Theme Main psychopathologic syndromes



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Theme 9. Main psychopathologic syndromes.


  1. The psychopathological syndromes of sensation and perception:

asthenic, senesthopathic, hypochondriac, metamorphopsia, syndrome of intermetamorphose, hallucinosis, derealisation, depersonalisation.

  1. The psychopathological syndromes of memory:

amnestic syndrome, Korsakoff’s productive and non-productive.

  1. The psychopathological syndromes of thinking:

overvalued ideas, obsessive syndrome, obsessive-phobic, obsessive-compulsive, paranoia, paranoid, paraphrenic, Clerambault-Kandinsky syndrome (ideational, affective and motor automatisms), Cotard's syndrome, dysmorphomanic.

  1. The psychopathological syndromes of intelligence:

mental retardation, partial dementia, total dementia syndrome, Ganser's.

  1. The psychopathological syndromes of emotions and mood:

anxiety syndrome, phobic, hypomanic, manic, depressive, dysphoric, agitated depression, masked depression.

  1. The psychopathological syndromes of Behaviour, violation and drivers:

apathetic-abulic, hypobulic, hyperbulic, hyperkinetic, apathetic stupor, depressive stupor and agitation, psychogenic stupor and excitation, catatonic stupor and excitation, neurotic stupor and excitation, hebephrenic excitation.

  1. The psychopathological syndromes of Consciousness: obnubilation, somnolent, soporouse, coma, delirious, oneiroid, twilight state of consciousness (somnambulism, absence, fugue, trance, ambulatory automatism), amentive syndrome.

  2. Hysterical, Fregoly psychopathological syndromes, syndrome of "the third person", Kanner's syndrome, "Wildness", organic brain syndrome, encephalopathic, Da Casta's, syndrome of changed reactivity, syndrome of psychological dependence, syndrome of physical dependence, bstinent syndrome.


Clinical tests

Below case descriptions are presented, and in each case 5 variants of syndromal diagnoses are suggested. Choose the right option.
1. A male patient, 37 years old, became too cheerful for no particular rea­son, he has a subjective feeling of high creative abilities, enthusiasm, elation and increased productivity, in spite of manifest disability to concentrate (im­paired attention); his speed of thinking processes is too high. He is uncritical to his state, and finds it normal.

Name the syndrome:

- Manic (non-psychotic) syndrome

- Syndrome of dysphoria

- Hypomanic (non-psychotic) syndrome

- Obsessive syndrome

- Depersonalisation syndrome


2. A patient, while making repairs at home, suddenly stood quite still with the painting brush in his hand, then dropped it. This state lasted for a few seconds. After that the patent was rather confused, for some moments he couldn't understand what was happening. He totally forgot the state he was in and the events around him, occurring while he was in that state.

Name the syndrome:

- Obnubilation

- Trance

- Fugue


- Absence (petit mal)

- Derealisation


3. A male patient 27 years old complained that suddenly and unintention­ally he found himself in a different city. He couldn't understand, how this could happen. During his travel, of which he was completely unaware, he made an impression of a person who was slightly confused and absentminded, absorbed in his thoughts, but his behaviour was more or less normal.

Name the probable syndrome:

- Fugue


- Trance

- Clerambault-Kandinsky syndrome

- Somnambulism

- Absence (petit mal)
4. The patient complains that all the police forces in the country are after him, and there are many "spies" in the department. He states that certain persecutors aim at taking away his money and remove him from his position at work. His awareness is not disturbed. The orientation in space and time is normal. His insight is impaired, the patient is sure he is sane. The behaviour corresponds to his thoughts and experiences; the patient demands justice, writes letters to different official bodies, asking to defend him from the ac­tions of the "spies."

Nome the probable syndrome:

- Paranoia syndrome

- Paraphrenic syndrome

_- Paranoid syndrome

- Clerambault-Kandinsky syndrome

- Cotard's syndrome


5. The observed patient's movements are retarded, she doesn't react to the attempts to contact her, answers no questions. Sometimes she spontane­ously stays in strange postures. It is possible to set (form) her body and limbs into different positions artificially. For instance, if the psychiatrist lifts her arm or leg, so that she remains standing on the other leg, the patient can stay in such an inconvenient position for quite a long time.

Name the probable syndrome:

- Depressive stupor

- Apathetic stupor

- Psychogenic stupor

_- Catatonic stupor

- Neurotic stupor


6. The patient has disturbed orientation in the environment and time, but orients well in his own personality. He takes the hospital for a railway station, and the other people — for passengers. Has visual hallucinations: sees white mice, cats and dogs, tries to shake off spiders, that seem to crawl over his body, feels disgust and fear. Tries to run away without explaining his intentions.

Name the probable syndrome:

- Somnolent syndrome

- Soporouse syndrome

- Oneiroid syndrome

- Delirious syndrome

- Amentive syndrome


7. The patient had consulted the psychiatrist several times. During this visit the complaints were as follows: the state occurred acutely, she felt that her body had changed "as if it was not hers", her voice became "somehow different." As she stood at night near the window, she suddenly saw her body as if from aside, and "felt the experiences and sensations of both bodies si­multaneously." The patient told the psychiatrist that all night she seamed to "live double life."

What is the syndromal diagnosis?

- Apathetic syndrome

- Derealisation syndrome

- Depersonalisation syndrome

- Paraphrenic syndrome

- Visual hallucinosis syndrome


8. At the psychiatric department the patient is lively and cheerful, her eyes shine, and her mood is elevated almost all the time. Her clothes look rather extraordinary: the slippers are decorated with bows and a lot of cot­ton wool balls are sewn all over her jersey. Her hair is made into a strange coiffure, her lips are painted with bright lipstick. The patient is excessively energetic and restless, she intrudes into every activity going on at the depart­ment, dances, sings, makes sexually advances to male visitors of the depart­ment. Seems never to get tired, sleeps only for 3 or 4 hours at night, her appe­tite is increased. Speaks very quickly, with no pauses, can't keep one line of conversation, and constantly "skips" from one topic to another.

Name the syndromal diagnosis.

- Catatonic excitation

- Manic syndrome

- Hebephrenic excitation

- Hyperbulic syndrome

- Hysterical syndrome


9. The patient is excited and restless, incessantly walks around the room, wrings her hands, weeps and groans. There is an expression of fear on her face. Asks the people around her to save her family, which is sure to be in great danger. Promises to give the people much money for rescuing her rela­tions. The personnel can't dissuade her: the patient stays extremely anxious. Couldn't sleep for two nights, and hasn't eaten any food for three days, say­ing, "How can I eat, when my dear ones are dying?" Tried to commit sui­cide.

Name the syndromal diagnosis.

- Hypochondriac syndrome

- Anxiety and depressive syndrome

- Agitated depression syndrome

- Masked depression syndrome

- Catatonic syndrome


10. Patient B., 51 years old, during the last 5 months didn't work, and had consulted a number of different doctors. Complained of weakness, sleeplessness, and bad appetite. Has a lot of unpleasant sensations in dif­ferent parts of his body, which are difficult to describe: "my heart is as if peppered," "blood makes noises in my veins," "I feel emptiness in my chest," etc. In spite of satisfactory results of medical investigations, the patient remains anxious and thinks that doctors conceal the diagnosis from him.

What is the syndromal diagnosis?

- Depressive syndrome

- Hypochondriac syndrome

- Senesthopathic hypochondria

- Asthenic syndrome

- Paranoiac syndrome


11. Patient S., male, 52 years old, an actor by profession, during a re­hearsal suddenly began to bite others and fool about: he ran around the stage, made faces, laughed loudly, tore the decorations, recited senseless rhymes, which he made up himself, then jumped down into the orchestra pit. Didn't let anyone come near him, was aggressive and used dirty language when peo­ple tried to stop or catch him. Before anyone could stop him, the patient sud­denly ran out into the street shouting, "Art for the masses!"

Name the probable syndrome:

- Maniacal excitation

- Catatonic excitation

- Hysterical excitation

- Agitated depression

- Hebephrenic excitation


12. Patient O.,72 years old, a cobbler, has no complaints. The patient is polite in communication with others. Greets the doctor several times a day, whenever he meets him. Can't name the date, month or year. Says, "I've come here today and drove my car, it is parked outside in the yard", (really the patient has spent a month at the psychiatric hospital). In a few minutes after the interview with his psychiatrist, completely forgot the content of their con­versation, and told his son: "the doctor showed me the photo of his wife and gave me some wine." The patient remembers well most of the events that oc­curred when he was young, can tell the dates if important historical events, but forgets recent events. The professional skills are intact.

Name the syndromal diagnosis:

- Asthenic syndrome

- Total dementia syndrome

- Partial dementia syndrome

- Organic brain syndrome

- Wernicke-Korsakoff syndrome


13. Patient V., male, 13 years old, is short, has dysplastic body frame. The occipital part of his head is flat, eye slits are narrow and slanted. Mimic movements are poor, the mouth half open. Tries to keep near the nurse. Is capable of doing simple errands (sweep and wash the floor, make beds, bring meals to other patients). Speech and language skills are underdeveloped, uses phrases consisting of 2 or 3 words, articulation is disturbed. Can't read or write. Is incapable of acquiring academic skills.

Name the syndromal diagnosis:

- Mental retardation syndrome

- Dementia syndrome

- Amnestic syndrome

- Organic brain syndrome

- Apathetic syndrome


14. Patient A., male, 66 years old, is a chronic patient of a psychiatric hospital. Isn't oriented in the environment; can't find his bed and lies down on somebody else's, is untidy when he eats. His mood changes frequently, often is angry and scolds people and grumbles, and sometimes is complacent and promises to "load everyone with money." Doesn't remember his doctors name, doesn't recognise his relatives who come to see him. Sometimes becomes anxious, looks for something under his bed, ties up his things in a bundle and sits on it. Explains these actions, telling that "there are thieves and robbers" around him. Directly after having had lunch says, that he didn't eat anything for three days and is starving, asked for a piece of bread.

Name the syndromal diagnosis:

- Mental retardation syndrome

- Amnestic syndrome

- Organic brain syndrome

- Dementia syndrome

- Paranoid syndrome


15. Patient A., female, 30 years old, at the psychiatric inpatient department lies all the time in bed, without changing her posture. Manifests no reaction to the changes in the environment, presence of other people, and sounds. Is abso­lutely devoid of activity. Doesn't eat on her own, has to be fed from the spoon. When a doctor or some other person speaks to her, the patient doesn't answer, but seems to listen and sometimes tears appear in her eyes. Her facial expression is constantly sad. Her muscular tonus is somewhat increased.

Name the syndromal diagnosis:

- Psychogenic stupor

- Catatonic stupor

- Asthenic stupor

- Apathetic and abulic stupor

- Depressive stupor
16. Patient N., 34 years old, an engineer, after a year of extremely intensive work with very little rest, noticed that he could hardly bear all kinds of external stimuli: "The shirt collar seems too tight, bright light simply enrages me, usual conversations between other passengers in the bus irritate me so much, that often I get off before my stop to compose myself."

- Depressive syndrome

- Hypochondriac syndrome

- Senesthopathic hypochondria

- Asthenic syndrome

- Paranoiac syndrome


17. Patient K., 29 years old, was brought to the psychiatric hospital by an ambulance because gradually he became passive, silent, stayed most of the time in bed, but did not sleep. Then he stopped answering his relative's questions and refused to eat. This state lasted for 12 days, then the patient returned to his normal state. He told the doctor that he remember how he was brought to the hospital, and what happened to him there. At the same time he recalled that he found himself in a huge hall with tall columns and mar­ble floor. The hall was so high, that clouds gathered near its ceiling. One staircase led to the hall from the sky, and another came up to in from below. Then he saw angels coming down the first staircase and devils coming up the second. They began a battle, and K. felt great responsibility for its outcome: it was his mission to save the world from evil powers.

- Somnolent syndrome

- Soporouse syndrome

- Oneiroid syndrome

- Delirious syndrome

- Amentive syndrome


18. Patient A.K. male, 56 years old, was hospitalised in the state of severe alcoholic delirium. The psychotic state with consciousness disturbance lasted for 7 days, and after restoration of consciousness the patient didn't remember at all when and why he was hospitalised. Every time he was asked about the circumstances of entering the hospital his answers varied: he said that he came there "today" because he "had a cough" (or "pain in his back", or "stomach problems", etc.). His descriptions of "yesterday" varied too: he was "at a football game" (or "stayed at home with his little daughter", or "went in his car to visit his parents"). He had no sense of time, and could not remember the way to his ward. He could never say, what he had for breakfast or lunch, or whether his relations came to see him today.

- Mental retardation syndrome

- Amnestic syndrome

- Organic brain syndrome

- Dementia syndrome

- Wernicke-Korsakoff syndrome


19. An elderly female patient, who lived in a communal flat, repeatedly complained to a policeman that her neighbour was trying to harm her. The patient was sure that this woman was a witch: she muttered something when she passed the patient's door, boiled some "magic potion" in the common kitchen with the aim of bewitching others, and put "herbal amulets" up on the attic with the same purpose. The patient had no hallucinations and spoke logically enough, trying to prove her beliefs. The policeman wanted to find out what was really happening, and came to speak to the neighbour. She told him that she really had a habit to speak to herself, and that she had a chronic disease for which she took herbal medicines (she kept the herbs in the attic and made the decoct herself). In spite of the proofs the policeman provided, the patient’s false beliefs re­mained unchanged. In fact, she decided that the policeman was also 'be­witched', and after the row she set up with him and the neighbor, an ambu­lance was called and she was taken to the psychiatric hospital.

- Paranoia syndrome

- Paraphrenic syndrome

- Paranoid syndrome

- Clerambault-Kandinsky syndrome

- Cotard's syndrome


20. A man, 36 years old, was brought to the psychiatric hospital from a police station. During the night previous to the hospitalisation he couldn't go to sleep and felt anxiety. He heard a car driving up to the house and voices speaking in the yard. He suddenly "understood" that the people in the yard were robbers, and heard voices threatening and abusing him from outside. He spent a sleepless night, and early in the morning hurried to the police station. On the way there he continued hearing loud abuses and threats in the street, and was sure that robbers, who were hiding behind trees (he saw nobody), were watching him. At the psychiatric department the patient still heard voices, shouting threats from the corridor, and was sure that some of the patients belonged to the group of his persecutors.

- Paranoia syndrome

- Paraphrenic syndrome

- Paranoid syndrome

- Clerambault-Kandinsky syndrome

- Cotard's syndrome


21. A schizophrenic patient states that he is "a raven sitting on Satan's shoulder," and as an answer to the question, where is Satan, points to another patient. "I can die and come back to life whenever I wish to – continues the patient – and the soul comes out of my body in the form of a flock of crows, flying above my head." He can see these crows with his "inner eye." He also can "talk with spirits", whose voices he hears "in his ears."

- Paranoia syndrome

- Paraphrenic syndrome

- Paranoid syndrome

- Clerambault-Kandinsky syndrome

- Cotard's syndrome


22. Patient A., male, 25 years old was hospitalised after he set a wardrobe on fire, when he was alone in his flat. He explained this action as follows: "I didn't do it. My acquaintance, Nadya, used laser rays to manipulate my arms and hands at a distance. She took up some paper with them, tore it up, threw it on the bottom of the wardrobe, and put a burning match toil..."

- Paranoia syndrome

- Paraphrenic syndrome

- Paranoid syndrome

- Clerambault-Kandinsky syndrome

- Cotard's syndrome


23. At the psychiatric department the patient has no motivation, no incen­tive, and no wishes. She doesn't speak to anybody, spends all her time in bed, fencing herself from others with a blanket. Eats only if she is led to the table under compulsion and fed with a spoon. Often urinates in bed and has no initiative to ask someone to change her bedclothes.

Name the probable syndrome:

- Organic syndrome

- Apathetic-abulic syndrome

- Asthenic syndrome

- Depressive syndrome

- Catatonic syndrome


24. The patient consulted a psychiatrist with a complaint of being what he called "too pedantic." He told the doctor that he simply couldn't begin doing any work without putting all his instruments symmetrically. "Recently I had to repair my car, but was putting the wrenches and screw drivers sym­metrically instead." Conflicts often occurred in the family about trifles: the patient insisted that all the things had to lie symmetrically. Otherwise he felt discomfort and nervous tension.

What is the probable syndromal diagnosis?

- Depressive syndrome

- Obsessive-compulsive syndrome

- Asthenic syndrome

- Cotard's syndrome

- Dysmorphomanic syndrome


Clinical tasks

1. A male patient 22 years old, complained of the decrease of physical and mental productivity, as well as increased fatigue, weakness, increased need for rest after easy work. He became irritable, impatient and less tolerate towards people, it is difficult for him to wait even for a short time; he often has headache, sweats easily, feels prickling sensations in the heart region when worries.



1. What signs of mental disorders does the patient have?

2. What psychic sphere is disturbed?

3. What symptoms does the patient have?

4. What is the syndromal diagnosis?

2. After a head injury that the patient had 5 years ago he developed affective disturbances: suddenly and for no serious reason he feels anger. His mood during these periods is characterized by tension, depression combined with anger or even rage, high irritability with a tendency to aggressive actions.



1. What signs of mental disorders does the patient have?

2. What psychic sphere is disturbed?

3. What symptoms does the patient have?

4. What is the syndromal diagnosis?

3. At the inpatient department of a psychiatric hospital a female patient is passive, inert and is never involved in any activities on her own accord. Does some primitive work (makes cardboard boxes), but constantly needs induce­ment and activation. She is completely indifferent to the situation in the department, to the members of her family and her own situation, does not care about being discharged from the hospital or left at the department for a longer time. Name the probable syndrome:



1. What signs of mental disorders does the patient have?

2. What psychic sphere is disturbed?

3. What symptoms does the patient have?

4. What is the syndromal diagnosis?

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