pace of thinking is accelerated, he is characterized by increased distractibility, superficiality of associations, and easy switching. In the case of slow thinking processes, switchability is impaired, associations arise with difficulty, and the patient slowly moves from one judgment to another. From the conversation, the pathology of thinking is also revealed: obsessive, delusional ideas, fragmented thinking, reasoning.
Methods for studying emotions. A special role in the study of emotional disorders belongs to the anamnestic method (the emotional sphere is studied during the patient’s life) and clinical observation of his behavior. One of the most significant in assessing emotional disorders is the Luscher color choice test.
To assess affective disorders, self-esteem scale questionnaires are used: determining the severity of anxiety (scale
Spielberger, Sheehan), depression (Beck, Hamilton). The subject independently assesses the level of his own emotionality, and then the results are compared with clinical indicators. More often, these techniques are used to assess the effectiveness of therapy.
To study the emotional sphere, psychological methods such as semantic differential, B.V.’s technique are also used. Zeigarnik (phenomenon of unfinished actions), method of conjugate motor actions A.R. Luria (assessment of emotional-motor stability), method by K.K. Platonov (emotional-sensory stability). Information about the state of the emotional sphere of the subject can also be obtained using projective methods of personality research (TAT, Rorschach test, etc.), questionnaires and scales (MMPI, Wesman-Rix, etc.).
Methods for studying individual psychological characteristics of personality. Conventionally, personality research methods are divided into two main groups: clinical and laboratory. The former are based on conversation and observation of the patient’s behavior. The second involves the use of psychological tools. Personality research methods traditionally used in psychology are the unfinished sentence test, the Rosenzweig frustration test, TAT, projective drawings, MMPI personality questionnaire of the Bekhterev Institute (LOBI).
LOBIs have a certain significance in express diagnostics and in mass studies. But these methods by themselves are not sufficient for studying individual cases where a deep characterization of the individual is needed.
Assessing the effectiveness of psychocorrectional and psychotherapeutic interventions. The problem of assessing the effectiveness of psychocorrectional and psychotherapeutic interventions is an important methodological problem in clinical psychology. B.D. Karvasarsky proposed a clinical scale (M.M. Kabanov, V.M. Smirnov,
A.E. Lichko, 1983), which includes the following four criteria:
- 1) degree of symptomatic improvement;
- 2) the degree of awareness of the psychological mechanism of the disease;
- 3) the degree of change in the disturbed relationships of the individual;
- 4) degree of improvement in social functioning.
Along with this scale, indicators of the dynamics of the mental state of patients according to various psychological tests are used (MMPI, Luscher's color selection method, etc.).