Disorders of thinking in schizophrenia psychological aspect. Violation (disorders) of thinking in schizophrenia: how is brain dysfunction expressed

Impaired thinking in humans- this is a disorder of information processing processes, the identification of relationships that connect various phenomena or objects of the surrounding reality, deviations in reflecting the essential properties of objects and in determining the connections that unite them, which gives rise to false ideas and imaginary judgments about objectively existing reality. There are several types of violations of the thinking process, namely, a disorder in the dynamics of thought processes, a pathology of the operational functioning of thinking, and disorders of the motivational-personal component of mental activity. In most cases, it is practically impossible to qualify the features of the mental operation of each patient within the framework of one type of violation of the thinking process. Often, in the structure of pathologically altered mental activity of patients, there are combinations of various types of deviations that are in unequal degrees of severity. So, for example, the disorder of the process of generalization in a number of clinical cases is combined with pathologies of the purposefulness of mental operations.

Thinking disorders are one of the most common symptoms of mental illness.

Types of thinking disorders

Disorder of the operational function of mental activity. Among the main operations of thinking are: abstraction, analysis and synthesis, generalization.
Generalization is the result of an analysis that reveals the main relationships connecting phenomena and objects. There are several stages of generalization:
- categorical stage, consists in attributing to the species, based on essential features;
- functional - consists in attribution to the species, based on functional features;
- specific - consists in classifying a species based on specific features;
- zero, that is, there is no operation - consists in enumerating objects or their functions without intentions to generalize.

The pathologies of the operational side of mental functioning are quite diverse, but two extreme options can be distinguished, namely, lowering the level of generalization and deformation of the generalization process.

In the reasoning of patients with a decrease in the level of generalization, direct ideas about objects and events prevail. Instead of emphasizing generalized properties, patients use specific situational compounds; they have difficulty in abstracting from specific elements. Such disorders can occur in mild, moderately severe and severe degrees. Such disorders are usually observed in mental retardation, severe encephalitis, and organic pathology of the brain with dementia.

One can speak of a decrease in the level of generalization only in the case when the individual had such a level earlier, and then decreased.

When the operational processes of generalization are distorted, patients are guided by overly generalized properties that are inadequate to the actual connections between objects. There is a prevalence of formal, fleeting associations, as well as a departure from the meaningful aspect of the task. Such patients establish exclusively formal, verbal connections, while true difference and similarity are not for them a test of their judgments. Similar disorders of mental activity are found in individuals suffering from schizophrenia.

Psychiatry distinguishes the two most common disorders of the dynamics of mental functioning: lability and inertia of mental operations.
Lability lies in the inconsistency of the tactics of completing the task. In patients, the level of generalization corresponds to their education and acquired life experience. The conducted studies show that the subjects, along with correctly generalized conclusions, may have conclusions made on the basis of updating random connections or based on a specific situational association of objects, events into a group of a certain class. Individuals with manifestations of mental operating lability have increased “reaction”. They have reactions to any random stimuli, they weave any passing stimulus from the external environment into their own judgments, while violating the established instructions, losing the purposefulness of actions and the sequence of associations.
The inertia of mental activity is called the pronounced "tight" mobility of switching from one activity to another, the difficulty in changing the chosen way of one's own work. The inertia of the relationship of past experience, the difficulty of switching lead to a decrease in the ability to generalize and the level of distraction. Patients cannot cope with mediation exercises. This pathology occurs in individuals suffering from epilepsy or the consequences of severe brain injuries.

With the pathology of the motivational-personal component of mental activity, such manifestations as the diversity of mental operations, reasoning, uncriticality, and delirium are observed.

The diversity of mental operations is manifested by the lack of purposefulness of actions. An individual cannot classify objects and events, highlight common features. Along with this, they retained such operations as generalization, comparison and distinction. Also, patients perceive instructions, but do not follow them. Ideas about objects and judgments about phenomena proceed in different planes, as a result of which they are distinguished by inconsistency. The systematization and selection of objects can be carried out on the basis of individual characteristics of perception, the tastes of individuals and their habits. Therefore, there is no objectivity of representations.

Reasoning can be imagined as a violation of logical thinking, which manifests itself in meaningless and empty verbosity.

The individual is thrown into endless, time-consuming reasoning that has no definite purpose and is not backed up by any concrete ideas. The speech of an individual suffering from reasoning is characterized by fragmentation, replete with complex logical constructions and abstract concepts. Often, patients operate with terms without understanding their meaning. Such individuals tend to constantly lose the thread of reasoning, and individual phrases in lengthy arguments are often completely unrelated to each other and do not carry a semantic load. In most cases, patients also lack the object of thought. The philosophizing of individuals suffering from reasoning is rhetorical in nature. "Speakers" with such a violation do not require a response or attention from the interlocutor. This pathology is characteristic of schizophrenia.

It is the signs that indicate a violation of logical thinking that are of great importance in the diagnosis of mental ailments.

Uncritical thinking activity is characterized by its superficiality and incompleteness. The thought process ceases to regulate the behavior and actions of individuals and ceases to be purposeful.

Delusion manifests itself as a conclusion, judgment or representation that is not related to information that comes from the surrounding reality. For the patient, the correspondence of his delusional ideas to reality does not matter. The individual is guided by his conclusions, as a result of which he moves away from reality, leaving it in a delusional state. Such patients cannot be convinced of the falsity of their crazy ideas, they are resolutely confident in their correspondence to reality. In terms of content, delusional reasoning is very diverse.

The listed types of thinking disorders are mainly characteristic of mental retardation, dementia and schizophrenia.

Thinking disorders in schizophrenia

A mental illness, which is characterized by a gross disorder of interaction with the surrounding reality, is called schizophrenia. The condition of patients with schizophrenia may be accompanied by inappropriate behavior, various hallucinations and delusional judgments. This disease is characterized by the collapse of the internal unity of feelings and will, in addition, there is a violation of memory and thinking, as a result of which the sick individual cannot adequately adapt to the social environment.

Schizophrenia is characterized by a chronic progressive course and is hereditary in nature.

The described mental illness has a devastating effect on the personality of the subjects, changing it beyond recognition. Most people associate schizophrenia with hallucinations and delusional judgments, but in fact, these symptoms are quite reversible, but there are no changes in thought processes and emotional sphere.

Psychology regards impaired thinking as the most common symptom of mental illness, in particular schizophrenia. When diagnosing a particular mental illness, psychiatrists are often guided by the presence of one or more types of pathology of mental activity.

The main violations of thinking are of a formal nature and consist in the loss of associative links. In individuals suffering from schizophrenia, it is not the meaning of judgments that changes, but the logical internal connections of judgments. In other words, what is happening is not a decomposition of concepts, but a violation of the process of generalization, in which patients have a lot of fleeting, non-directional associations that reflect very general connections. With the progression of the disease in patients, speech changes, it becomes torn.

Schizophrenics are characterized by the so-called "slipping", which consists in a sharp inconsistent transition from one idea to another judgment. Patients are not able to notice such a "slip" on their own.

“Neologisms” often appear in the thoughts of patients, that is, they come up with new artsy words. Thus, atactic (non-concrete) thinking is manifested.

Also, in schizophrenics, fruitless philosophizing is observed, the specificity and generalization of speech are lost, coordination between phrases is lost. Patients give phenomena, other people's statements their own secret meaning.

According to the results of the experiments, in comparison with the results of healthy individuals, schizophrenics better recognize stimuli that are less expected, and worse - stimuli that are more expected. As a result, nebula, vagueness, intricacy of mental activity of patients are noted, which provokes violations of mental processes in schizophrenia. Such individuals cannot determine the significant connections that exist between objects, do not reveal secondary specific situational properties, but actualize rather general, often superficial, fleeting, formal signs that do not reflect the real situation.

In schizophrenia, the basic disorders of thinking cannot be considered without taking into account the integral life of the individual. Violations of mental activity and personality disorders are interrelated.

In schizophrenia, impaired memory and thinking, attention disorders, can also be detected. But in the absence of organic changes in the brain, these pathologies are the consequences of mental disorders.

Thinking disorders in children

By the end of the early age period, small individuals develop intellectual activity, including the ability to generalize, transfer acquired experience from initial conditions to new ones, establish relationships that exist between objects by conducting original experiments (manipulations), remember connections and apply them when solving problems.

Psychology represents mental disorders in the form of mental disorders that occur with various ailments or anomalies in the development of the psyche, as well as local brain lesions.

The mental processes that take place in the cerebral cortex of the brain of babies determine their interaction with society.

The following types of thinking disorders in children are distinguished: slippage, fragmentation and diversity, reliance on hidden signs.

Due to the fact that mental operation is the process of displaying specific features of objects, as well as the relationships that connect them, it leads to the emergence of judgments and views on objective reality. When there is a disorder of such representations, the acceleration of thought processes may come to replace it. As a result, the crumbs have spontaneous and fast speech, ideas quickly change each other.

The inertia of mental activity is manifested in the slowdown of the processes occurring in the cerebral cortex. The speech of the child is characterized by monosyllabic answers. One gets the impression about such children, the word they have a head “without thoughts” - completely empty. A similar disorder of mental functioning can be observed in manic-depressive syndrome. epilepsy or psychopathy.

Of much greater clinical significance is the inertia of mental processes with inhibition of comprehension, the comparative scarcity of associations, unhurried and laconic impoverished speech.

The inertia of mental activity makes it difficult for sick children to learn the school curriculum, since they are not able to learn at the same pace as healthy kids.

The fragmentation of mental functioning is found in the absence of purposefulness of mental activity, the relationships that have been established between objects or representations are violated. The order of mental operation is distorted, while sometimes the grammatical structure of phrases can be preserved, which transforms speech, devoid of meaning, into an externally ordered sentence. In cases where grammatical connections are lost, mental activity and speech is transformed into a meaningless verbal set.

The illogicality (inconsistency) of reasoning is manifested in the alternation of correct and incorrect methods of performing exercises. This form of impaired mental activity is easily corrected through focused attention.

The responsiveness of mental functioning in children is manifested by the variability of the ways of performing exercises.

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In the history of the study of schizophrenia, there has been a special interest in the characteristics of the cognitive activity of patients. Thought processes have always been at the center of attention here and taken into account both in the differential diagnosis of this disease with other mental disorders, and in studies conducted as part of the study of the pathogenesis of schizophrenia.

Despite the fact that traditionally, from the point of view of psychopathology, many symptoms of impaired thinking in schizophrenia are considered in the circle of positive symptoms, we describe in this section some of these disorders, believing that they are directly related to cognitive deficits and the boundary here is partly conditional.

Psychopathological syndromes, in particular the disorganization of thinking and speech, are not equivalent to pathopsychological and neuropsychological phenomena, if only on the grounds that they are in a different “conceptual space” related to different disciplines: medicine and clinical psychology. To illustrate the foregoing, we note that acutely emerging disorganization of thinking and speech can be reversible as the psychotic state is relieved, manifestations of cognitive deficit, on the contrary, are distinguished by their persistence.

Over the course of the 20th century, there has been a certain evolution of views and even terms regarding impaired thinking in schizophrenia. Such figurative expressions and words as "diversity", "slips", "breaks", "splitting", "ataxia" of thinking, gradually gave way to clearer concepts of clinical psychology. Attempts to derive from the analysis of clinical manifestations the essence of cognitive impairment in schizophrenia were erroneous from a methodological point of view.

Thought disorders specific to schizophrenia are noticeable both during relapse and in remission of the disease, they are unusual and difficult to explain, sometimes remaining in the shadows, sometimes noticeably affecting the patient's behavior.

Thinking disorder in schizophrenia:

• violation of figurative and abstract thinking;
• actualization of the "latent background" (emphasis on secondary details);
• symbolism;
• neologisms;
• perseveration;
• meaningless rhymes;
• concept agglutination.

E.A. Back in 1930, Shevalev proposed to single out prelogical (archaic) thinking, symbolic and identifying thinking, typologically close to magical, in schizophrenia. The author believed that such thinking is the result of an undifferentiated combination of perception and mythological poetics, the predominance of the protective power of formulas and symbols, the replacement of natural phenomena by the supernatural and the dominant meaning of faith. E.A. Shevalev believed that the thinking underlying delusions of imagination and acute sensory delusions in schizophrenia is so similar to prelogical thinking that it is difficult to differentiate formal thought disorders from thought disorders by content.

At different times, depending on the ideas dominant in the scientific community, the change in thinking in schizophrenia was explained in different ways. Beringer (1936) wrote about the “insufficiency of the intentional arc”, in which the patient is forced to rebuild his judgments each time, although solving current problems, but not using previous experience; Kleist (1942) tried to find a relationship between the pathology of thinking and organic damage to certain areas of the brain, R. Payne (1955) talked about "impaired cortical inhibition", T. Weckowicz (1959) - about changing the "filtering function of the reticular formation".

In domestic clinical psychology, the works of L.S. Vygotsky (1936) (the concept of impaired conceptual thinking in schizophrenia) and B.V. Zeigarnik (1962) (pathology of thinking), devoted to the study of the features of the cognitive process in schizophrenia.

B.F. Zeigarnik (1962) wrote that with the obvious pathological nature of the thinking of patients with schizophrenia, he is not characterized by a “decrease” in the level of conceptual thinking.

Yu.F. Polyakov (1966, 1969, 1972), head of the laboratory of pathopsychology of the Institute of Psychiatry of the USSR Academy of Medical Sciences, put the analysis of the structure of cognitive processes in schizophrenia into the focus of his experimental psychological research (processes of comparison, classification, generalization, problem solving, etc.). Cognitive processes were compared with the features of visual and auditory perception.

Psychological level for Yu.F. Polyakova was an intermediate link between psychopathological and pathophysiological research methods.

Especially detailed in the laboratory of pathopsychology of the Institute of Psychiatry of the USSR Academy of Medical Sciences, juvenile schizophrenia was studied, characterized by a sluggish (continuous, and in some patients fur-like) type of course (the presence of clear negative symptoms against the background of erased positive symptoms), in the opinion of the laboratory staff (Meleshko T.K. Bogdanova E. I. Abramyan L. A. and others), clearly demonstrating the main violations of thinking in this disease.

Yu.F. Polyakov noted (1972) that some researchers, on the basis of their experimental psychological and literary data, seek to determine the role of impaired cognitive processes in schizophrenia and erroneously compare it with the mechanisms of its development.

From a psychodynamic point of view, the pathology of thinking in schizophrenia was explained by a violation of social ties, a regression to the previous stages of libido development. In the latter case, there was also a connection with the ideas of J. Jackson, who wrote that mental illness returns a person to an earlier onto- and phylogenetic level.

The thinking of a patient with schizophrenia is characterized by actualization of the "latent background", secondary details, the use of insignificant features of concepts when generalizing.

Minor features of the general concept, fragments, details that are not relevant for normal purposeful mental activity, occupy a dominant place, become predominant.

A patient with schizophrenia can operate with neologisms - words with a special combination (mixture) of syllables that have a special meaning for him and only he understands.

He invents words, tends to repeat the same words and statements (perseveration), can senselessly rhyme words based on sound associations.

The boundaries between concepts seem to be erased, and the concepts themselves lose their original meaning. In some cases, agglutination (contamination) is noted images and concepts. The last symptom can be found in the work of some artists (I. Bosch, S. Dali) or poets and writers (D. Kharms, K. Balmont).

Projective methods of clinical psychology, in particular the Rorschach test, were used quite actively in the study of patients with schizophrenia. With the help of such methods, the motives and tendencies of the individual in the process of cognitive activity were analyzed.

When interpreting Rorschach spots, a patient with schizophrenia can simultaneously see several images in one fragment.

Mediation of concepts with the help of graphic images in schizophrenia does not contribute enough to memorization and reproduction. Along with adequate, in many cases distant, stereotypically repetitive graphic images are used.

Discontinuity of thoughts and foreign thoughts, as well as the experience of withdrawal of thoughts, are relatively common in schizophrenia.

With schizophrenia figurative thinking is broken. Experiments in which certain images were required during fMRI have shown that patients with schizophrenia demonstrate functional hypofrontality and decreased activity of the prefrontal dorsolateral cortex.

There are indications in the literature that these results may be due to disruption of motivation processes in schizophrenia. A lack of motivation is an almost obligatory symptom of schizophrenia, which significantly complicates the study of cognitive impairment. It is interesting to note that when financial incentives are provided, the motivation to perform some action in schizophrenia is enhanced. With an increase in motivation, the activity of the prefrontal dorsolateral cortex does increase.

With schizophrenia, patients with this mental disorder, even for a long time, may demonstrate the ability to perform certain mental operations that require short-term concentration of attention, such as complex digital operations or a game of chess. Some authors of the early twentieth century explained this fact by the fact that in schizophrenia the thinking process is disturbed, but the prerequisites for intelligence are preserved (Gruhle H. 1922). E. Bleuler (1911) wrote about the separation of thinking from experience due to the “loosening of associations” in schizophrenia, emphasizing that this leads to the formation of false connections that do not correspond to past experience.

We have already noted that persons predisposed to schizophrenia, as well as relatives of patients, sometimes show similar features of thought processes.

Many talented mathematicians or chess players often have schizophrenic patients among their relatives.

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V is the amount of short-term memory;

A is the maximum number of stimuli in a row, at which the entire row was reproduced completely;

m is the number of correctly reproduced rows;

n is the number of samples with the same row length.

Indirect memorization (A.N. Leontiev). The main theoretical concept of this diagnostic technique was borrowed from the one developed by L.S. Vygotsky and A.R. Luria "functional technique of double stimulation", which is based on the principle of introducing into the experimental task offered to the subject, in addition to the main initial stimuli, a second additional series of stimuli that can serve as the "psychological tool" for the subject, with which they can solve the problem.

To conduct the experiment, it is necessary to have pre-prepared sets of images (30 cards with a clear image of objects and animals) and sets of 15 words. It is recommended to use standard lists, but the possibility of selecting your own, for specific research tasks, is not excluded.

The cards are laid out in front of the subject so that they are all visible at the same time. After that, the words from the prepared set are read out one by one with a request to the subject to choose one of the cards so that later she can remember the word she read, but the images themselves should not be a direct illustration of the word. Having picked up the right picture, the subject must explain the motives for his decision. Selected cards are set aside.

After the end of the memorization stage (and sometimes after 1 hour), the subject is alternately offered selected cards with a request to remember the word associated with it,

The subject of research here is not only memory, but also the nature and adequacy of the use of formed associations, the correctness of logical constructions when explaining one's memories, the recall of words that are close in meaning instead of actual ones, the presence of secondary, independent associations that are not associated with the corresponding word or card.

It has been experimentally proven that the formation of mediated connections in mentally retarded people is difficult or impossible, and the selection of cards in people with mental disorders (in particular, schizophrenia), both in the formation of associations and in motivation, reveals connections with secondary, very distant or generally poorly understood from the standpoint of common sense. signs, or the selection of a card for a word turns out to be generally impossible, chaotic.

The double stimulation method can be used in another modification. When naming and words, the subject does not select the pictures himself, but the experimenter shows them at his own discretion, reproduction is carried out as follows: they present one picture at a time and suggest that for each of them they recall the corresponding word that the experimenter had previously read. The number of correctly reproduced words is an indicator of the degree of development of the active establishment of meaningful connections in the process of memorization and the use of various kinds of auxiliary techniques.

There is also a more simple version of the study, proposed in 1935 by L.V. Zankov and reduced to memorizing a specific word using a specific image in a picture by establishing a connection between the word and the image.

Visual retention test A.L. Benton. ( Arthur Lester Benton) The technique is intended for the study of visual memory and spatial perception by the reproduction of geometric figures presented to the patient. The material of the methodology includes three equivalent series of cards, 10 cards each. The cards show simple geometric shapes from one to three.

Research procedure. The subject is presented with a sample for memorization for 10 seconds, after which he must reproduce on a sheet of paper with maximum accuracy in form, size and location, if there are any, figures. Success is measured by the number of correctly reproduced images. An answer is considered incorrect if it contains at least one error.

Thus, for one series you can score 10 points

Patients with organic lesions of the brain usually receive 4-5 points, Patients with neurosis receive an average of 6-8 points. Patients with schizophrenia -6-7 points. The norm is 8-9 points.

For pathopsychology, a qualitative analysis of the course of the study and the results obtained is of great value. In particular, V.M. Bleicher and I.V. Kruk propose to single out the so-called "organic" errors that occur in people suffering from cerebral pathology:

the patient has divided one of the main figures into fragments (when such a dismemberment of the original leads to the impossibility of identifying the sample figure),

reproduced all figures in one size,

complete or partial omission of small figures,

duplication of the main figure,

the location of the peripheral figure between the main ones,

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The main symptom of schizophrenia is thought disorder. In patients, the possibilities of correctly establishing links between concepts and ideas are violated. Phrases are sometimes built grammatically correctly, but they do not have a logical sequence in the presentation of thoughts, that is, thought processes do not follow the laws of logic, but become paralogical. There is a kind of distortion of reality, isolation from the real world, the patient goes into the world of his distorted concepts and ideas. Such autistic thinking puts the patient outside the existing reality. Thought processes become inert, lack of initiative, non-purposeful. Influxes of thoughts and dips in them (voids) are possible. In some cases, the lack of clarity leads to stagnation in thoughts, their repetition.

In some patients, thinking takes on a resonant character: it does not lead to knowledge of reality, but distorts it, the lack of factual material and the ability to abstract deprives it of concreteness, the ability to make generalizations, and conclusions. All these violations are revealed in speech and writing, which become limited or profuse, ornate, stereotypical, symbolic.

Many patients are prone to the formation of new words. "Goopshelon" - this is how sick S. called the reorganization of all board games proposed by him. “Active - neutral - passy” - the patient V. denoted her embroidery. Often speech, writing become torn, a kind of verbal "salad", in which there are only fragments of thoughts. An illustration of this is the following letter from sick E., written to his daughter.

“Hello, my dear daughter Svetlana.

I am writing you a letter from the nameless infinity of the achievements of human perfection of the mind and the ability of the mind. At this time, my personal health is satisfactory-excellent. Memory of images, I periodically remember you according to my personal desires with associated associations, movements and continuations, I perfectly remember you and your childish smile. I am your voice in the perfection of verbal and written contacts, our best relationships, considerations, has always been embodied in your beautiful future, in every thought, my best discoveries in the field of sociological, physiological, gradually and naturally rightfully belong to you, my dear, sincere, dear ..."

Most patients have delusional ideas. They can be in the nature of persecution, relationship, impact. Delusions can be systematized, persistent, prolonged, most often ridiculous. Here is an excerpt from the extensive "labor" of the patient V.P.O. entitled "Brief information about hypnosis."

“The main sign - the definition of persons who possess the power of hypnosis and belong to the second subgroup, is - in these persons the cerebral cortex is either all black-velvet in color, or the upper part of the cortex of the heads. the brain is black-velvet in color, and in the lower part of the cerebral cortex there is a belt of orange or dark orange phosphorically luminous color. In almost all of this subgroup, insects (flies) start up in the cerebral cortex, the same thing of a black-velvet color of microscopic size, and white worms appear in the depths of the brain, microscopic quantities." The described violations of thinking will gradually lead to changes in memory, its impoverishment.

1. Blockage of thinking, often with a subjective sense of loss of control over thoughts (sperrung)
2. Neologisms- new, own language
3. Blurred thinking– lack of clear conceptual boundaries
4. reasoning- the chain of reasoning eludes the patient
5. slipping- sudden change of topic of conversation
6. Verbigerations- mechanical repetition of words and phrases (especially common in chronic forms)
7. Own logic
8. Difficulties in generalizing and understanding similarities and differences
9. Difficulties in separating the major from the minor and discarding the non-essential
10. Combining phenomena, concepts and objects according to insignificant features

It happens: the clinical method (psychiatrist) does not reveal disorders, he asks the psychologist: look carefully if there are thought disorders. The psychologist begins to lay out the cards and highlight the thinking disorders. Psychologists who will work in clinical psychology are of great help to psychiatrists in the early diagnosis of mental disorders.

4. Decrease in mental activity (“reduction of energy potential” according to K. Konrad (or “broken wing syndrome”))

Lost "steel" and "rubber" in the individual. There are problems with learning, with work, it becomes difficult to read books, watch TV, learn new knowledge. The condition improves after physical work. He does it with pleasure and does not get tired. "Steel" is purposefulness, striving for achievements. "Rubber" is flexibility, the ability to adapt to the environment (Gannushkin).

P. Janet - mental strength - determines the ability of an individual to implement any mental functions; psychic tension is the ability of an individual to use his psychic power.

A balance is needed between psychic strength and psychic tension.

The extreme expression of a decrease in mental activity is abulia.

Apato-abulic syndrome.

It often happens: there is psychic strength, but there is no tension. In everyday life, we call this laziness. There are opportunities, but you don't want to use them. A schizophrenic patient cannot use his psychic power. "Broken wing syndrome" - you have to force, give the command. Otherwise, nothing will be done, a push from the outside is needed.

5. Disharmony of the mental make-up of the personality - schism - splitting

The coherence between the main mental processes is violated: perceptions, feelings, thoughts and actions (the unity of the personality is lost).

5. 1.Schisis in thinking:

Diversity of thinking (both essential and non-essential confessions are used at the same time. Honesty is a category of reasonable relations reflected in mathematics, physics and psychiatry - the definition of a patient)

Fragmentation of thinking (the patient tells the psychiatrist that he has a somatic disease, and why is he being treated by a psychiatrist? Because there was a queue for the therapist ...)

schizophasia

How to distinguish schisis from Kandinsky-Clerambault syndrome? We understand schism as a negative disorder. Some psychiatrists consider Kandinsky-Clerambault to be a manifestation of schism. But this is a productive disorder.

5. 2. Schism in the emotional sphere:

According to E. Kretschmer, the psychesthetic proportion is “wood and glass” (emotional dullness + fragility, sensitivity of mental organization). He does not cry at the funeral of a loved one, but at the sight of an abandoned kitten, he begins to sob over him.

Ambivalence

Paramimia (what worries you? - longing (and at the same time he has a smile on his face)

Paratimia (the funeral of a loved one, everyone is crying, but he rejoices)

Violations of thought processes in schizophrenia consist of several processes. Purpose disorder.

Violation of purposefulness is one of the defining features of the entire mental life of patients with schizophrenia, being traced both in the emotional-volitional sphere and in the sphere of thinking. The main symptom in which this is most clearly seen is reasoning. Reasoning, or fruitless sophistication- reasoning that does not have a final goal, in which the patient strings words one on top of the other, not coming to anything in the end. This trend is most clearly visible in the so-called. schizophasia, when the patient builds a grammatically correct phrase from words that are completely unrelated in meaning. Decreased volitional activity, which underlies the violation of the purposefulness of thinking, can lead, when strengthened, to a loss of comprehension, simplification of associative processes, up to the acquisition of a primitive, formal, concrete character by thinking, the loss of the ability to understand the abstract meaning of statements, for example, when interpreting proverbs and sayings. The next trend is a violation of the associative process. In schizophrenia, we are dealing with a tendency to form associations, connections between concepts based on the so-called. latent (weak, not obvious, not basic) signs. As a result, thinking acquires a strange, difficult to understand character. Such thinking is called paralogical. Thus, the patient's reasoning becomes difficult to understand, not only because he himself often does not know where he is moving and whether he is moving somewhere at all, but this movement is carried out along obscure paths. One of the possible options in this case is the predominant use in thinking of the symbolic "figurative" meaning of words and concepts. Such thinking is called symbolic. The tendency to form new connections, associations between concepts also finds its expression in the merging of several concepts into one and the formation of new words to denote such concepts. This trend leads to the formation of the so-called. neologisms. The extreme form of paralogical thinking, in which the violation of the associative process is pronounced, total, is called atactic thinking or schizophrenic incoherence. The combination of negativism in the volitional sphere, violations of purposefulness and paralogicality finds its expression in the so-called. slips or answers not in terms of the question, when the patient, in response to a question, begins to talk about something that is not related to the question at all or has little relation to it.

As noted by B.V. Zeigarnik, thinking disorders are one of the most common symptoms in mental illness. In addition, there is no single principle for the analysis of thinking disorders, since different researchers are based on different thinking models. Psychological research on schizophrenic thinking goes mainly in two directions. The first is characterized by the study of individual variants of schizophrenic thinking, often having their analogues in the clinical symptoms of schizophrenia (slips, fragmentation, reasoning), the second is the search for general patterns of schizophrenic thinking.

Primary thinking disorders are not characteristic of all types of schizophrenia. O. P. Rosin and M. T. Kuznetsov write that not in every form of schizophrenia, mental disorders are observed: the degree of its disorders and their dynamics, they believe, directly correlate with the form and content of the mental process.

The author associated violations of the boundaries between the ego and the outside world with the difficulties of separating the figure and the ground.

To explain the peculiarities of thinking of patients with schizophrenia, the concepts of "overgeneralization", "overinclusion" were put forward, which was considered as an expression of the inability to stay within the given semantic boundaries, an expansion of the conditions of the task. Among the reasons for over-inclusion were: violations of the proposed filtering mechanism, which does not ensure the differentiation of essential features from non-essential ones, divorced from reality, not significant in a given problem situation; violation of the creation of the necessary inhibitory installations and the inability to develop installations, without which the differentiation of signs characteristic of normal thinking is impossible.

L.S. Vygotsky suggested that the functions of concept formation in patients with schizophrenia were disintegrating – the latter are reduced to the level of complexes, i.e. specific meaning formations - which is based on a change in the meanings of words. As noted by B.V. Zeigarnik, a decrease in the conceptual level is noted only in a number of cases in the initial state (defect). The basis of such a violation is not a decrease, but an inadequacy to specific life relations (real), indicating a thickening of their individual aspects and properties due to the loss of focus on the objective content of phenomena and objects. M. S. Lebedinsky believed that in schizophrenia the direction and stability of thinking suffers, the associative process of patients with schizophrenia is characterized by a lack of focus on the ultimate goal. OK. Tikhomirov traced three links in the psychological mechanism of impaired thinking in schizophrenia:

The first link is a violation of the motivational sphere, which leads to violations of personal meaning. For patients with schizophrenia, the personal meaning of objects and phenomena often does not coincide with the generally accepted knowledge of a person about them, which is conditioned by the real situation. At the same time, standard and non-standard informative features are equalized.

The second link is giving non-standard informative features more importance than standard ones.

The third link is violations of the selectivity of information, which are manifested by violations of the selectivity of information in connection with past experience and its probabilistic disorganization.

indicates V.M. Bleicher, such a structure of the psychological mechanism of thought disorders in schizophrenia corresponds to the ideas of A. R. Luria about the relationship between the material substrate and clinical symptoms. Violations of motivation, personal meaning and selectivity of information underlie certain clinical manifestations: on the one hand, this mechanism (the first two links) is associated with an increasing emotional decline, on the other hand, changes in dissociative type thinking. It can be assumed that, depending on which link is more disturbed, in the clinical picture of schizophrenia, there is a greater severity of one or another type, type of thought disorder. The first classification scheme for the pathology of thinking in psychopathology was proposed by Gresinger. He distinguished two types of thinking anomalies: painful ideas about the form of thinking (slowdown / acceleration) and anomalies of ideas about their false content (false content of thoughts - delirium). Disorders of the content of thinking (productive) are characterized by an inadequate reflection of the essential qualities, aspects, relationships and patterns of objective reality due to the diseased state of the brain. They are divided into obsessive, overvalued and delusional ideas. Disorders of the form of the associative process are represented by violations of the pace, mobility, purposefulness of thinking and the grammatical structure of speech.

Numerous studies have been devoted to the pathology of thinking in patients with schizophrenia. The works of Vygotsky, Birenbaum, Zeigarnik and others contain indications of violations of the function of concept formation as an essential feature of the schizophrenic psyche, a disorder in the correlation of abstract-semantic and subject-specific components of analytical-synthetic activity. Moreover, as Korsakov and Vygotsky noted, mental disorders at the level of concepts in patients with schizophrenia do not exclude the relative safety of formal-logical (algorithmic) operations.

Features of the pathology of thinking in schizophrenia are most fully reflected in the works of Zeigarnik, Polyakov and their collaborators.

Here are just some of the most characteristic manifestations of impaired thinking in schizophrenia: diversity, rationalization, slippage, bizarre associations, etc.

Thinking disorder, described by Zeigarnik as diversity, is close to such concepts as "polysemanticism", "weakening the influence of contextual restrictions" in the works of other researchers. Diversity is revealed more often when performing the “classification”, “exclusion of objects” methods. For example, in a test for classification, either the properties of the objects themselves, or personal tastes, attitudes, and attitudes can act as signs by which it is carried out. The focus on the objective content of the action is lost, the thinking of patients becomes diverse, judgments about some phenomenon are on different planes.

Tepenitsyna analyzed the peculiarities of reasoning in patients with schizophrenia - the tendency of patients to long-winded unproductive reasoning, fruitless sophistication. For schizophrenic reasoning, a combination of a distortion of the level of generalization with violations of the sequence and critical thinking is typical. In its structure, attention is drawn to the weakness of judgments, affective changes and the verbosity associated with the latter, significantness, inappropriate pathos of statements. Noting that in the structure of reasoning, violations of intellectual operations proper are not leading, the author attaches the main importance to violations of the personal component of mental activity, a change in attitude to the environment, and inadequate self-esteem. The role of distortion of motivational attitudes as a factor directly responsible for the formation of the structure of this disorder is emphasized.

For the thinking of patients with schizophrenia, a number of authors consider the so-called “slips” to be characteristic (Zeigarnik, S. Ya. Rubinshtein, etc.). Performing tasks (especially those related to such techniques as "classification", "exclusion", etc.), the patient correctly solves the problem or adequately talks about some subject, but suddenly strays from the correct train of thought to a false inadequate association, and then continues task without correcting the mistake; thus, on the whole, his judgments are devoid of logical consistency.

The associative processes of patients with schizophrenia also differ in a certain originality. A significant elongation of the associative chain was noted due to the absence of rigid strong ties and a large number of once used associations. Most of the associations are non-standard, insignificant, which, like the increase in the entropy index, may indicate the processes of disorganization, disorder in the probabilistic-statistical structure of associations.

To explain the features of impaired cognitive activity in schizophrenia, in particular thinking, Polyakov proposed a hypothesis about a change in the selectivity of thinking, determined by various factors of past experience. In order to test this hypothesis in a number of experiments, we studied the features of updating knowledge by patients with schizophrenia. At the same time, it was found that when performing tasks for "classification", "comparison", etc., patients with schizophrenia actualize a wide range of insignificant, "latent" signs and relations of objects that are not used by healthy people. There is an alignment of the significance of individual features, essential and non-essential, their probabilistic assessment changes; patients may consider significant and those signs that are unlikely from the point of view of their past experience. The resulting redundancy of information is used by the author to explain the uneconomical mental activity of patients with schizophrenia. In further studies, it was shown that violations of the selectivity of updating knowledge as an essential feature of the cognitive activity of patients with schizophrenia are characteristic not only for themselves, but also for their immediate relatives without mental pathology. Based on these data, these changes were classified as premorbid. Further, it was shown that the degree of change in the selectivity of knowledge based on past experience did not change significantly with the progression of the disease and was not determined by the severity of the schizophrenic defect.

In many works, the subject of research was speech disorders in patients with schizophrenia with thinking disorders. Linguistic analysis in relation to two groups of patients - with schizophasia and atactic thinking showed that thinking disorders in the subjects manifested themselves in deviations from the speech norm and in other speech features not only at the semantic, but also at the grammatical, graphic and lexical levels.

The question of the intellectual activity of patients with schizophrenia is far from new and has been discussed many times in the literature. In the earliest studies, it was indicated that delusional patients have an intellectual defect. However, it was later shown that this representation is incorrect. In Serebryakova's studies, the features of the intellectual activity of patients with schizophrenia were the subject of a special study. The examination was carried out using a standardized Veksler kit. When analyzing the results obtained, it was noted that the indicator of success in completing the tasks of the methodology as a whole did not reveal any sharp deviations from the norm. No significant difference was found between verbal and non-verbal assessments.

More clear results were obtained with a qualitative analysis of the responses of patients. The correct performance of difficult tasks was noted, but at the same time, patients did not always cope with easy tasks. Quite often, the performance of tasks was accompanied by lengthy reasoning, in which the patients were close to the correct answer, but could not achieve it, and it was difficult to identify essential features. Some of the patients were diagnosed with autism, a tendency to include questions in the structure of their painful experiences.

The peculiarities of the intellectual activity of patients with a predominance of apato-abulic and paranoid disorders were subjected to a special analysis. Patients of the first group were indifferent to the study, they performed the tasks with motivation, reluctantly, sometimes negatively, they did not react to mistakes, they were not interested in the results. Profile analysis showed a decrease in intellectual activity when performing tasks. In the “awareness” subtest, patients used old knowledge, gave correct answers to easy questions, but did not cope with complex ones. Questions related to economic, political and social life were not answered. This was especially evident in the comprehension subtest, which required understanding of certain social phenomena. The inability of patients to give an answer to this range of questions testified to social isolation, isolation from others. When performing the "understanding" subtest, a violation of ethical and social norms of behavior was revealed. The patients interpreted the most commonly used proverbs correctly; in case of presentation of complex proverbs, they had difficulty explaining them incorrectly. For example, the proverb: “One swallow does not make summer” was explained as follows: “Swallows fly in flocks” or “A swallow has beautiful wings and a beak.” In the “similarity” task, the patients did not single out the main essential features, they found the similarity of objects according to unlikely, insignificant features. So, to the question "What is the similarity between a dog and a lion?" They answered: "The lion and the dog are snub-nosed." The subtests "Kos cubes" and "addition of figures" are aimed at studying constructive thinking. Nevertheless, the patients coped more successfully with the Cubes of Kos, which were abstract in content, and they did not cope only with complicated tasks, which required more effort.

In the “addition of figures” subtest, patients performed only the first test - “addition of a little man”. They didn’t cope with the rest, made ridiculous decisions, according to certain signs they didn’t “cover” the figures as a whole, they folded the first parts of the figure that came across, then applied the rest of the details. There was no purposefulness of actions, the patients did not identify significant features of the figure, the informative significance of all parts of the figure was the same for them.

In patients with schizophrenia, assigned to the second group - with paranoid disorders, the results differed in some features. They got involved in the work well, some of them, for delusional reasons, were wary of the study, and showed no interest in the tasks. The thinking of patients with paranoid syndrome was characterized by an inability to identify the main, essential features, and difficulties in analysis. Decisions were made according to outwardly random connections, sometimes absurd, the subjects did not cover the whole subject or issue. When analyzing the "profile" of this group of patients, it can be seen that they performed the tasks unevenly, successfully coped with some, and much worse with others. The intellectual level of these patients was also reduced. There was almost no difference between verbal and non-verbal assessments. Relatively more successfully, the patients coped with the “awareness” subtest, and in this task, difficulties were caused by questions reflecting the socio-political side of life. Of the group of verbal tasks, the lowest results were found in the subtest "comprehension". Delusional experiences of patients were often reflected in answers to questions. So, to the question “What would you do if you found a sealed envelope with an address and a stamp?” the patient answered: “I wouldn’t pick it up, suddenly something dangerous in the letter.”

By indicating the missing part of the image, patients often add their delusional experiences to the answers. For example, when looking at a picture of a car, patients with delusions of persecution often ask: “Who is this car going to follow?” Cos cubes are dealt with fairly quickly, the average mark for this task is within the normal range. The difficulty for them is the subtest "addition of figures". In this task, on the basis of individual features, they cannot single out a whole figure, while compiling they allow ridiculous decisions, the information content of essential and secondary features as parts of a whole is absent for them. When performing the task, “successive pictures” found it difficult to establish a logical connection between individual pictures, the content is explained in terms of their delusional experiences. So, for example, in the task “taxi”, a patient with a delusion of jealousy says: “These pictures show how a wife is cheating on her husband.” The humor of plot pictures is not understood. When comparing the average scores for the performance of all tasks of the Veksler technique by patients of both groups, no significant differences were found. Qualitative differences in responses were revealed, which were determined by psychopathological symptoms. All the manifestations of the characteristic disorders of thinking in schizophrenia in the form of reasoning, diversity, slippage, etc., noted above, were determined to varying degrees of severity during a qualitative analysis of the results of the patients performing the tasks of the Wechsler technique.

Below are the typical responses of patients with schizophrenia during a pathopsychological examination (in the form of reasoning and diversity).

Techniques
Subject exception	Light bulb, kerosene lamp, candle, sun	“You can exclude a light bulb, then all other objects belong to the same kind of lamps and emit natural energy when burning”
Wardrobe, bed, bookcase, linen closet	“I exclude the closet, the rest of the items for the lonely “book lover””
verbal exclusion	Tree, bud, bark, leaf, bough	“You can exclude a leaf or a bud, since everything else is always present on the tree, depending on the season. But you can also exclude a tree, then everything else will join it. ”
similarity	Shoe - pencil Cloak - night Fly is a tree Plate - boat	"Leave a trace" "Envelop Reality" "The wings of a fly are like tree leaves" “The concave can swim on the water”, “They can be given movement: the boat moves on the water, the plate may fall”
Pictogram	Doubt	The patient draws a donkey and two haystacks on the sides: "Doubt is the position of Buridan's donkey"
Development	The patient puts the letter "B": "You can develop muscles with the help of a bicycle"
Doubt	A wavy line is depicted: "This line expresses the excitement that always arises when in doubt"

intellectual schizophrenia psychasthenia neurosis