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DONETSK NATIONAL MEDICAL UNIVERSITY

named after M. Gorkiy


PSYCHIATRY. NARCOLOGY


Methodical directions for self-preparation

(for medical students)


Donetsk – 2010


PSYCHIATRY. NARCOLOGY. Methodical directions for self-preparation (for medical students)


Abramov V.A., Ryapolova T.L., Golodenko O.M., Vasylyeva G.Yu.


PSYCHIATRY. NARCOLOGY. Methodical directions for self-preparation (for medical students). – Donetsk: 2010. – 32 p.


It is intended for realization of the program-target approach to quality management of preparation of experts on medical psychology, the general psychopathology and private psychiatry.

The purposes of each employment formulated, as professional skills are determined. Target tasks (training tasks) that allow the student to determine a degree of mastering of a theme are resulted.

Methodical directions are designed for controlled self-preparation of students of medical faculties of higher educational institutions and are addition to corresponding manuals and textbooks.


Recommended by DonNMU Academic Council

(protocol №7, 22.10.2010)


Abramov V.A., Ryapolova T.L., Golodenko O.M., Vasylyeva G.Yu.


^ GENERAL PSYCHOPHATHOLOGY. PATOLOGY OF COGNITIVE PROCESSES.

This topic is the beginning of study of the general psychopathology and its main part – the semiotic of mental diseases. Sensations and perception are the personal mental processes; they have subjective features, which are conditioned by personal properties of the organs of senses, knowledge, and experience. Subjectivity concerns to the level of depth of reflection and understanding and not to the reality of the objective existence of the perceptible. So, due to this the reality perceives in her natural condition, but with different level of the depth and understanding of its meaning.

Attention and memory is a mental process of imprinting, preservation and reproduction of the previous experience. Disturbances of memory and attention in mental and somatic diseases manifest themselves began inability to memorize, retain and reproduce the material mastered. Most frequently disturbances of memory occur in organic psychiatric disorders. It is possible to observe reduced capacity for memorizing against a background of a disturbance of attention in cases of development of overstrain states, as well ass at the period of convalescence following somatic diseases.

^ General purpose: to be able to expose and differentiate the breaches of sensations and perceptions.

Obligatory skills to develop

Previous basics of knowledge

1. To carry out purposeful clinical research of the cognitive processes.

1. To take the history, to expose complaints, to carry out clinical examination of the patients.

2. To expose the objective singes of the breaches of the cognitive processes




3. To quality the exposed breaches as psychopathological symptoms.

2. To carry out pathopsychological research of sensations and perceptions and interpret the received results.

4. To interpret the received results.

3. To collect facts from the patient’s anamnesis, find out his complaints and carry out the patient’s objective examination (Department of General and Faculty Therapy)

5. To classify the disorders as psychopathological symptoms.

4. To indicate the most informative signs of a breach of mental function disorders and to interpret the obtained results (The Cycle of Medical Psychology of Department of Psychiatry and Medical Psychology).


You can check your knowledge level with the following tasks:

Task 1. Patient S., 35, reading an interesting book didn’t notice his parents entering his room and asking him a question. One to which property of attention didn’t he react to the patients?

  1. Stability

  2. Distribution

  3. Volume

  4. Switching

  5. Concentration

Task 2. A 68-year-old woman with cerebral atherosclerosis complains of a fatigue, irritability, frequent headaches, absent-mindedness, insomnia. From 60 ages has decreased of memory, forgot phone numbers, names of relatives. At the examination: exhaustion of attention, remember of 10 words: 3, 3, 4, 3, 4. What memory processes disturbed in this patient?

  1. Recollection

  2. Storage

  3. Forgetting

  4. Memorizing

  5. All together

Task 3. During the research by the “Exemption of the superfluous” method the examinee choosed the thermometer from the group of things (thermometer, watch, glasses, balance). He explained that only sick persons need thermometer. Define the type of thinking:

  1. Obviously - operative

  2. Obviously – figurative

  3. Concrete

  4. Paralogic

  5. Abstract

Task 4. During the explanation of the metaphorical meaning of the proverb “An apple falls near the apple-tree”, the examinee told that “an apple always falls near the branch, on which it has been growed”. Define the type of thinking:

  1. Obviously – figurative

  2. Abstract

  3. Obviously - operative

  4. Concrete

  5. Paralogic


^ TABLE OF CONTENTS OF TEACHING

Questions:

  1. Disorders of sensations: hypoaesthesia, hyperaesthesia, anaesthesia, cenestopathy.

  2. Disorders of perception: illusions (affective, interpretative, pareidolia), hallucinations (simple and complex; visual, auditory, smelling, tactile etc; hallucinations and pseudohallucinations; imperative, commutative, neutral), psychosensory disorders: metamorphopsia, autometamorphopsia).

  3. Normal and pathological imagination.

  4. Aging peculiarities of sensation’s and perception’s disturbances.

  5. Methods of discovering of sensation`s and percepton`s disturbances. Psychophysiological and neuropsuchological mechanisms of sensation`s and percepton`s disturbances.

  6. Disorders of memory (hypermnesia, hypomnesia, amnesia (progrssive, reproductive, retrogradness, anterogradness). Paramnesias: confabulations, pseudoreminiscentions). Paculiarities of memory disturbances in different disorders. Psychophysiological and neuropsuchological mechanisms of memory disturbances.

  7. Disorders of thinking (disorders of the stream of thought – pressure of thought, thought blocking, flight of ideas; disorders of the form of thought – perseverations (Knight’s move, word salad, verbigeration), talking past the point, widening of concepts, paralodical thinking, incohherent thinking, neologisms; delusions (primary, secondary; according to contents), obsessional symptoms, overvalued ideas).

  8. Disorders of speech.

  9. Disorders of intellect (dementia, oligophrenia, borderline mental retardation, infantilism).


The literature

  1. Gelder M., Gath D., Mayou R. Oxford Textbook of Psychiatry. Second edition. – Oxford University press. – 1991. – 1080p.

  2. Gavenko N.I. Essentials of Medical Psychology - Kharkiv. - 2006. - 320p.

  3. Vasilenko V., Grebenev A. Internal diseases an introductory course – Moscov: Mir Publishers, 2006. – 545p.

  4. Essentials of Medical Psychology. – 2006. – 172p.

  5. Essentials of General Psychology. – 2006. – 134p.

  6. Talalaenko A.N., Donets V.F., Zayka T.O. Pharmacology. (Short textbook for the Students of the medical Faculties being educated in English). Part 1. General Pharmacological Principles and Pharmacology of Nervous System. – Donetsk M. Gorky Donetsk State Medical. – 2006. – 134p.

  7. Polewik I.V., Beketov A.I., Kurhenko M.G. Elementary Pharmacology (Short Manual For the Students of the Medical Faculties Being Educated in English). – Simferopol, 2004. – 258p.

  8. Burtsev O.K. Subject and tasks of Psychiatry and Narcology. Pathology of sensations and perception. – Lectures.

  9. Ryapolova T.L. Pathology of memory and thinking. - Lectures.

Tasks for self-preparation:

Task 5. A 36-year-old patient L. was referred by a therapeutist for consultation. The patient complained of a swollen head, numbing brain, knocking in his ears; his tongue getting swollen up. The patient was anxious, his mood was depressed, he was afraid that he had a brain tumor. The therapeutic examination did not reveal any pathology of the internal organs. Determine the patient’s feeling:

  1. Tangible hallucinations

  2. Senestopathies

  3. Hyperaesthesia

  4. Paraesthesia

  5. Hyposthesia

Task 6. A 40-year-old patient K. was delivered to the mental hospital by his relatives. A few days before his relatives had observed the patient sleeping badly and depressed his mood. Once at night his behavior was irrational. He began to listen to, checked if the door was closed, he was looking out of the window, and watched something with a great attention. He was sure that somebody was watching him and wanted to kill him. In admission department: the patient’s mood is depressed and suspicious. The patient oriented himself, in the time and space correctly. He reported some anamnestic facts, but he did it reluctantly. He said that he heard “some strange conversations”, behind the wall a few people discussing his actions and behavior. Some of them said that he was a “good-for-nothing man”, “a criminal”, that he did harm to his family that’s why he must be punished, even killed. And the others tried to protect and approved; recalled his merits and asked to “pardon” him. He did not see the people speaking but he heard the voices clearly and distinctly. He complained of the sense of fear, asked for help. What disorder of perception took a place?

  1. Real verbal hallucinations

  2. Verbal illusions

  3. Verbal pseudohallucinations

  4. Functional hallucinations

  5. Automorphopsy

Task 7. Patient S., aged 87, is a pensioner. For the last 5 years her relatives have noted her forgetting the relatives names. She cannot remember where she has put her things. She takes reckless actions and is helpless: when she leaves the house she is unable to come back because of forgetting her address. When examined by the psychiatrist she demonstrated an odd allopsychic orientation. She could not say how old she was. She could not say how many children she had and what their names were. The critical attitude to the disease is absent. Which memory disorder takes place?

A. Hypomnesia

B. Anteromnesia

C. Retromnesia

D. Fixation amnesia

E. Cryptomnesia

Task 8. Patient N.is 42 years old. Mental disorder appeared after the major operation. The patient complains of weakness, inability to concentrate his attention, “to collect his thoughts”. He easily gets tired in mental and physical activities. The patient states that he cannot keep in memory a text read. In conversations he loses the thread of talking. Objective examining: physical weakness, skin is pale. Arterial pressure – 90/60. There are no place have any pathology of internal organs. Neurological condition is normal. Mental state: he answers the psychiatrist’s questions correct, but in a slow tempo. Predominantly he gave short answers (only a few words). More complicated questions make the contact worse. Answers of a refusal character appear. It was difficult for the patient to concentrate his attention till the end of conversation, he gets tired quickly. Which pathology of attention takes place?

  1. Inertion of attention

  2. High digression of attention

  3. Aprosection

  4. High exhaustion

  5. Weakness of a movement of the attention


After learning of the chapters of the textbook solve the tests. If your answers are wrong, read the chapters of the textbook again.

Tasks for self-control

Task 9. A 17-year-old patient was hospitalized in neurosurgical department in a comatose state following a brain trauma. When he regained his consciousness, he couldn’t recall what he did in the morning, which he saw on the way, where he fell down. Determine the type of disturbance of memory in these patients?

  1. Anterograde amnesia

  2. Progressive amnesia

  3. Fixation amnesia

  4. Retrograde amnesia

  5. Hypomnesia

Task 10. The patient 80 ages doesn’t recognize her children and grandchildren, doesn’t remember their names and age, her address, where she worked and the position she occupied, if her husband is alive. From her daughter’s words, disturbances of memory in the patient appeared 5 years ago and developed in the following way: at first she forgot recent events, and then her memory began to lose more remote ones. What disturbance of memory does the patient have?

  1. Progressive amnesia

  2. Anterograde amnesia

  3. Fixation amnesia

  4. Retrograde amnesia

  5. Pseudoreminiscence

Task 11. The patient K. 36 age in during examination speech fast with prevailed of mechanical associations. The patient reveals of increased ability of reproduction of separate details since the last life. Recites of poems from the school program. What disturbance of memory does the patient have?

  1. Hypomnesia

  2. Hypermnesia

  3. Cryptomnesia

  4. Confabulation

  5. Pseudoreminiscence


^ GENERAL PSYCHOPHATHOLOGY. PATOLOGY OF EMOTIONS AND VOLITION.

This topic is the continuing of study of the general psychopathology and its main part – the semiotic of mental diseases. The disorders of emotions are leading in the clinic of mental and somatic diseases. During acute somatic disorder the reaction of personality to the fact of the disease appears. Its depth and steadfastness may differ, it may need psychotherapeutic or medicine correction. During chronic diseases more steadfast “totality of feelings” – “the inner picture of the disease” forms (R.A. Luria). Emotional may promote appearing of psychosomatic diseases. The disorders of emotions are often at psychosis, neurosis, and the disorders of personality. Because of the wide spectrum of the disorders of the emotions doctor of any specialty should be able to expose them and to carry out psychopharmacological and psychotherapeutic correction.

^ General purpose: to be able to expose and to classify the disorders of the emotions.

Obligatory skills to develop

Previous basics of knowledge

1. To carry out purposeful clinical research of emotions and will and evaluate expression and adequacy of feelings.

1. To take the history, to expose complaints, to carry out clinical examination of the patients.

2. To expose the objective features of the disorders of emotions and will.

2. To carry out pathopsychological research of emotions and interpret the received results.

3. To quality the exposed breaches as psychopathological symptoms.




4. To interpret the received results.

3. To collect facts from the patient’s anamnesis, find out his complaints and carry out the patient’s objective examination (Department of General and Faculty Therapy)

5. To classify the disorders as psychopathological symptoms.

4. To indicate the most informative signs of a breach of mental function disorders and to interpret the obtained results (The Cycle of Medical Psychology of Department of Psychiatry and Medical Psychology).


You can check your knowledge level with the following tasks:

Task 12. Patient S., 35, reading an interesting book didn’t notice his parents entering his room and asking him a question. One to which property of attention didn’t he react to the patients?

  1. Stability

  2. Distribution

  3. Volume

  4. Switching

  5. Concentration

Task 13. A 68-year-old woman with cerebral atherosclerosis complains of a fatigue, irritability, frequent headaches, absent-mindedness, insomnia. From 60 ages has decreased of memory, forgot phone numbers, names of relatives. At the examination: exhaustion of attention, remember of 10 words: 3, 3, 4, 3, 4. What memory processes disturbed in this patient?

  1. Recollection

  2. Storage

  3. Forgetting

  4. Memorizing

  5. All together

Task 14. During the research by the “Exemption of the superfluous” method the examinee choosed the thermometer from the group of things (thermometer, watch, glasses, balance). He explained that only sick persons need thermometer. Define the type of thinking:

  1. Obviously - operative

  2. Obviously – figurative

  3. Concrete

  4. Paralogic

  5. Abstract

Task 15. During the explanation of the metaphorical meaning of the proverb “An apple falls near the apple-tree”, the examinee told that “an apple always falls near the branch, on which it has been growed”. Define the type of thinking:

  1. Obviously – figurative

  2. Abstract

  3. Obviously - operative

  4. Concrete

  5. Paralogic


^ TABLE OF CONTENTS OF TEACHING

Questions:

  1. Disorders of emotion (apathy, blunted, flattened, labile, incontinence, incongruity of affect, anxiety, depression, elation, mania, phobias).

  2. Somatic and vegetative signs of emotion’s disturbances.

  3. Disturbances of effector-volition sphere.

  4. Disorders of will: abulia, hypobulia, hyperbulia.

  5. Disorders of attractions: increasing, decreasing, distortion of instincts.

  6. Compulsive attractions (dromomania, pyromania, gambling, Internet-dependence).

  7. Motor symptoms (stereotypies, posturing, negativism, echopraxia, ambitendency, waxy flexibility, stupor, abulia).

  8. Disturbances of consciousness and selfconsciousness.

  9. The state of consciousness in tiredness, in sleeping and dreams, affective cloudiness of consciousness.

  10. The main features of observation by the patients with disturbances of consciousness.

The literature

  1. Gelder M., Gath D., Mayou R. Oxford Textbook of Psychiatry. Second edition. – Oxford University press. – 1991. – 1080p.

  2. Gavenko N.I. Essentials of Medical Psychology - Kharkiv. - 2006. - 320p.

  3. Vasilenko V., Grebenev A. Internal diseases an introductory course – Moscov: Mir Publishers, 2006. – 545p.

  4. Essentials of Medical Psychology. – 2006. – 172p.

  5. Essentials of General Psychology. – 2006. – 134p.

  6. Talalaenko A.N., Donets V.F., Zayka T.O. Pharmacology. (Short textbook for the Students of the medical Faculties being educated in English). Part 1. General Pharmacological Principles and Pharmacology of Nervous System. – Donetsk M. Gorky Donetsk State Medical. – 2006. – 134p.

  7. Polewik I.V., Beketov A.I., Kurhenko M.G. Elementary Pharmacology (Short Manual For the Students of the Medical Faculties Being Educated in English). – Simferopol, 2004. – 258p.

  8. Ryapolova T.L. Pathology of emotions and effector-volitional sphere. - Lectures.

Task 16. Patient G. was a 14-year-old boy. His early years passed uneventfully. He growing as a merry and cheerful child. He finished 7classes of a middle school, he was studying in a musical college. Before hospitalization he became fussy and to match cheerful, garrulous; he was asking for some money from his neighbours and was sending it for sweets. Psychical condition in stationary department: patient is easy for a productive contact, his mood is rised, he is garrulous. He jokes all time, he strive for activities, interferes everywhere, “makes order”. He starts to make a lot of business, makes plans of the reorganization of department, but he doesn’t finish anything from that. Patient is fussy, unconsistent, friendly, easy irritable, can be coarse, he doesn’t keep regime but calms quickly. What kind of emotion’s breach has a place?

  1. Hypotymia

  2. Hypertymia

  3. Euphory

  4. Explosivity

  5. Patient is emotionally non-adequate

Task 17. Patient K., 8 years old. He was easy bitterness in early childhood, pinched his mother, beat his parents by legs, he hadn’t any reaction to punishment. He was dehampered, in a kindergarden he beat another children and spited in their plates. He was trying to burn different stuffs, tried to find matches, once he had set shed on fire. In a school he beat another children, during classes he got up on a desk, stained another children by ink. He was tormenting cats and draging them on their tails, “he was training them for pain”. Qualificate these branches of behaviour of this patient.

  1. Antisocial behaviour

  2. Demonstrative behaviour

  3. Simulative behaviour

  4. Aggressive behaviour

  5. Gallutinative behaviour

After learning of the chapters of the textbook solve the tests. If your answers are wrong, read the chapters of the textbook again.

Tasks for self-control

Task 18. Patient S., 26 years old, invalid of III group, suffers from mental disease since 14 years. Disease got malignant course. During last years the patient is in closed department of psychiatric clinic. Psychical condition: productive contact is difficult; it’s hard to draw his attention. Speaking is incoherent, often in a form of monologue. The patient is inactive, careless, spends much time in a bad. The patient is cynical. He masturbates in staff presence; he doesn’t find staying in the department hard. He doesn’t show interest in his mother’s dating. Which of the disorders of emotions was described?

  1. Apathy

  2. Emotional impoverishment

  3. Painful psychical anesthesia

  4. Hypothymia

  5. Irritability

Task 19. Patient G., 58 years old. She thinks that she’s been suffering from the disease during last two years. During the admission to the psychiatric clinic she tells about her disease readily and in details, strokes the doctor’s hand, asks about help with the tears in her eyes. She tells about her tearfulness “I can’t see a pitiful film without tears” “I always cry when I tell my grand-daughter about my youth”. During the conversation patient cries. In the department sometimes registers stormy highly emotional reaction on the less cause. Patient says “Earlier I was very patient, and now I burn as a match”. Which of the disorders of emotions was described?

  1. Emotional labiality

  2. Explosivity

  3. Tightness of emotions

  4. Tearfulness

  5. Hyperthymia

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