The data obtained during research within this discipline are of great theoretical and practical importance. Let us consider further the basics of pathopsychology.

general characteristics

In the modern scientific environment, there is some confusion of different concepts, incorrect use of certain terms. In this regard, it is natural to separate pathopsychology and psychopathology. The latter is considered a branch of medical science. It focuses on the study of diseases of the mental system. Within the framework of this discipline, various kinds of violations and their mechanisms are studied. Pathopsychology is based on the regularities of the structure and development of the psyche in the norm. It explores and compares the decay of personality traits with the normal course of processes. Thus, both of these sciences have similar objects of study, but different subjects.

Tasks

Pathopsychology is a science aimed at obtaining additional information about the patient's condition. In particular, his cognitive activity, emotional-volitional sphere, and personality as a whole are subject to research. This information is essential for making a diagnosis. Experimental methods of pathopsychology make it possible to identify many signs of disorders, to establish their structure and connection with each other.

Another important task that is solved within the framework of the discipline is to conduct research for examination (judicial, military, labor). In the process of such a procedure, a specialist can establish the structure of disorders and their relationship with the intact aspects of the activity of the psyche or conduct differential diagnostics. Such a study is associated with certain difficulties. They are primarily driven by the interest of the patient. In this regard, the patient may underestimate the manifestations of violations, intensify them, or even simulate them in order to avoid responsibility or to obtain disability. Another problem that pathopsychology solves is the study of changes under the influence of therapy. In such cases, the same type of sets of techniques are used. With repeated research with their help, the dynamics of the state is established, the effectiveness of treatment is determined.

Additional functions

In recent years, experimental pathopsychology has been used to solve two additional problems. The first is related to rehabilitation measures. During their conduct, specialists pay great attention to the discovery of the intact aspects of the personality and psyche of the patient. In addition, the patient's social environment, the nature of relationships with other people, educational and work attitudes are studied. The task of such a study is to develop recommendations that would contribute to faster rehabilitation. The second independent function of specialists is their participation in psychotherapeutic activities. Here, however, it is worth noting that the question of the participation of a doctor in them is not sufficiently regulated at the legislative level.

Development of science

As an independent branch, pathopsychology began to take shape at the beginning of the 20th century. The most clear ideas about the subject of science are reflected in the works of Bekhterev. In his opinion, pathopsychology is the process of studying abnormal manifestations at the initial stages of the formation of the system. Various courses were taught at the institute organized by Bekhterev. At the same time, a clear line was immediately drawn separating pathopsychology and psychopathology.

Domestic figures

From the very beginning, the development of the industry was based on strong natural science traditions. The formation of principles and techniques was carried out under the influence of Sechenov's works. He attached particular importance to the connection between psychology and psychiatry. Bekhterev became Sechenov's successor on this path. He is considered the founder of the pathopsychological branch in psychological science. Representatives of his school developed many mental patients. They are still widely used in the discipline today. The main principles of the study were formulated:

Child pathopsychology

Before the works of Zeigarnik appeared in science, there was an opinion that with a number of neurotic diseases, the patient's behavior begins to move to a lower level, which reflects a certain stage of the child's development. Based on this concept, many scientists have tried to identify a correspondence between the process of personality decay and a specific stage of childhood. For example, Kretschmer brought the thinking of a schizophrenic closer to adolescent development. In 1966, at the 8th International Congress, Azhuriaguerra (Swiss scientist) defended the opinion about the layered mental decay from higher to lower forms. These conclusions were based on a number of observations:

Luria, Zeigarnik, Rubinstein: pathopsychology and biological patterns

The data of these researchers concerned reading and writing in patients with vascular diseases, Alzheimer's disease, who had brain injuries. Based on the information received, a new point of view was justified. It consisted in the fact that the flow is under the influence of biological laws. They cannot repeat the principles and stages of development. Even when young, specific brain regions are affected by the disease, the patient's psyche does not acquire the structure of a child at an early stage of development. The fact that the patient is unable to reason and think at a high level indicates the loss of complex forms of cognition and behavior. But this does not mean that he returns to the childhood stage.

Myasishchev's theory

She also played an important role in the development of pathopsychology. In accordance with the theory, the human personality is presented as a system of relationships between a person and the outside world. Such interactions are characterized by a complex structure and find expression in mental activity. The disease brings changes and destroys the formed system of relations. These disorders, in turn, can provoke the disease. Through this kind of contradiction, Myasishchev studied psychoses.

Pathopsychology, like neuropsychology, can rightfully be considered a domestic branch of clinical psychology, at the origins of which were L. S. Vygotsky, B. V. Zeigarnik and S. Ya. Rubinshtein. Pathopsychology began its development in the 1930s, during the Great Patriotic War (1941-1945) and post-war years, when it was in demand, like neuropsychology, to restore mental functions in patients with military trauma. Pathopsychology, along with somatopsychology and neuropsychology, is an integral part of clinical psychology and therefore bears all the main features inherent in clinical psychology as a whole. Pathopsychology refers to the borderline branches of science that have arisen at the intersection of disciplines that are similar in object and research issues. If clinical psychology is an area bordering between psychology and medicine in general, then pathopsychology is most closely bordered by a special section of clinical science and practice - psychiatry. It can be said that pathopsychology- this is a special section of clinical psychology, in particular, studying the nature of the course and structural features of mental processes leading to disorders observed in the clinic

Psychiatry- describes, investigates and systematizes MANIFESTATIONS of disturbed mental functions, i.e. explores the disturbed phenomenon

Object of study- mental disorders

Subject of study- regularities of the decay of mental activity and personality traits in comparison with the regularities of the formation and course of mental processes in the norm

Tasks- psychodiagnostics in order to clarify the medical diagnosis and justify treatment, in particular psychotherapy and occupational therapy

Thus, psychopathology studies the causes, manifestations, course, treatment and prevention of various mental disorders.

2) tasks of pathopsychology

Pathopsychology is aimed at providing specific practical assistance to clinicians dealing with mental disorders in a variety of mental disorders.

The main tasks of pathopsychological research include the following six:

Obtaining data for diagnostics.
Study of the dynamics of mental disorders in connection with the ongoing therapy.
Participation in expert work.
Participation in rehabilitation work.
Participation in psychotherapy.
A study of understudied mental illnesses.

Obtaining additional data on the mental state of the patient(about the features of his cognitive activity, emotional-volitional sphere and personality as a whole) is one of the most important tasks of practical pathopsychology

Study of the dynamics of mental disorders in connection with the therapy is also an important task implemented by the pathopsychologist in the clinic.

Another important task of the pathopsychologist is participation in expert work. Pathopsychological studies play an important role in the conduct of forensic psychiatric, military and labor examinations. At the same time, the psychologist not only provides data that facilitates the solution of diagnostic issues, but also objectively establishes the severity of the mental defect.

Participation in rehabilitation work is currently of particular importance. Modern psychiatry pays much attention to the problems of rehabilitation and resocialization of patients. The provision of medical care to mentally ill people involves not only active and supportive therapy, but also the implementation of measures to restore their social status. The prevention of disability also depends on properly constructed rehabilitation measures.

Participation in psychocorrection, as well as carrying out rehabilitation measures, should be carried out by a psychologist under the guidance and at the request of a psychiatrist. Recently, there has been a trend of active inclusion of psychologists in the conduct of psychotherapy.

Less often, the pathopsychologist has to solve the problem research on understudied mental illnesses. As a rule, such studies are carried out in clinics operating on the basis of research institutes. The purpose of such scientific research is to analyze the still insufficiently studied psychopathological manifestations of certain mental illnesses. At the same time, a study of large groups of patients with similar psychopathological symptoms is carried out. Here, the statistical reliability of the data obtained acquires a special role. Moreover, the solution of this problem differs significantly from pathopsychological research aimed at solving issues of a clinical and practical nature.

3) methods and techniques of pathopsychology

In assessing the mental state, conversation and observation still occupy the main place, while the somatic state of the patient is studied by a variety of modern laboratory and experimental methods. Meanwhile, when analyzing the pathology of the psyche, the methods of questioning and observation must necessarily be supplemented by experiment, since it is the experimental method that allows one to move from describing the phenomenon to analyzing the causes and mechanisms of symptom formation.

Pathopsychology, being a branch of psychology, uses the entire arsenal of psychological methods, and among them the experiment occupies a leading place. Due to the specifics of the subject and the practical problems it solves, we can say that pathopsychology is an experimental science.

4) violations of sensations and perception in psychiatry and pathopsychology

In pathopsychology, the emphasis is not on describing symptoms and syndromes, but on revealing their psychological mechanisms and patterns of formation.

DISTURBANCE OF PERCEPTION

agnosia- violation of the semantic side of perception, that is, the patient can describe the object, but cannot name it, cannot say why it is needed

pseudoagnosia in dementia- violation of not only semantic but also structural components. Patients snatch out individual parts of the image and cannot catch this image as a whole.

deception of the senses- hallucinations, cases of difficult concentration on the source, increased orienting activity of the analyzers, contribute to the occurrence of hallucinations. The main role in the occurrence of hallucinations is played by a change in the activity of external and internal analyzers, the presence of subthreshold (unconscious) stimuli that cause an overload of these analyzers.

motivational component- (the motivation of perception is not set; the study of the imagination; the study of mental capabilities)

healthy- interest in tasks varied depending on the "motive of expertise"

schizophrenia- no interest in the task, no motive for expertise, only own motive for perception

epilepsy- too much interest in the task

A change in the motivational component leads to a change in perceptual activity; accordingly, some perception disorders are a manifestation of a violation of the motivational sphere

MEMORY DISTURBANCES

-impaired direct memory

Violation of remembering images

Korsakov's syndrome is a violation of immediate memory for current events. violation of the reproduction of events, and not the imprinting of traces. Missing memories can be replaced by fictional events (confabulations)
progressive amnesia - impaired memory for current events and events from the past. The disturbance spreads gradually, the earliest memories being the last to be cut. Patients confuse the past and the present, lose their orientation in time and space. Repeated repetition of the material does not improve its memorization, the total amount of memorization is reduced.

- mediated memory impairment

violation of remembering the image with the help of any symbols denoting this image (mediated image)

Pictograms of Luria

Patients cannot establish a conditional connection adequate to the content of the task
Epileptics could not independently choose one of the many options.
Schizophrenics make overly formal connections, such as sound
May be too detailed

Due to such disturbances in thinking, patients remember material worse if they resort to mediation, unlike healthy people.
In case of violation of mediated memory, the playback process does not go as indicated in the scheme of A.N. Leontiev A-X-A, it can be A-X-X or even A-X-Y

Depending on the disease and the structure of the impairment of activity specific to each disease, there is a specific impairment of mediated memory (that is, it is impaired differently in different patients)

- violation of the dynamics of mnestic activity

Violation of the efficiency of memorization and reproduction depending on time (today is good, tomorrow is bad), usually associated with similar disorders in all forms of their activity, their cognitive and affective-emotional sphere.

Accordingly, a violation of the dynamics of memory is an indicator of the instability of mental performance in general.

Violations of the dynamics of mnestic activity can also be associated with affective-emotional instability or effective capture of patients. Affective disorganization of patients, often found in organic brain diseases of various origins, can manifest itself in forgetfulness, inaccuracy in assimilation, processing and reproduction of material. Effective capture of patients, excessive focus on the mandatory success of activities can also lead to forgetting intentions, undifferentiated perception and retention of material.

- violation of the motivational component of memory

In patients with a disturbed motivational sphere, memorization and reproduction is at a lower level than in healthy people, which is explained by the lack of desire for proper memorization and reproduction.

DISTURBANCE OF THOUGHT

Violation of thinking - a violation of the components included in its structure

1) operational side of thinking

the decrease in the level of generalization lies in the fact that direct ideas about objects and phenomena dominate in the judgments of patients. Operating with general features is replaced by the establishment of purely specific relationships between objects. That is, objects are combined on the basis of secondary and particular features. The book and the sofa will be combined because the book is convenient to read on the sofa, and the ball and tomato because they are red. In particularly severe cases, patients may lack the ability to classify objects. A narrow circle of connections, few associations.
the distortion of the level of generalization consists in reflecting only the random aspects of phenomena, while the essential relationships between objects are little taken into account, the subject content of things and phenomena is often not taken into account. For example, when performing a task on the classification of objects, patients are guided by excessively general features that are inadequate to the real relationships between objects. So, the patient combines a fork, a table and a shovel into one group according to the principle of "hardness". There are a lot of associations, but they are incorrect and reflect only excessively general connections.

2) the dynamics of thinking

The lability of thinking is characterized by the instability of the way the task is performed, that is, by the alternation of adequate and inadequate solutions. The level of generalization of patients generally may not suffer, patients are able to correctly generalize the material, they do not violate the operations of comparison, transfer. However, the adequate character of judgments can be unstable.
inertia of thought. In these cases, there is a pronounced difficulty in switching from one mode of work to another. Patients cannot change the course of their judgments, switch from one type of activity to another. Patients with such a disorder hardly change their behavior model, algorithm of actions, the way of solving when changing activities, changing the task.

3) personal component of thinking

Violation of the motivational component, thinking is tied to motives and needs that are different in patients from those accepted in society. When classifying objects, healthy people rely both on personally significant meanings based on personal experience and feelings, and on socially accepted ones, based on a developed body of knowledge about the subject.

diversity. Patients with such a violation in the process of performing one task rely either on adequate knowledge about the subjects, or on personal experiences associated with these subjects. The judgments of such patients about some phenomenon proceed in different planes.
reasoning. fruitless sophistication, unproductive long-winded reasoning. the reasoning reasoning of the patient is determined not so much by a violation of his intellectual operations, but by increased affectivity, inadequate attitude, the desire to bring any, even an insignificant phenomenon, under some kind of concept. Reasoning is expressed in the patient's pretentious and evaluative position and a tendency to generalize more in relation to the small object of judgments. Affectivity is manifested in the very form of the statement: significant, with inappropriate pathos. The grammatical structure of speech reflects the emotional features of reasoning: the syntax is peculiar, the vocabulary of reasoning statements, inversions and introductory words are often used.

Diversity and reasoning are reflected in speech, which acquires the character of "disintegration". Its main characteristics:

in the rather lengthy utterances of the patients there is no reasoning;
in the speech of patients it is impossible to detect a specific object of thought;
patients are not interested in the attention of the interlocutor; they do not express in their speech any relation to other people.

Thus, the "torn" speech of patients is devoid of the main features characteristic of human speech. It is neither an instrument of thought nor a means of communication between people.

4) violation of critical thinking

Critical thinking in this case is the deliberateness of actions, their verification and correction in accordance with objective conditions.

Patients show critical thinking in different ways, some are ready to correct mistakes on their own, others do it only under external pressure, and still others stubbornly defend their point of view. Worst of all, errors related to the diversity of judgments lend themselves to correction, i.e. with a violation of the motivational component of thinking

PERSONALITY DISTURBANCES

1) violation of the structure of the hierarchy of motives

The most obvious examples are dependency generation.
Motives become less mediated, correspondingly less controllable. Gradually, the leading motive - the satisfaction of a need (dependence) subjugates the entire personality of a person.

This is the transformation of a social need into a pathological attraction that subjugates all human activity.

2) the formation of pathological needs and motives

Initially, an adequate motive as a result of some events (trauma, stress, illness, lifestyle change) becomes dominant in a person’s life. The hierarchy of motives changes, the actions necessary to satisfy the need themselves become a motive, and all human activity begins to be built around the satisfaction of this need, this need becomes pathological.

3) violation of meaning formation

the weakening of the meaning-forming function of the motive, the motive becomes simply known. "paradoxical stabilization of some circle of semantic formations" (Kochenov)
the narrowing of the circle of semantic formations, that is, the motive, while retaining the motivating force, began to direct it to a smaller number of phenomena than before the disease. As a result, the motivating force of the motive decreased

Such patients are not included in the general system of interrelations of people. Therefore, one of the most important measures of psychocorrection is the inclusion of patients in labor activity.

4) Violation of self-regulation and mediation

Mediation occurs at the level of operations

A sign is a means of mastering behavior, mastering behavior is an indirect process

By mediating his behavior, a person gets the opportunity to develop new ways of acting, activity, new motives. Human behavior becomes more arbitrary and conscious

In patients with organic diseases of the brain, the inability to operate with a sign is part of a wider pathology - a violation of mediation, regulation of one's actions

Mediated behavior is a "path" to the goals that a person sets for himself, while realizing not only his actions, but also the motives behind them. The ability to make knowledge and experiences about the situation and their capabilities in it the object of their consciousness. The process of meaning formation is possible only in the presence of mediation.

Self-regulation is awareness of the situation, setting goals.

In patients, due to impaired mechanisms of mediation and self-regulation, the process of meaning formation is disrupted, despite the understanding of the need to perform some actions, the motivating force of the motive may not be enough for them to begin to perform these actions.

5) Violation of criticality and spontaneity of behavior

In case of violation of the critical controlled attitude towards oneself and the environment, it becomes impossible to realize the kaleidoscope of impressions of the surrounding patient, the ability to resist these impressions is lost. The actions of patients cease to be dictated by internal motives and needs. A person begins to act on the basis of the situation around him, without relying on motivation, a new object that appears in the field of attention can easily force the patient to change activities. This phenomenon is called aspontaneity. The loss of the ability to evaluate oneself and others leads to the loss of motives, goals, awareness of actions and judgments. Such patients have anosognosia not only in relation to the disease, but also in relation to their behavior.

6) Violation of the formation of characterological features of the personality

The character of a person, both healthy and sick, is formed in vivo depending on the conditions, the disease creates conditions leading to anomalies of motives.

PATHOPSYCHOLOGICAL SYNDROMES

In pathopsychology, as in psychiatry, a syndrome is understood as a pathogenetically determined community of symptoms, signs of mental disorders, internally interdependent, interconnected. This is the greater diagnostic significance of syndromes compared with symptoms. In the diagnostic thinking of a doctor, the correct qualification of the syndrome is an approach to determining the nosological affiliation of the disease. Each of the pathopsychological syndromes includes a number of symptoms. The totality of symptoms is a symptom complex (syndrome). A syndrome (symptom complex) is a stable combination of interrelated positive and negative symptoms due to a common pathogenesis.

Symptoms and syndromes are the material from which the clinical picture of the disease is created. Syndromes and their dynamics manifest the pathogenesis of the disease, the sequence of its stages. When recognizing a mental illness (nosological form), one should focus not only on the currently dominant psychopathological syndrome in the patient’s condition, but mainly on the entire context of the disease: how this syndrome is related to other symptoms and syndromes, what is their dynamics, how it affected the safety of the patient's personality, that is, what are the depth and dimensions of the lesion, the degree of involvement of the mental sphere in the painful process.

According to the peculiarities of origin, all psychopathological symptoms with a certain degree of conventionality can be divided into positive and negative. Positive symptoms (productive, plus symptoms) arise in connection with the pathological production of the psyche. This includes hallucinations, delusions, obsessions, overvalued ideas and other pathological formations. Negative symptoms (deficient, minus symptoms) are a sign of persistent loss of mental functions, a consequence of gender, loss or underdevelopment of some links of mental activity. The manifestations of a mental defect are memory loss, dementia, dementia, a decrease in the level of personality, etc. It is generally accepted that positive symptoms are more dynamic than negative ones; it is changeable, capable of becoming more complex and, in principle, reversible. Deficiency phenomena are stable, they are highly resistant to therapeutic effects.

Isolation of positive and negative symptoms in the patient's condition corresponds to the clinical reality. Since the time of the neurologist J. Jackson, who proposed the concept of productive and deficient symptoms in the first half of the 19th century (within the framework of the theory of a single psychosis), many concepts have accumulated to clarify the term "deficit" in the mental sphere. Deficiency is not only an irreversible defect, loss of mental function, but also its inhibition, temporary shutdown. The clearer the destruction of the brain, the weaker the mental reaction, the more clearly the signs of deficiency appear, which are most pronounced in organic dementia.

Productive (positive) psychopathological syndromes are an indicator of the depth and generalization of damage to mental activity. Positive psychopathological syndromes include neurotic, affective, depersonalization-de-realization, confusion syndrome, hallucinatory-delusional syndromes, syndromes of movement disorders, clouding of consciousness, eyleptiform and psychoorganic.

As a result of the identification of pathopsychological syndromes, it becomes possible to assess the features of the structure and course of the mental processes themselves, leading to clinical manifestations - psychopathological syndromes. The pathopsychologist directs his research to the disclosure and analysis of certain components of brain activity, its links and factors, the loss of which is the cause of the formation of symptoms observed in the clinic.

The following pathopsychological register-syndromes are distinguished (I.A. Kudryavtsev):

schizophrenic
affective-endogenous
oligophrenic
exogenous organic
endogenous-organic
personality abnormal
psychogenic-psychotic
psychogenic-neurotic

The schizophrenic syndrome complex consists of such personality-motivational disorders as: a change in the structure and hierarchy of motives, a disorder of mental activity that violates the purposefulness of thinking and meaning formation (reasoning, slipping, diversity, pathological polysemanticism) while maintaining the operating side, emotional disorders (simplification, dissociation of emotional manifestations, sign paradoxicality), changes in self-esteem and self-awareness (autism, sensitivity, alienation and increased reflection).

The psychopathic (personality-abnormal) symptom complex includes: emotional-volitional disorders, violations of the structure and hierarchy of motives, inadequacy of self-esteem and the level of claims, impaired thinking in the form of "relative affective dementia", impaired prediction and reliance on past experience.
An organic (exo- and endogenous) symptom complex is characterized by such signs as: a general decrease in intelligence, the collapse of existing information and knowledge, mnestic disorders affecting both long-term and operative memory, impaired attention and mental performance, impaired operational side and purposefulness of thinking, changes in emotional spheres with affective lability, violation of critical abilities and self-control.
The oligophrenic symptom complex includes such manifestations as: inability to learn and form concepts, lack of intelligence, lack of general information and knowledge, primitive and concrete thinking, inability to abstract, increased suggestibility, emotional disorders.

REASONING

Reasoning is a type of thinking characterized by a tendency to empty, fruitless reasoning based on superficial, formal analogies. It manifests itself in philosophizing, verbosity and banality of judgments that are inadequate to the real situation. At the same time, the goal of the mental task is relegated to the background, and the patient’s desire for “reasoning” comes to the fore.

The psychological structure of resonant thinking was revealed by T. I. Tepenitsyna (1965, 1968, 1979). The author found that reasoning is not associated with any particular type of error in the implementation of mental operations proper. It is due to the peculiarities of the personal-motivational sphere of patients. This variant of the patient's personal position is defined as an excessive need for "self-expression" and "self-affirmation". This explains such typical features of resonant thinking as the exaggerated pretentious and evaluative position of the patient, the affective inadequacy of the choice of the subject of discussion, the latter’s inconsistency with the methods of evidence and reasoning, the tendency to “overgeneralize” on a trifling matter, insufficient self-criticism, a peculiar manner of speech (floridity, a tendency to meaningful intonations, the use in excess of concepts that are often completely inappropriate for the subject of discussion, verbosity)

Neuropsychology. Pathopsychology Conclusion List of used literature Introduction One of the leading and most intensively developing areas of modern psychology is clinical psychology, which is not only a fundamental science but also an area of professional activity of psychologists aimed at increasing a person’s mental resources and his adaptive capabilities, harmonizing mental development, protecting health, overcoming ailments and psychological rehabilitation. In our country, clinical...

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Introduction

One of the leading and most intensively developing areas of modern psychology is clinical psychology, which is not only a fundamental science, but also an area of professional activity of psychologists aimed at increasing the mental resources of a person and his adaptive capabilities, harmonizing mental development, protecting health, and overcoming ailments. and psychological rehabilitation.

The focus of clinical psychology is a person with mental “pains” and problems, with difficulties in adaptation and self-realization associated with his health conditions. A person not only forms his attitude to the disease, he can also positively or negatively influence the course of his illness and its outcome.

3. Freud, A. Adler, K. Jung, K. Horney, E. Fromm, V. Frankl, K. Rogers, A. Maslow and others worked in the field of clinical psychology.

Professors of Moscow University, laureates of the Lomonosov Prize, holders of many international awards A. R. Luria, B. V. Zeigarnik and others stood at the origins of domestic clinical psychology.

In our country, clinical psychology was formed as a result of the integration of a number of related disciplines, but with different histories and problems. First of all, these are such areas of psychology as neuropsychology and pathopsychology recognized by the entire world psychological community, as well as the psychology of corporeality (psychosomatics), the psychology of abnormal ontogenesis, psychological correction, and health psychology, which were formed somewhat later.

The purpose of this work: to study the basics of clinical psychology, to characterize the sections - neuropsychology, psychosomatics, pathopsychology.

1. The concept, tasks and structure of clinical psychology

Here are some definitions of the subject of clinical psychology.

The International Guide to Clinical Psychology, edited by M. Perret and W. Bauman, 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). 1

In our country, clinical psychology is considered as part of the medical. Clinical (medical) psychology is a science that studies the psychological characteristics of people suffering from various diseases, methods and techniques for diagnosing mental disorders, differentiating psychological phenomena and psychopathological symptoms and syndromes, the psychology of the relationship between a patient and a medical worker, psychoprophylactic, psychocorrective and psychotherapeutic methods of helping patients, and also theoretical aspects of psychosomatic and somatopsychic interactions. 2

As you can see, experts give different definitions of clinical psychology, but they all agree on one thing: clinical psychology considers the area that borders between medicine and psychology. This is a science that studies the problems of medicine in terms of applying the knowledge and methods of psychology.

A person in a situation of illness forms his attitude to this situation.

The object of research and influence in clinical psychology is a person with any disorder or disease, the subject is emotions and behavior in a state of illness and all forms of disease prevention.

In the 60s-70s. 20th century the specific goals of clinical psychology were formulated as follows (M.S. Lebedinsky, VN. Myasishchev, 1966, M.M. Kabanov, B.D. Karvasarsky, 1978):

1) the study of mental factors affecting the development of diseases, their prevention and treatment;

2) study of the influence of certain diseases on the psyche;

3) the study of mental manifestations of various diseases in their dynamics;

4) the study of developmental disorders of the psyche; study of 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 prophylactic purposes.

Thus, clinical psychology considers an important area of human life - the area of somatic and mental diseases, and specific manifestations of the human essence in this area. Clinical psychology allows you to see a holistic picture of a person as a subject of his disease, actively overcoming it.

The structure of clinical psychology covers the entire spectrum and complex of problems associated with the psychological aspects of maintaining healthy health, preventing disorders, treating and rehabilitating patients.

In connection with the level and scale of the problems, clinical psychology can be structured as follows: general clinical psychology, particular clinical psychology and special clinical psychology.

There are also specific sections that find practical application of knowledge in the relevant clinics: in a psychiatric clinic - pathopsychology; in neurological - neuropsychology; in the somatic - psychosomatics.

2. Neuropsychology. Psychosomatics. pathopsychology

2.1 Neuropsychology

Clinical neuropsychology, formed on the borders of psychology, neurology and neurosurgery, is a structural component of clinical psychology, the task of which is to study neuropsychological syndromes that occur when a particular part of the brain is damaged. 3

Neuropsychology - studies the brain mechanisms of mental activity based on the study of mental disorders in patients with local brain lesions (consequences of cerebral strokes, brain injuries and tumors, inflammatory diseases, cerebral circulation disorders), develops methods for diagnosing and restorative education of patients with brain lesions. Such patients are patients of neurosurgical and neurological clinics.

The object of study in it is the brain of a sick or injured person. According to B.V. Zeigarnik, the object of study of neuropsychology are diseases of the central nervous system (central nervous system), mainly local focal lesions of the brain. 4

The subject of neuropsychology research is the causal relationship between damage (tumor, hemorrhage, trauma - their localization, volume) and the changes that have occurred in mental processes of different levels and personality behavior.

Tasks of neuropsychology in practice:

Establishment of patterns of brain functioning in the interaction of the body with the external and internal environment;

Neuropsychological analysis of local brain damage;

Checking the functional state of the brain and its individual structures.

Neuropsychology is essential for understanding the mechanisms of mental processes. At the same time, by analyzing mental disorders that occur with local brain lesions, neuropsychology helps to clarify the diagnosis of local brain lesions (tumors, hemorrhages, injuries), and also serves as the basis for the psychological qualification of the resulting defect and for restorative training, which is used in neuropathology and neurosurgery. .

There are a number of approaches used in neurophysiology:

1) Experimental neurophysiology - explores the relationship between the functioning and structure of the nervous system and cognitive functions (cognitive processes). Most studies are carried out in laboratory conditions on healthy people;

2) Clinical neurophysiology - is used for the rehabilitation of people suffering from diseases or injuries that are accompanied by damage to human cognitive functions;

3) Connectivism - the use of models of the functioning of neurons to study disorders in the brain.

The emergence of neuropsychology made it possible to use new techniques for the purpose of early and possibly more accurate topical (i.e., schematized in relation to mental systems in the form of various instances) diagnosis of local brain lesions and scientifically substantiated restoration of its functions. At the same time, it became a powerful impetus for revising the basic ideas about the internal structure of psychological processes, the most important means of creating a theory of the brain foundations of human mental activity.

The practical application of the techniques developed by neuropsychology is found in various specialized clinics, forensic medical examination. In addition, neuropsychologists are in demand as consultants in a number of organizations where neuropsychological theory is used to organize the management and production process.

2.2 Psychosomatics

Psychosomatics (psychosomatic medicine) is a relatively new direction in psychology and medicine that studies the relationship between mental and somatic phenomena. Psychosomatics studies the influence of psychological factors on the occurrence and course of somatic diseases.

The term itself comes from two Greek words: "Psyche" - soul and "soma" - body. Thus, psychosomatic diseases are such illnesses when the physical body is sick, but the cause must be sought in the soul of a person (in his perception and attitude to ongoing events, etc.), i.e. the mental or emotional state of a person is directly related to the physical state. 5

Psychosomatics studies the psychological, social and cultural factors that cause bodily diseases.

Psychosomatic illnesses belong to the border area between psychoanalysis and body medicine.

Psychosomatics explores the problems of patients with somatic disorders, in the origin and course of which the psychological factor plays an important role.

Psychosomatics studies how changes in the psyche affect the occurrence of somatic diseases.

The scope of psychosomatics also includes issues related to oncological and other serious diseases (diagnosis notification, psychological assistance, preparation for surgery, rehabilitation, etc.) and psychosomatic disorders (when experiencing acute and chronic mental trauma; problems include symptoms of coronary heart disease, peptic ulcers, hypertension, neurodermatitis, psoriasis and bronchial asthma).

According to the basic postulate of this science, a psychosomatic illness is based on a reaction to an emotional experience, accompanied by functional changes and pathological disorders in the organs. The corresponding predisposition can influence the choice of the affected organ or body system. Therefore, psychological stress in a particular area of emotional or sensory experience often causes corresponding diseases. And now understanding the causes of the occurrence of psychosomatic diseases, getting rid of the root cause makes it possible to effectively influence the disease that has arisen, including the methods of psychotherapy.

As a rule, psychosomatics “disguises” itself as the symptoms of a particular disease. The psychotherapist understands by psychosomatics the diseases of the internal organs and systems of the body that arise as a result of the influence of mental or emotional factors. As people say, these are the diseases that appear "on a nervous basis."

There are many classifications of psychosomatic disorders and diseases. Conventionally, they can be divided into two main groups (according to Karvasarsky B.D.): “major” psychosomatic diseases, which include diseases from the classic “seven” (hypertension, gastric ulcer, etc.) and “small” psychosomatic disorders - neurotic disorders of the internal organs (the so-called "organ neuroses").

The most famous of them are: bronchial asthma, peptic ulcer of the stomach and 12 duodenal ulcer, ulcerative colitis, hypertension, migraine, diabetes mellitus, thyrotoxicosis, rheumatoid arthritis, urticaria, neurodermatitis, psoriasis, many sexual disorders, as well as menstrual disorders in women, climacteric syndrome, etc.

Despite the fact that all these diseases are different, the psychologist finds in them a number of common features. So, the onset of the disease is provoked by mental factors (psychic trauma, emotional stress, neurosis), the effect of which can be short-term (death of a loved one, depression), rather long-term (conflict in the family, at work, illness of a loved one) or chronic (presence of insoluble problems due to personality traits, inferiority complex, ugliness).

But not only the onset of the disease is associated with a stressful situation, but also any exacerbation or relapse of the disease. The course of the disease to a certain extent depends on the sex and stage of puberty. For example, bronchial asthma before puberty is 2 times more common in boys than in girls, while at a more mature age it is more common in women than in men. Chronic urticaria and thyrotoxicosis are more typical for women, and coronary disease and arterial hypertension - for men.

Psychosomatic disorders usually proceed in phases and their exacerbations are to some extent seasonal. So, seasonal autumn-spring exacerbations are characteristic of peptic ulcer of the stomach and duodenum, and during psoriasis, summer and winter forms are distinguished.

Psychosomatic illnesses occur in individuals with a genetic and constitutional predisposition. Practitioners are well aware of this fact. In heredity, a person suffering from hypertension has necessarily "hypertension", peptic ulcer disease - "ulcers".

The same emotional stress causes different reactions and diseases in different people. This difference is determined not only by genetic predisposition to certain diseases, but also by characterological features. If a person who is quick-tempered, excitable, prone to aggressive reactions and forced to restrain them usually has high blood pressure, then a person who is shy, impressionable, with an inferiority complex has ulcerative colitis.

At the present stage of the development of psychosomatics as a specific field of knowledge, the main ones are the theoretical problems of the mechanism of psychosomatic interaction, specificity and individual variability, as well as the problem of developing an effective method of treating psychosomatic disorders.

Further development of psychosomatics as a scientific direction within the framework of psychology is impossible without the study of healthy physicality. Therefore, recently, a direction adjacent to psychosomatics, health psychology, which studies the psychological factors of safe and risky behavior, has been intensively developing.

2.3 Pathopsychology

There are several interpretations of the term "pathopsychology" (from the Greek. Pathos - "suffering"). Pathopsychology is a branch of clinical psychology that studies the regularities of the decay of mental activity and personality traits in comparison with the regularities of the formation and course of mental processes in the norm. 6

V.P. Zinchenko and I.Yu. Levchenko understand pathopsychology as a branch of psychology that studies changes in mental activity in pathological conditions of the brain associated with mental or somatic diseases. In the interpretation of B.V. Zeigarnik pathopsychology studies the regularities of the decay of mental activity and personality traits in comparison with the regularities of the formation and course of mental processes in the norm, the regularities of distortions of the reflected activity of the brain. 7

The subject is the study of the regularities of the disintegration of mental activity and personality traits in comparison with the regularities of the formation and course of mental processes in the norm, the study of the regularities of distortion of the reflective activity of the brain.

The object is mental disorders, mental anomalies that combine a wide range of neuropsychic abnormalities, diverse in clinical manifestations, severity and nosological nature, but common in terms of a shallow level of mental disorders bordering on the areas of normal and health.

The task of psychopathology is psychodiagnostics in order to clarify the medical diagnosis and justify treatment, in particular psychotherapy and occupational therapy. Pathopsychology provides assistance to patients with mental illness (psychotic patients - schizophrenia, epilepsy, manic-depressive psychosis, oligophrenia, psychoses, consequences of brain injuries, etc.). Such patients are patients of a psychiatric clinic.

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 decay are studied), and private (when mental disorders of a particular patient are studied to clarify the diagnosis, conduct a labor, judicial or military examination).

The main range of theoretical problems of pathopsychology as a synthesis of general psychological and clinical psychiatric knowledge includes:

The study of the psychological mechanisms of the formation of complex psychopathological syndromes (delusions, hallucinations, etc.); the influence of the individual experience of the patient and his personality on the content and dynamics of these syndromes;

Studying the structure and dynamics of disorders of cognitive activity and the emotional-personal sphere in various mental disorders; the possibility of psychological correction of these disorders;

The study of the personality of patients with various mental disorders; the role of the patient's personality both in the development of painful symptoms and in its psychological correction;

Identification and description of the structure of pathopsychological syndromes of violation of certain types of mental activity (memory, thinking, perception, etc.), as well as pathopsychological syndromes typical of various diseases; the ratio of primary and secondary disorders in the structure of syndromes;

The problem of correlation between the decay and development of the psyche.

Pathopsychology should be distinguished from psychopathology, which focuses on the medical concept of the disease and is part of the general doctrine of human disease, nosology. Pathopsychology is a part of psychiatry and studies the symptoms of a mental illness by clinical methods, using medical concepts: diagnosis, etiology, pathogenesis, symptom, syndrome, etc., the main method of psychopathology is clinical and descriptive.

Pathopsychology is associated with special psychology (in particular, with oligophrenopsychology) and defectology, which is confirmed by the presence of many textbooks for defectological specialties with the inclusion of sections and chapters on pathopsychology, as well as with psychiatry, within the walls of the clinic of which it originated as an applied scientific psychological discipline. and area of practice.

In the structure of pathopsychology, theoretical and applied pathopsychology are distinguished: 8

Theoretical (academic) pathopsychology studies the general patterns of changes in mental activity in pathological conditions of the brain in comparison with the norm. Its purpose is to assist in understanding the processes that occur in pathological conditions of the brain. Having pathopsychological material, we can reveal the structure of various forms of mental activity (discover the mental factors "responsible" for one or another structure of the patient's cognitive activity). It has been proven that mental illness leads to the disintegration of not only formed processes, motives and needs, but also to the formation of new motives, qualities, traits;

Practical (applied) pathopsychology meets the needs of practice when conducting an examination, evaluating the effectiveness of treatment, especially when using psychopharmacological agents, etc., and also serve as additional material in establishing a diagnosis.

In the treatment of psychosomatic patients, the whole range of psychotherapeutic methods is used, each of which is chosen taking into account the nature of the somatic treatment of the patient or arbitrarily. These methods include individual, group, family psychotherapy; conflict-revealing therapy; supportive and educational methods; body-centered treatment; gestalt therapy. Special modifications, for example, long-term homogeneous or mixed group therapy, are often useful in helping the patient with his attitude to assess the disease as an organ suffering, with his inadequate self-perception and difficulty in emotional self-expression.

Conducting a pathopsychological study includes several stages: an experiment, a conversation with a patient, observation, analysis of the life history of a sick person (a medical history written by a doctor), comparison of experimental data with a life history.

The basic principle of pathopsychological research is a systematic qualitative analysis, and is aimed not at measuring individual processes, but at studying a person who performs real activities. Namely, on a qualitative analysis of various forms of the disintegration of the psyche, the disclosure of the mechanisms of disruption of activity and on the possibility of its restoration.

The pathopsychological experiment is a mutual activity of the experimenter and the subject. Therefore, its construction cannot be rigid. The main difference between such an experiment and a general psychological one is that we cannot always see the peculiarity of the patient's attitude to the experiment, which depends on his morbid condition. From this we can conclude the following:

1. Mental patients often not only do not try to complete the task, but also misinterpret experience or actively oppose instructions;

2. The peculiarity of the pathopsychological experiment also lies in the diversity, a large number of methods used;

3. The fulfillment of experimental tasks has a different meaning for different patients;

4. In his conclusion, the pathopsychologist has to operate with a system of concepts that characterize the personality of the patient as a whole, along with the characteristics of individual processes;

5. A pathopsychological study reveals the real layer of the patient's life because the presented activity, the experimenter's remarks cause an equally real experience of the subject.

Usually, during the study, several methods are used from simpler to more complex (with the exception of patients with expected aggravation or simulation).

Conclusion

Thus, clinical psychology is a private psychological discipline, the subject of which is mental disorders (disorders) and mental aspects of somatic disorders (diseases). The main sections of clinical psychology are: pathopsychology, neuropsychology and psychosomatic medicine.

Pathopsychology studies methods and techniques for diagnosing and correcting mental disorders in a psychiatric clinic. The significance of pathopsychological research for psychology lies in the possibility of a deeper knowledge of the patterns of functioning and development of a normal psyche, the study of the categories of mental norms, mental health, as well as factors that activate or inhibit the development of a personality in the course of its ontogenesis and sociogenesis.

Neuropsychology studies disorders caused by diseases and developmental disorders of the brain, as well as special techniques for helping such patients. The goal of neuropsychology is to understand the connection between the structure and functioning of the brain and the mental processes and behavior of living beings. The following tasks of neuropsychology are distinguished:

Determining the patterns of brain functioning when interacting with the external and internal environment;

Neuropsychological analysis, especially relevant for localized brain damage;

Assessment of the functional state of the brain as a whole, individual structures.

Psychosomatics studies the psychological nature of human bodily diseases, the internal picture of the disease and the reaction of the individual to the disease, the psychology of the behavior of a healthy and sick person. There is an opinion that human diseases develop due to psychological disorders and inconsistencies that appear in the subconscious and thoughts of a person. The most studied psychological factors of such diseases: bronchial asthma, essential arterial hypertension, irritable bowel syndrome, autonomic disorders, dizziness, headache.

Bibliography

Bizyuk A.P. Fundamentals of neuropsychology. Textbook / A.P. Bizyuk. - St. Petersburg: Speech, 2005. - 293 p.
Zalevsky G.V. Introduction to clinical psychology: Proc. allowance / G.V. Zalevsky. - Tomsk: TML-Press, 2010. - 224 p.
Clinical psychology: textbook / Ed. B.D. Karvasarsky. - St. Petersburg: Peter, 2010. - 864 p.
Lakosina N.D. Clinical psychology: Textbook. / N.D. Lakosina, I.I. Sergeev, O.F. Pankov. - M.: MEDpresssinform, 2007. - 416 p.
Orlova E.A. Pathopsychology: textbook / E.A. Orlova, R.V. Koziakov, N.S. Kozyakov. - M.: Yurayt, 2011. - 235 p.
Pezeshkian N. Psychosomatics and positive psychotherapy / N. Pezeshkian. - M: Medicine. -2006. - 464 p.
Titova N.M. Clinical psychology. Lecture notes / N.M. Titov. - M.: Prior-izdat, 2006. - 112 p.
Frolova Yu.G. Psychosomatics and health psychology: Proc. allowance / Yu.G. Frolova. - Minsk: YSU, 2003. - 172 p.

1 Clinical psychology / Ed. M. Perret, W. Baumann. - St. Petersburg: Peter, 2007. - 1312 p.

2 Mendelevich V.D. Clinical and medical psychology: Textbook / V.D. Mendelevich. - M.: MEDpress-inform, 2008. - 432 p.

3 Zalevsky G.V. Introduction to clinical psychology: Proc. allowance / G.V. Zalevsky. - Tomsk: TML-Press, 2010. - 224 p. S. 171.

4 Zeigarnik B.V. Pathopsychology: textbook / B.V. Zeigarnik. – M.: Yurayt, 2013. – 367 p.

5 Pezeshkian N. Psychosomatics and positive psychotherapy / N. Pezeshkian. - M: Medicine. -2006. - 464 p. S. 69.

6 Clinical psychology: textbook / Ed. B.D. Karvasarsky. - St. Petersburg: Peter, 2010. - 864 p. P.421.

7 Orlova E.A. Pathopsychology: textbook / E.A. Orlova, R.V. Koziakov, N.S. Kozyakov. - M.: Yurayt, 2011. - 235 p. S. 9.

8 Ibid. - S. 12.

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