PSYCHOPATHIES (psychopathia; Greek psyche of a shower + pathos suffering, disease; synonym: psychopathic constitutions, constitutional psychopathies, psychopathic persons, pathological persons, pathological characters, anomalies of character, frustration of the personality) — a condition of resistant disharmony of the personality at sufficient safety of intelligence.
The item as an independent wedge, forms fullestly are also comprehensively described by P. B. Gannushkin. Disharmony of the personality at P. such is that interferes with painless social and professional adaptation of the patient. The psychopathic warehouse of the personality, though can be exposed to the known change, i.e. amplify or develop in a certain direction during life, represents constant inborn property of an individual. Patol, properties of the psychopath of a totalna, define structure persons (see).
Descriptions of the wrong behavior which is not followed by symptoms of psychosis contain in works F. Pinelya (1809). In 1835 Prichard (J. Page of Prichard) the option of patokharakterologichesky changes — moral insanity, in 1838 Zh. Eskirol — an instinctive monomania allocated. The domestic psychiatrist F. I. Gertsog in 1846 reported about persons, the Crimea strangenesses and falsities of character (irascibility, irritability, uncontrollability of inclinations) are inherent. Ideas of constitutional and genetic conditionality of P. proceed from B. Morel (1857) doctrine about a degeneration which was widely adopted in the second half of 19 century. Significant progress was outlined in this area thanks to V. Grizinger's works, 1886, G. of Model (1871), Krafft-Ebinga (R. Krafft-Ebing. 1897), promoting allocation of psychopathic states from group of so-called degenerative psychoses.
the Term «psychopathies» in foreign medical literature was entered by Y. Koch who in monographs «About Conditions of Psychopathic Inferiority» (1891 — 1893) and «Pathological characters» (1900) gave the typological description of borderline cases including and constitutional options of psychopathic persons. Development of the doctrine about P. in domestic psychiatry is connected with names of S. S. Korsakov, V. of X. Kandinsky, I. M. Baliysky, S. A. Sukhanova, O. A. Chechotta, V. M. Bekhterev. As an incentive to P.'s studying as showed O. V. Kerbikov (1971) researches in the field of history of domestic psychiatry, served pressing needs of forensic-psychiatric examination. V.'s views of X. Kandinsky on a problem P. were for the first time stated in 1883 in work «A case of doubtful state of mind before jury». He considered P.'s basis the wrong organization of a nervous system resulting in inconstancy, variability, instability, disharmony of all sincere life. Formation of psychopathies of V. of X. Kandinsky, as well as. M. Balinsky, connected with congenital anomalies of mentality.
V. M. Bekhterev in 1886 in the monograph «Psychopathy (Psychonervous Irritability) and Its Relation to a Question of Imputation» defined P. as patol, the states which are characterized by the expressed deviations in the mental sphere (lability of emotions, impulsiveness, insufficiency of moral sense). Items are the cornerstone of change in structure of a brain which cause malformations and the postponed diseases can be.
At the end of 19 — the beginning of 20 century in domestic and foreign psychiatry in a habit view the concept «psychopathy» as the inborn or acquired at early stages of life anomaly of the personality was formulated. The merit of allocation of P. in independent forms in a psychiatric systematics belongs to S. S. Korsakov who in «A course of psychiatry» (1893) devoted the special chapter to psychopathic constitutions. In it a psychopathy as inborn, caused genetically, and connected with the disturbance of development of a brain happening in the pre-natal period, is considered as the anomaly of character which is shown disbalance and disharmony of a sincere system. In 1904 in the guide to E. Krepelin's psychiatry the section «Psychopathic Persons» appeared. At the heart of a psychopathy, on E. To Krepelin, the disturbances caused by hereditary degeneration, damage at a stage of a germ or in a prenatal stage lie.
In further researches essential discrepancies in clinical and pathogenetic assessment of P. were found that found reflection in their classifications. E. Krepelin (1915) classification including 7 groups (excitable, impetuous — unstable, impulsive — people of inclinations, odd fellows, liars and deceivers — a pseudologia, enemies about-va — antisocial, patol, debaters), is not consecutive since one groups are allocated by the kliniko-descriptive principle, others — on social psychologically or just social.
A systematics To. Schneider (1923), as well as classification of abnormal persons of N. Petrilovich (1960), close to it, is constructed by descriptive psychologically principle: on the basis of the prevailing characterologic lines 10 psychopathic types — gipertimik, the depressive, diffident, fanatical, looking for recognitions are allocated. emotionally labile, explosive, heartless, weak-willed, asthenic.
E. Krechmer created P.'s classification by the principle «the movement from a disease to health». It took two polar groups of endogenous psychoses (schizophrenia, maniac-depressive psychosis) for starting point and respectively combined all anomalies of the personality in two types — schizos and a cycloid. For interpretation of a variety patol, characters which were considered within two constitutional types, AA. Krechmer put forward the concept of proportions, i.e. «collisions» in various combinations in each constitutional type of polar properties of the corresponding temperament. The diatetichesky proportion is inherent to a cycloid (various ratios between the increased and depressive affect). The psikhestetichesky proportion is characteristic of schizos (various ratios between a hyperesthesia and anesthesia). One of the main shortcomings of the concept of E. Krechmer — ignoring of qualitative distinctions between a warehouse of the personality as option of the norm expressed by anomaly of the personality (psychopathy) and painful frustration, including finding a tendency to a progrediyentnost (schizophrenia).
In domestic psychiatry since 30th 20 century the greatest distribution was gained by classification of psychopathies of P. B. Gannushkin. In the monograph «Clinic of Psychopathies, Their Statics, Dynamics, Systematics» P. B. Gannushkin allocates the following groups: cycloid, astenik, schizos, paranoids, epileptoida, hysterical characters, unstable psychopaths, antisocial psychopaths, constitutional and silly. The important place in this classification is taken by the constitutional P.' group (schizos, a cycloid, epileptoida) which are directly resisting to certain psychoses. Unlike E. Krechmer's classification, psychopathic types in it received already known a wedge, definiteness. E.g. P. B. Gannushkin opposed assessment of anomalies of the personality and psychoses as the states differing only on degree of intensity of painful manifestations. Across Gannushkin, not procedural strengthening of schizoid lines can develop to the state which is already at a boundary between sincere health and a disease (patol, character, boundary type), i.e. only to level P. Existence of such mental constitution does not predetermine developing of psychosis yet. The similar position was taken by T. I. Yudin (1926).
the Leading role in P.'s etiology, according to a number of researchers, belongs to constitutional predisposition, genetic factors. Value of genetic factors is revealed by Shields (J. Shields, 1972), O'Connor (M. O’Connor) with sotr. (1980) at the twin researches which showed that among monozygotic partners concordance on anomalies of the personality is several times higher, than among dizygotic. About same similarity of abnormal personal characteristics at the monozygotic twins who are brought up separately testifies. Also significance is attached to not rough organic exogenous injuries of a brain to the pre-natal, early post-natal and perinatal periods of development connected with various diseases of a brain (an infection, an injury, intoxication). These patokharakterologichesky changes are defined as organic Items.
According to O. V. Kerbikov's representations P.'s formation is possible not only at constitutional predisposition and anomalies of development, but also at adverse environmental and situational influences. V. P. Osipov (1936) such described the acquired P. as a pseudo-psychopathy, E. K. Krasnushkin (1940) — as reactive psychopathies, A. K. Lenz (1927) — as sociopathy. A number of foreign psychiatrists refers the changes of the personality connected with harmful social conditions to sotsiopatiya (an adverse family situation, neglect, etc.).
V. A. Guryeva and V. Ya. Gindikin (1980) researches showed that emergence and fixing of psychopathic manifestations can be caused by imitation psychopathic behavior of people around (fixing of reaction of imitation, imitation) or cultivation by people around of psychopathic reactions of the teenager, fixing of the negativistichesky reactions (reaction of a protest, opposition) repeating owing to features of a situation. Association of the acquired psychopathic states with constitutional anomalies is not conventional. From the point of view of a wedge, practicians it is fraught with danger of expanded diagnosis of psychopathies. V. V. Kovalyov (1979) considers the acquired psychopathic states within psychogenic patokharakterologichesky formations of the personality, A. E. Lichko (1977) — within psychopathic or patokharakterologichesky development. Than a deviation of century of N of in cases patol, development of the personality at favorable changes of the social environment it is easier (in comparison with constitutional P.) give in to involution. According to G. E. Sukhareva (1959), emotional life of such persons is richer, interests are steadier, their highest forms of strong-willed activity are developed, there is no infantility.
the Pathogeny is studied insufficiently. E. Krepelin (1915) referred the disturbances in process which are shown partial infantility to the main mechanisms of formation of P. However, not only the partial delay of formation of these or those properties of the personality is inherent to psychopaths. As showed G. E. Sukhareva's researches, among the types of a dizontogenez which are the cornerstone of anomalies of the personality along with the detainee (disproportional) and damaged development which is also distorted is observed (see. Mental dizontogenez ).
From positions neyrofiziol. I. P. Pavlov's doctrines P.'s formation is connected with disturbances in the ratio of the main properties of century of N of and in interaction of the second and first alarm systems. O. V. Kerbikov, N. I. Felinskaya (1977), G. K. Ushakov (1978) on the basis of correlation patol, the devil of the personality with the prevailing types, select to century of N of excitable and tormozimy Items. Excitable psychopaths treat representatives of extreme options of impetuous type. Kinds of tormozimy psychopaths correspond to weak types of century of N of. Among hysterical psychopaths persons of art type with a prevalence of the first alarm system prevail. Patol, mobility and inertness of the basic nervous processes are respectively unstable and paranoic
P. N. A basis. Krasnushkina (1971), investigating electric activity of a brain, found in psychopathic persons of disturbance of interaction between a cerebral cortex, structures of an interstitial brain and a reticular formation. The basis of disturbances at P. as A. M. Ivanitsky (1976) showed, is made by changes of regulation of afferent flows in a brain that is caused by change of the general tone of the subcrustal centers.
Veyllant and Perry's Researches (G. E. Vaillant, J. Ch. Perry, 1980) showed that depending on criteria of diagnosis of P. at adult population make 5 — 15%. According to E. D.» Sokolova (1980) and other researchers, among staying on the registry in psychoneurological clinics and arriving in psychiatric-tsy psychopathic persons make 4,3 — 5%. According to Gorvaya (I. Horvai, 1968), 10,04% hospitalized in psychiatric hospitals are made by psychopathic persons. A number of researchers specifies that among psychopathic persons males prevail.
The clinical picture
Allocation of types P. is conditional since the mixed types are generally observed. According to Broytigam (W. Bräutigam, 1978), it is impossible to carry 66,2% of psychopathic persons to one pure type. In a basis the wedge, P.'s classifications lies the principle of allocation of the properties, main, obligate for this personality.
Wedge, a picture P. is considered in a statics and dynamics. At the description it in a statics is allocated by the following types of psychopathic persons: schizoid (schizos), paranoic, psychasthenic, asthenic, affective (cycloid), hysterical, excitable (epileptoida), unstable (weak-willed). The schizoid psychopathic personalities — closed, the unsociable, reserved, deprived of flexibility people. Their contacts with people around have formal character; attachments are limited to a narrow circle of the family or friends in whose choice they are very picky. Allocate extreme (in the presence of a wide scale of passage types) types of schizoid psychopathic personalities: sensitive and expansive. Sensitive schizos are vulnerable, sensitive (mimozopodobna), giperestetichna, are pensive; they easily get tired, avoid rough manifestations of feelings, are painfully ambitious. The deep and long reactions which are followed by the sensitive ideas of the relation in response to these or those ethical conflicts (office or house failures, sexual complexes) are characteristic of them. Expansive schizos — the cold, resolute, strong-willed natures indifferent to needs of others; they are sometimes heartless and are even cruel, but at the same time are open to injury, with deeply hidden dissatisfaction and uncertainty in themselves.
Paranoic psychopathic persons are inclined to formation of the supervaluable ideas in the power of which they also appear then. These are people of the unilateral, but resistant affects getting the best of logic. They are distinguished by the distrustfulness, vigilance in relation to people around which are combined with the increased self-conceit, sensitivity, narrowness of an outlook and limitation of interests. Carry pathological jealous men, hypocrites to this type P., sutyag, the persons inclined to the conflicts and a reformatorstvo, and also fanatics, i.e. persons with the blind person, the confidence which is not demanding logical justification (e.g., religionism), degree a cut happens such is that fanatics are capable to carry away the idea others.
Psychasthenic psychopathic persons differ in tendency to doubts, lack of internal confidence in correctness of the judgments and acts, in assessment of people, at last, in indecision in acts. S. A. Sukhanov (1905) carried persons with alarming and hypochondriac character to this type, and Schneider (K. Schneider, 1923) — anankast which In it the ant and Perry (1980) define l of l within a compulsive psychopathy. Anankastichesky psychopathic persons alarming are hypochondriac, scrupulous, conscientious, are sometimes excessively careful, constantly find a reason for concern, in panic are afraid of the future troubles, are anxious not only about themselves, but also about others. They differ in the rigidity, commitment to an order and any conventions which is combined with fears to make a false step, superscrupulousness; tendency to fixing of some neurotic frustration is inherent to them (phobias, tics, etc.).
The general nervous weakness, insufficient activity, the increased shyness, impressionability, fatigue, and also vegetative stigmatization (constitutional neuropathy) which is found since childhood is characteristic of asthenic psychopathic persons. At such persons in the course of the work demanding tension of forces concentration of attention is quickly broken, productivity decreases. At the unusual, going beyond daily situations along with a febricula, a headache, the amplifying exhaustion, there is a hyperesthesia, irritability, sometimes fits of anger. Ya. B. Gannushkin (1933) carried hypochondriacs to asthenic psychopathic persons, Schneider (1923) and E. K. Krasnushkin (1960) — somatopat at which into the forefront concern in a condition of the health acts. They concentrate the attention on activity of an organism, and insignificant functional frustration are fixed, psikhogenno amplify and fixed.
Affective psychopathic persons (cycloid) — sociable, kind, friendly, good-natured people. Their distinctiveness — emotional lability, instability of affect. The changes of mood arising in connection with psychogenic influence or it is causeless, can reach depth of the expressed affective phases (see below). Distinguish from affective psychopathic persons distimik and gipertimik. Distimiki — inherent pessimists, silent, sad, the most part of time staying in gloomy mood. Gipertimiki — optimists, enterprising, quite often versatily gifted, mobile, irritable people. Their irrepressible activity can be the reason of the numerous conflicts.
«thirst of recognition», aspiration to draw attention to themselves and to appear before the surrounding more considerable persons allocated with advantages and opportunities which they do not have are inherent to psychopathic persons of hysterical type. Hysterical psychopaths are inspired, to their judgments lacks a maturity and gravity, emotions — depths and stability; the behavior is dictated not by internal motives, and is expected outer effect. To draw attention, to reach the desirable or, on the contrary, to avoid troubles, they use all possible — eccentricity in clothes, theatricality, peacockery, unusual acts, views contrasting with standard, mysterious symptoms to nobody the known disease, which suddenly appeared at them faints, and also slanders and self-accusations. As Delbryuk noted (A. Delbrück, 1891), a specific place among hysterical psychopaths is held by the pseudologias finding tendency to fantastic fictions. Distortion of the valid sense, a lie, exaggeration of real events characterizes their behavior. Dyupre (E. Dupre, 1933) allocated such psychopaths in independent group — mifoman, E. Krepelin (1915) — liars and swindlers, P. B. Gannushkin (1960 — patol, liars. Fantastic. constructions and a lie of pseudo-logs are not always innocent. The definite mercenary purposes leading to offenses are more often pursued.
Excitable psychopathic persons differ in irascibility, irritability, rancor, sometimes the cruelty which is combined with sadistic bents. Similar persons form group of epileptoid at which psychopathic manifestations are similar to changes of the identity of patients with epilepsy. Some researchers allocate epileptoid in independent type P. In life they are active, persistent, stubborn, apply for leadership, are intolerant of opinion of others in this connection they quite often have conflicts with people around. Early the found tendency to gloomy mood is combined at them with periodically arising short dysphorias. The most characteristic forms of reaction at excitable psychopathic persons — the attacks of anger, rage arising at the slightest pretext affective categories. Inability to constrain inclinations, and also the tendency to rash, and at times and dangerous actions amplifying in connection with alcoholic excesses lead them quite often to violent acts.
Weakness of the highest forms of strong-willed activity, suggestibility, vulnerability in relation to any external influences, the inconstancy which is combined with inability to purposeful activity is inherent to unstable (weak-willed) psychopathic persons. Without hesitation they change decisions and installations, the place of work and a profession, do not finish the begun business, live in one afternoon, without having serious plans, without thinking of the future. The main driving mechanism of their life — thirst of new impressions and pleasures. They easily adopt negative forms of behavior, indulge in alcoholism, do drugs, submit to bad influence, quite often make the offenses which are limited most often to small thefts, hooligan acts.
Irrespective of type P. of psychopathic persons hypersensitivity to action internal (e.g., the critical age periods) and external somatogenic and psychogenic influences distinguishes. At superficial anomalies these or those psychopathic deviations can remain a long time latent (latent psychopathies, across Gannushkin), without breaking processes of social adaptation. At aktsentuation of the personality there is strengthening not of all features of the personality, but her separate lines that does not lead to noticeable disadaptation and gains considerable expressiveness only during the periods biol, perturbations (the pubertal period, involution), and also under the influence of the situational and psychoinjuring factors. In such cases clinically expressed anomalies of character come to light only in dynamics. Schematically in the loudspeaker P. it is possible to allocate two ground states: compensation and a decompensation which are defined by interaction of a number of factors (weight and type P., age, social conditions). On materials of the katamnestichesky research conducted in 1966 Mr. of R. Tülle, rather full compensation is possible to lay down at 2/3 psychopathic persons who were earlier needing in. help and even hospitalization. The disturbances of compensation caused by endogenous features of dynamics or connected with influence of environmental factors are designated as a decompensation. Clearly communication of a decompensation acts with age. By results of the kliniko-statistical analysis which is carried out in 1973
by Ya. Gindikin, the largest frequency of psychopathic manifestations falls on the next age periods: 3 — 4 years, 7—8, 13—14, 18 — 20 years, 30 — 31 year, 42 — 43 years, 48 — 50 years. At the same time the most dangerous periods for approach of a decompensation are age crises. Among manifestations of the decompensation which arose during the transition age periods, especially in pubertal the reactions of a protest (opposition) which quite often have the nature of supervaluable educations are most often observed (see. Supervaluable ideas ) — offense on parents in connection with insufficient attention about their parties, the restrained vanity, desire to revenge. They are shown by disobedience, failure from food, grubostyo, an agressive behavior, escapes from the house, suicide attempts.
Manifestations divide loudspeakers P. into spontaneous phases and pathological (psychogenic) reactions. Spontaneous phases can arise at psychopathic persons unjustly or under the influence of the external or somatogenic factors playing a role of releasers. After end of phases the state taking place till their beginning is established. Wedge, a picture of phases includes the broad range of the psychopath of l. frustration — from the easiest causeless changes of mood, passing fluctuations of affect inherent to most of psychopathic persons, an endoreactive dysthymia of Vaytbrekht (see. Depressive syndromes ), dysphorias to rather seldom found heavy long depressions. Along with the phases proceeding with dominance of affective frustration in the loudspeaker P. asthenic, asthenohypochondriac, neurotic states which according to the existing systematics can be carried to are observed to neurosises (see).
Patol, reactions — psychopathic, neurotic or psychotic symptom complexes. which arise in response to external irritations, both somatic (somatogenic reactions), and mental (psychogenic reactions). Carry to pathological (psychogenic) reactions reactive psychoses (see), and also constitutional reactions. Considerable weighting of the main abnormal lines of the personality (e.g., schizoid reactions at schizoid psychopaths), in more hard cases — strengthening of all psychopathic properties of the personality can be a wedge, manifestation of constitutional reactions. Refer hypochiondrial, hysterical, paranoic and some other reactions to such universal forms of psychopathic reaction. The psychopathic reactions gaining long character and leading to gradual deepening patol of manifestations, are defined as pathological development of the personality (see).
Existence in mentality of this or that subject in general of any separate characterologic deviations does not give the grounds for diagnosis of the Item yet. The diagnosis is established on the basis of the anamnesis, by a wedge, pictures.
At differential diagnosis the wedge, pictures consider features of a state and pattern of dynamics. Items differentiate with a psychogenia, for a cut acute emergence of psychopathic symptomatology, the expressed dynamism of painful manifestations which is followed by expansion of their circle and formation at influence of external factors of syndromes of a reactive disease, the considerable specific weight of neurotic symptomatology and senesthopathias are characteristic. At epileptic paroxysms and other phenomena of the broken consciousness, at rudimentary displays of psychosis or symptoms of dementia connected with earlier postponed disease process, P.'s diagnosis is excluded. The greatest difficulties arise at P.'s differentiation and the pseudo-psychopathies acquired most often as a result of the postponed mental disease. One-planned character of structure, monotony and a monomorfnost of psychopathic lines is inherent to pseudo-psychopathies; dynamics of pseudo-psychopathies has a number of the features consisting in reflection of properties of the disease which caused their formation. If in the loudspeaker P. reactive lability is found. that is characteristic of the pseudo-psychopathies which resulted, e.g., from the postponed schizophrenia monotony of the mental reactions a little connected with influence of external factors and having sometimes paradoxical character.
Treatment and prevention
the Solution of the problem of compensation of anomalies of the personality demands purposeful social and environmental, pedagogical and medical influences.
Prescription of medicines at P. is shown to hl. obr. during the periods of acute and long reactions and phases, at the expressed anomalies of the personality, in the cases finding a tendency to frequent decompensations. Along with medicinal therapy it is carried out psychotherapy (see), main objectives a cut — compensation of characterologic deviations and stimulation of socially useful activity.
P.'s prevention — the prevention of prenatal, early post-natal and perinatal damages of a nervous system. The normal intra domestic surroundings promoting harmonious development of the personality are of great importance for formation of the full-fledged personality. In this regard perhaps early identification of parents with psychopathic behavior and asocial bents and use of measures to them medical and social character is represented essential. In the most hard cases withdrawal of the child from a dysfunctional family is possible.
At the created P. preventive actions are directed to stabilization of a condition of the fullest compensation and prevention of a decompensation — improvement of the environment, isolation of the psychopath from the persons with bents to criminal acts abusing alcohol, addicts and also formation of the permanent labor installations and skills providing successful professional activity.
At commission of an offense psychopaths (except for cases with profound psychopathic changes) admit responsible and are subject to criminal liability.
Bibliography: Gannushkin P. B. Chosen works, page 116, M., 1964; Guryeva V. A. and and N d and to and and V. Ya. Youthful psychopathies and alcoholism, M., 1980, bibliogr.; Kerbi-k about in O. V. Chosen works, page 37, M., 1971; Lichko A. E. A psychopathy and accentuation of character at teenagers, L., 1977; Sukhareva G. E. Clinical lectures on psychiatry of children's age, t. 2, M., 1959; Yudin T. I. Psychopathic constitutions, M., 1926; Bräutigam W. Reaktionen, Neurosen, Abnorme Persönlichkeiten, Stuttgart, 1978; Leonhard K. Akzentuierte Persönlichkeiten, B., 1976; Petrilowisch N. Abnorme Persönlichkeiten, Basel — N. Y., 1960; Schneider K. Die psychopathischen Persönlichkeiten, Lpz. — Wien, 1923; Tülle R. Katam-nestische Untersuchungen zur Biographie abnormer Persönlichkeiten, B., 1966; V an i 1 1 n t G. E. and. P e of of at J. With h. Personality disorders, in book: Comprehens. textbook of psychiat., ed. by H. J. Kaplan and. o., v. 2, p. 1562, Baltimore — L., 1980, bibliogr.
A. B. Smulevich.