Keywords: the abstract on psychiatry, distresses of the person, a psychopathy, personal anomalies, the psychopath, an etiology of psychopathies, classification of distresses of the person
DISTRESSES OF THE PERSON (PSYCHOPATHY)
Each of us has character - a unique, unique panel of individual personal fig. At the majority of us it is not pathological. To regard somebody as the person having pathological character or personal infringement it is possible only in that case when its models of behaviour so nonflexible, that interfere with high-grade psychologic development or acclimatization.
An assessment and descriptions of pathological persons contain in the sources belonging to ancient cultures. For example, Hyppocrates excreted 4 classical temperaments dependent on predominance of certain fluid in an organism (choleric persons, sanguine persons, phlegmatic persons, melancholiacs). In psychiatry the various theories concerning persons with distresses of the person from the beginning of XIX blepharon have started to appear, and the scientific substantiation has developed only to 30-50 of XX century.
In Phillip Pinelja's works (1809) irregular behaviour without attributes of a psychosis is defined as " a mania without delirium ". Prichard (1835) described some pathological changes of character under the name " moral insanity ", and Eskirol (1838) surveyed them as " an instinctive monomania ", and Trela (1853) - as ljutsidnoe insanity. In the same season the domestic psychiatrist of F.I. Gertsog (1846) has informed about persons with strangenesses of character, irascibility, irritability, uncontrollability of appetences.
Researches of anomalies of the person have extended in second half XIX century due to works Morelja (1875), Grizingera (1866), Modsli (1868), Kraft - Ebinga (1890). These given away figures have described series the patient with " strange characters ", with unusual phylums of intellection.
In 1900 Kokh has entered the term of "psychopathy". However the psychopathy as the diagnosis for the first time was put by Victor Hrisanfovich Kandinsky by treating action of proceeding about murder which has been accomplished by the person without the expressed mental changes. V.H.Kandinsky's views on a psychopathy were sustained by such large psychiatrists and neurologists, as Sergey Sergeevich Korsakov and Ivan Mihajlovich Balinsky. A basis of psychopathies of V.H.Kandinsky counted the irregular organization of nervous system adducting in inconstancy, variability, jar of all sincere life. It connected originating of psychopathies to an ancestral burdeness or with influence of choronomic harmfulnesses on a central nervous system in the early postnatal season.
In the monography published in 1886 of Vladimir Mihajlovicha Behtereva devoted to psychopathies, they were defined as morbid conditions of psychics with a lability of emotions, an impulsiveness and failure of moral sense. In a basis of psychopathies, in opinion of the author, changes in frame of a brain lay.
In domestic psychiatry development of the doctrine about psychopathies - first of all with Peter Borisovicha Gannushkina's researches and representatives of its school. P.B.Gannushkin spoke, that psychopathies " define all mental appearance of an individual, imposing on all its sincere depot the imperous impress ", " during life... Are not exposed to a little sharp changes ", " prevent... To adapt to environment ". Thus, P.B.Gannushkin for the first time has described diagnostic criteria of psychopathies:
From the beginning of 70th years definition of "psychopathy" in the psychiatric literature is gradually changed with concept of " distress of the person ". This term reflects nature of infringements available at patients more precisely and is deprived socially negative sounding which was peculiar to representations about psychopathies since time of their abjection in separate bunch of alienations.
The modern psychiatry defines following as distresses of the person. Distresses of the person - the morbid conditions described by inharmoniousness of a mental depot and representing constant, more often congenital property of an individual, retained during all life.
Personal deviations can change, i.e. strengthen or, on the contrary, become at the certain age (more often on the average) with less manifestative. As against neurotic infringements, distresses of the person are individual comprehensible and not accepted as alien, demanding the psychiatric help. Distresses of the person are ascertained when pathological changes are expressed so considerably, that interfere with high-grade acclimatization in a society, i.e. in their diagnostics social criteria matter.
On some data up to 40 % of the population have the certain characterologic deflections well compensated and adducting in pathological behavior disorders only in certain situations. These are so-called accentuations of character.
With the purpose of differentiation of personal distresses with extreme variants of norm K. Leonhard has entered concept of " the accentuate person ". Recognizing that character as rod property of the person, is shaped to teenage age. Andrey Evgenjevich Lichko has frameed the concept of accentuations of character at teenagers and has described their various phylums applied and to pathological distresses of the person.
As against psychopathies, at accentuations of character can not be any of attributes of psychopathies: neither relative stability of character during life, nor totality of its exhibitings in all situations, a social disadaptation as consequences of gravity of anomaly of character. Anyway, never it happens conformity to all these three attributes of a psychopathy at once. At psychopathies of a decompensation, acute affective and psychopathic reactions, a social disadaptation arise from any mental traumas, in the diversified difficult situations, from every possible causings and even for no apparent reason. At accentuations of infringement arise only at the mental traumas determined a sort, in some difficult situations, namely only then when they are addressed to " a place of the least resistance ", to " a weak part " given type of character. At each phylum of an accentuation there are inherent to it, distinct from other phylums, " weak places ".
Usually accentuations educe in the season of a becoming of character and smooth out with the years. Features of character at accentuations can show not constantly, and only in some situations, in the certain situation, and to not be found out almost in usual conditions. The social disadaptation at accentuations or at all is absent, or it happens short.
On the establishment told the following of an accentuation of character is possible to define. Accentuations of character are extreme variants of norm at which separate character traits are excessively forced owing to what selective vulnerability in the attitude of the certain sort of psychogenic influences is found out at good and even the raised fastness to anothers …
It is proved, that in formation of distresses of the person play genetical factors. Also the role of an organic cerebral dysfunction is great, is especial in formation emotionally unstable and epileptoidnogo phylums. Distresses of the person can form also under influence of unfavorable situational influences or irregular education.
Biochemical factors take part in an etiopathogenesis of distresses of the person. Rising a level of some sexual Hormonums is found out in patients with a high level of an impulsiveness (Testosteron-Depotum, 17-Oestradiolum, Estronum). The reduced level of separate metabolites of a serotonin is found in them also. The high level of a monoaminoxidase correlates with the general downstroke of social activity of patients.
The big stuff on nosotropic mechanisms of personal distresses is received in a course of psychoanalytical research of patients. Freud described distresses of character as unfavorable sotsializatsiju instinctive drives owing to the broken attitudes with parents. Distresses find various clinical frame in dependence on the season of development of the patient in which they were generated. The main role is played here with mechanisms of psychologic protection with which help the individual tries to overcome the conflicts arising between key parameters of mental life - own impressions, needs and a reality. At patients with distresses of the person prevail dezadaptivnye protective mechanisms which reduce efficacyy prisposobljaemogo behaviour. But at the same time, these protective receptions allow patients to supervise morbid reactions to the conflict and result in homeostatic decisions of problems. The principal cause of their fastness also consists in it.
Development of clinical classification of distresses of the person meets serious obstacles. They are caused first of all by variety of variants of abnormal persons and existence of numerous transitive phylums, studying and which ordering is very complex. Difficulties in differentiation of personal anomalies depend, figuratively speaking, " in the greater measure from the person of the psychiatrist, rather than from the person of the patient ". One pole of a psychopathy adjoin to endogenic psychosises, and anothers - to the broad audience of psychogenias. Such position quite often conducts to mixture of various principles (clinical, psychologic and social) at building a systematics of psychopathic states.
Some classifications of distresses of the person received the greatest popularity and retaining clinical value till now below are resulted.
Classification E. Kraepelin (1915) will consist of 7 bunches:
In this classification one bunches joint by a kliniko-descriptive principle, and others - by social - psychologic or only social criteria.
In systematics K. Schneider (1928) 10 phylums of psychopathic persons are excreted. This classification is constructed by a descriptive - psychologic principle.
As opposed to the resulted typologies in classification E. Kretschmer (1930) all personal anomalies joint in two bunches: schizoids and tsikloidov. Such dichotomizing division reflected essentially other positions of the author in classification of psychopathies. A starting point of this classification constructed by a principle " locomotions from illness to health ", was offered E. Kraepelin separation of endogenic psychosises into two polar bunches (a schizophrenia and a maniacal - depressive psychosis). The essence received wide popularity psihobiologicheskoj theories E. Kretschmer consist in the following. There are biological correlations between endogenic psychosises and the corporal constitution. Among patients with a schizophrenia persons leptosomnoj, the asthenic, athletic and dysplastic constitution prevail. At diseases of a circular circle the pyknic constitution prevails. In opinion E. Kretschmer, similar allocation of somatic constitutional phylums is observed and in two bunches of pathological temperaments (psychopathies) of schizoids and tsikloidov. Schizoids and cycloids, on E. Kretschmer, are the persons "shaking" between illness and health.
Cycloids - simple natures with immediate, natural and unfeigned sense. They are sociable, affable, good-natured, cheerful, during too time can be quiet, sad, mild. At schizoids, on E. Kretschmer, distinguish " the choronomic party " and "depth". Venomous severity or blunt gloom, caustic irony, fearfulness, silent isolation - is those the choronomic party of the schizoid. Whatever became with the maintenance of their representations is to anybody it is inaccessible, all this only for them one.
For an explanation excreted within the framework of two basic constitutional phylums (schizoids and cycloids) various variants of pathological characters E. Kretschmer has put forward the concept of proportions, i.e. combinations ("interference") inside each constitutional circle of polar properties of the conforming temperament. The cyclotymic circle is defined so-called diateticheskaja with a proportion, i.e. various interrelations between raised - cheerful and depressive - a sad affect. To schizoids the proportion, i.e. various interrelations between a hyperesthesia (sensitivity) and an anaesthesia (coldness) is peculiar psihesteticheskaja. Thus, in limens of each of the basic constitutional bunches there is a differentiation of pathological characters in dependence on, whether more the cyclotymic temperament comes nearer to a cheerful or sad pole, and shizotimichesky - to a sensitive or cold pole.
However concept E. Kretschmer based on primacy constitutional in a genesis of endogenic psychosises and anomalies of the person, had series of essential defects. The basic from them was ignoring qualitative differences, and consequently, and denying of a basic opportunity of clinical differentiation between human character as variant of the norm, the expressed anomaly of the person (psychopathy) and morbid distresses with tendencies to progredientnosti.
Nevertheless, despite of inconsistency in series of questions of principle, works E. Kretschmer became the important stage in development of the doctrine about psychopathies. In particular, it for the first time has raised the question about a clinical heterogeneity stable psychopathic, including schizoid, states. To them E. Kretschmer carried alongside with constitutional psychopathies also the nonperishable not progreduated psychopathic states generated after erased attacks of illness (" a psychologic product of already completed flash "). From point of view E. Kretschmer, such postpsychotic persons differ from constitutional schizoids sharper psychopathic features.
Popularity psihobiologicheskoj concepts and systematics of psychopathies E. Kretschmer was short-lived, that the hysterical phylum of a psychopathy speaks first of all uncertainty of kliniko-typological differentiations, besides, for example, has remained outside of its systematics.
In domestic psychiatry, since 30th years, the greatest recognition was received P.B.Gannushkina's with classification (1933). P.B.Gannushkin has secured the following phylums of psychopathic persons:
In this classification the kliniko-descriptive criterion earlier laying in a basis of classifications E. Kraepelin and K. Schneider only is partly used. Alongside with phylums of psychopathies, discharged on the establishment of clinical and psychologic features (unstable, asthenic, etc.), in P.B.Gannushkina's classification there is a bunch of so-called constitutional predispositions, or constitutional psychopathies (schizoids, cycloids, epileptoids, etc.), conforming to the certain psychosises. In comparison with systematics E. Kretschmer P.B.Gannushkina's classification is typologically considerably more differentiated. Besides psychopathic phylums here have got the big clinical definiteness.
The general in the concept of constitutional psychopathic phylums E. Kretschmer and P.B.Gannushkina is tendency to generate a typology of psychopathies according to similar on psychopathologic frame, but is sharper the outlined morbid states meeting at endogenic psychosises.
At a generality of approaches to a typology of psychopathies P.B.Gannushkina's views and E. Kretschmer on kliniko-nosotropic value discharged constitutional phylums essentially differ with them. If E. Kretschmer surveys a schizoid psychopathy as one of the initial stages of a psychosis on P.B.Gannushkinu intensifying of schizoid features can "develop" up to a state which are taking place already on a boundary between mental health and illness. At the same time such abnormal depot of the person arising not owing to choronomic (morbid, psychogenic, etc.) influences, and under influence of other (a heredity, the constitution, etc.) the causes, can serve as bedrock for development of mental disease. However such mental constitution does not predetermine originating a psychosis. Moreover, in some cases endogenic diseases demonstrate at persons without the conforming predisposition.
At differentiation of distresses of the person as criterion the mean of their formation is used also. Such approach educed O.V.Kerbikovym and its school. Within the framework of this direction of researches two bunches of psychopathies are excreted: constitutional ("nuclear") and got.
To "nuclear" psychopathies carry congenital (including genetical caused) or generated as a result of unfavorable influences in the intra-uterine season of anomaly of the person.
The bunch of the got (reactive) psychopathies unites the pathology of character formed in the childhood. In a genesis of personal anomalies in these cases the big place unfavorable social - psychologic factors (borrow bad conditions of life in the childhood, sirotstvo, absence of maternal caress or, on the contrary, hypertrusteeship, asotsialnye installations of a microsocial environment, a narcomania, an alcoholism of parents) to which do not resist korrigirujushchie educational influences.
On a measure of final formation patoharakterologicheskoj frames of difference between clinical exhibitings of nuclear and regional psychopathies are gradually levelled. Nevertheless the mean of formation of distresses of the person is expedient for taking into account at a choice of treatment-and-prophylactic and educational actions, and also at an establishment of the forecast.
According to psychoanalytical theory Z. Freud, O. Fenichel and A. Adler, individual patoharakterologicheskie properties are connected to bracing on one of stages psihoseksualnogo ontogenetic development: oral, anal or fallicheskoj.
Prototipicheskimi models of oral character are complete dependence on mother and the pleasure connected to meal. The sense of dependence is kept on all life, despite of development "?", and leaves on the foreground when the person feels alarm and danger. This character unites persons dependent, passive acknowledgement of the significance expecting from the outside. Anal character wears the features connected to early conflicts, arising during formation at the child of skills of cleanliness and unites persons economical, irritable, obstinate and quite often severe. Fallichesky character, assotsiiruemyj with functioning genitalias, unites people ambitious, vain, resolute, self-confident, inclined to a lead and contest.
Among nejrofiziologicheskih the concepts which have served by a basis of a systematics of distresses of the person, first of all it is necessary to specify I.P.Pavlova's doctrine about the maximum nervous activity. Carrying out correlations between phylums of the maximum nervous activity and features of a mental depot of the person, I.P.Paul surveyed psychopathies as extreme variations of normal phylums of the maximum nervous activity. However they differ the least fastness and a fitness, fragility and a fragility. By this principle excrete erethitic and brake bunches of psychopathies.
Erethitic, i.e. quick-tempered, irritable, explosive, persons concern to representatives of extreme variants of impetuous type. Various variants tormozimyh psychopathies (asthenic, psychasthenic, schizoid) concern to weak phylums of the maximum nervous activity with failure of processes as exaltations, and inhibitions and predilection to predominance of an external inhibition.
Precise otgranichenie separate variants of abnormal persons always carries in itself an element of reserve. In limens of each variant transitive or regional forms are observed. On data W. Brautigam (1969), 66,2 % of psychopathic persons cannot be attributed to one "pure" phylum.
Clinical phylums of psychopathies traditionally excreted in domestic psychiatry - schizoid, psychasthenic, asthenic, affective, paranoic, hysterical, erethitic (epileptoidnyj), unstable, bunch of emotionally blunt persons are appreciably comparable to variants of distresses of the person, submitted in ÌÊÁ-10.
Keywords: the abstract on psychiatry, distresses of the person, a psychopathy, personal anomalies, the psychopath, an etiology of psychopathies, classification of distresses of the person