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MEDICAL PSYCHOLOGY
Class 3: Psychic disorders in medical practice.
Title: Psychic Syndromes.

There is a correlation between mental disorders and structural changes in the brain, so mental signs are divided into two
large groups:

1. Functional Syndromes.
2. Organic Syndromes

FUNCTIONAL SYNDROMES.
They are not accompanied by changes in the brain structures that can be detected by anatomical and histological
methods, and are manifested by alterations in psychic functions and processes.

Syndromes: A set of symptoms and signs grouped together with a certain regularity in a significant manner, which is an
expression of different diseases and facilitates nosological diagnosis.
The syndrome is much more specific than the symptom although less specific than the nosological entity (disease).

The diagnosis of syndrome often becomes the only possibility available to the general physician in the case of psychiatric
entities.

Functional psychic syndromes.

They are grouped according to the burden of the main symptoms in the psychic spheres and
functions affected in the patients. We will study the most frequent ones.

ÿ Anxiety syndrome.
ÿ Depressive syndrome
ÿ Neurasthenic syndrome
ÿ Hypochondriac syndrome.

ANXIETY SYNDROME.
It is characterized by: •
Affective manifestations.
• Global impact of needs.
• Without alteration of sensory perceptions.

Excessive anxiety is the fundamental characteristic that can have manifestations.

Subjective such as:
ÿ Fear. What the person feels and cannot explain.
ÿ Restlessness.
ÿ Restlessness.
ÿ Fear of facing a serious illness or dying.
Objectives given by neurovegetative symptoms such as:
ÿ Palpitations.
ÿ Tachycardia.
ÿ Chest tightness.
ÿ Dyspnea.
ÿ Anorexia.
ÿ Nausea.
ÿ Vomiting.

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ÿ Diarrhea. ÿ
Paleness. ÿ
Coldness. ÿ
Palpal hyperhidrosis. Among others…

Anxiety syndrome can be an expression of a situational disorder, for example: A woman who comes to a consultation with anguish,
anxiety, irritability, dysphoria, and evening insomnia. Her symptoms appear after separation from her partner.

DEPRESSIVE SYNDROME It
manifests itself fundamentally by: • Sadness. •
Affectation of
needs. • Decreased associative capacity. •
Decreased motor activity.

The depressed person shows: • A

depressed mood. • Nervousness. •
Hypobulia or ablulia.
• Self-reproachful thoughts. •
Morning insomnia. • Anorexia. •
Hypoeroticism. • Loss of
personal hygiene
habits.

Example: A father who, after the death of his son, reports feeling sad, with little desire to do things, lack of appetite, inhibition
of sexual desire and difficulty sleeping, especially in the early morning. This syndrome can manifest itself at two levels of depth: 1.
Neurotic: Where the symptoms are attenuated.

2. Psychotic: They are more colorful and intense.

At the neurotic level, the depressive syndrome is accompanied by:

ÿ Low mood. ÿ Anorexia. ÿ Insomnia.
ÿ Self-reproach.
ÿ Anxiety. ÿ
Hypobulia.

And it is part of the situational picture.

At the psychotic level: ÿ

Deep sadness ÿ Slowing of
thought ÿ Slowing of motor activity. ÿ
Hallucinations and delusions.

It is an expression of affective and manic-depressive psychosis.

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NEURASTEMIC SYNDROME It consists

of: • Physical and mental
fatigue. • Irritability. • Affective lability.
• Low productivity
at work. • Difficulty
concentrating and remembering. • Hyperesthesia.
• Suboccipital headache. • Digestive and sexual disorders.

This syndrome only occurs at the neurotic level. Example: University student who reports:
• Difficulty concentrating. • Poor teaching
performance. • Annoyed by noise. •
Headache. • Depressed. • Irritable
with classmates.

HYPOCHONDRIAC SYNDROME
When the person shows: ÿ Excessive
concern for health. ÿ Continuous self-observation of
significant bodily functions. ÿ Constant fear of death. We are in the presence of a hypochondriac
syndrome.

In which the ideas of illness or hypochondriacal are characteristic. It can be presented at a neurotic and psychotic level. Example: The
patient who: • Uses medical terminology, comes looking for
help because he thinks he is sick. • Uses risky medical exams. • Moves from doctor to doctor and from one health
institution to another.

LEVELS OF PSYCHIC FUNCTIONING.

Depending on the degree of severity of the psychopathological manifestations, they can be: Neurotic, psychotic, deficient or
defectological and psychopathic.

Neurotic: The patient: ÿ

Maintains a critical view of the illness, that is, he/she recognizes himself/herself as ill. ÿ Quantitative
disorders. ÿ The affective sphere predominates.
ÿ Discrete impairment of adaptation to the
environment. ÿ Expression of psychological conflicts maintained
over time. ÿ Present in patients with anxiety, depressive, neurasthenic and
hypochondriac syndromes.

Psychotic: The patient; ÿ

There is no criticism of the disease ÿ Evident
quantitative and qualitative changes in psychic processes. ÿ Serious impairment of psychic functions
and distortion of reality. ÿ Significant damage to adaptation to the environment. ÿ The patient needs
hospitalization. ÿ It occurs in psychiatric diseases such
as schizophrenia, manic psychosis.

depressive disorders and reactive psychosis. Among others…

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Deficient or Defectological:
ÿ Low intellectual level, congenital or acquired early before developing the person's potential or established
after having reached their development.
ÿ The deficit functioning was always present or from a very early age and another
It developed after adolescence or later. Oligophrenic or demented patients function at this level.

Psychopathic:
ÿ Maladaptive personality trait.
ÿ Behavioral patterns that hinder adjustment to the environment.
ÿ It causes suffering for the patient, those around them, or both.
ÿ It is characteristic of personality disorders ranging from obsessive to antisocial.

According to the levels of neurotic and psychotic functioning, there are two groups of syndromes:

1. Neurotic Syndrome: characterized by: • No distortion

of reality.
• Personality with relative adaptation to the environment.
• Critical judgment of the patient.

2. Psychotic Syndrome: characterized by:

• Marked distortion that incapacitates the person from recognizing and handling reality.
• Disorganization and deterioration of personality.
• Does not possess critical judgment.
• He is not aware of the disease.

Psychic syndromes are called organic cerebral syndromes when they are accompanied by alterations in the function of the
brain tissue and its envelopes that can be seen by anatomical and histological methods. Depending on whether these
alterations are reversible or irreversible, they are called acute and chronic cerebral syndromes.

The fundamental symptom that characterizes “ACUTE CEREBRAL SYNDROME” is the alteration of consciousness in
different degrees determined by alterations of:
ÿ Attention
ÿ Orientation.
ÿ Fixation and evocation memory.
ÿ Associative process of thought.
ÿ Sensory perception: illusions and hallucinations.

Acute brain syndrome is divided into several sub-syndromes, these are: • Obnubilation

• Delirium.
• Twilight state.
• Mental confusion.
• Seizures.
• Coma state.

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SYNDROME OF DELIRIUM.
It is a syndrome that involves: ÿ
Distortion of reality. ÿ Agitation,
trembling and sweating. ÿ Memory with
evocation after the condition has been overcome. ÿ Unstable orientation.
ÿ Visual and tactile hallucinations.
ÿ Disintegrated and persevering thinking ÿ
Anxiety and terror with agitation in large spaces. ÿ It
occurs in alcoholic delirium, severe infectious processes and traumas.

cranial.

OBNUBILATION SYNDROME.
Its fundamental symptom is the need to:
ÿ Use of strong stimuli to achieve communication. ÿ Slow thinking. ÿ
Decreased memory. ÿ
Distractibility. ÿ Abulia and hypoactivity.
ÿ Quiet, hypo-mimic
patient with neglect of his habits.

To be obnubilated means to see through a cloud. In reality the patient not only sees but also hears, smells, feels, and tastes, as if
there were obstacles between the stimuli and the perceptual sinus.

TWILIGHT STATE SYNDROME.

It is expressed by:
ÿ Sustained disorientation. ÿ Total
amnesia after the condition has been overcome. ÿ It can
manifest itself in two ways:
1. Passive or orderly.
2. Disorderly or agitated.
ÿ It occurs in hysterical and epileptic patients, in poisoning and cranial trauma.

MENTAL CONFUSION SYNDROME.

Also called amnesia, highlighting the almost total absence of psyche, the patient shows:
ÿ Restlessness limited to bed with carpholic or purposeless movements, such as rolling up clothes. ÿ Perplexed
facial expression. ÿ
Absent memory and understanding. ÿ Total
disorientation. ÿ Visual illusions. ÿ Incoherent
thinking. ÿ Affective indifference.
ÿ Repeats movements from
his/her usual work. ÿ Frequent in
poisonings and infections,
severe traumas and strokes.

vascular.

SEIZURE SYNDROME.
A state of transient coma that accompanies the symptoms of paroxysmal cerebral dysrhythmia in the form of
grand mal, whether this is primary or consecutive to focal epilepsy that becomes generalized.

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COMATOUS STATE SYNDROME.

It is produced by multiple causes, which are clinically characterized by the loss of the functions of relational life (consciousness,
voluntary motility, and sensitivity) with preservation of the functions of vegetative life (respiration, circulation, etc.) in a more or
less altered form.

CHRONIC BRAIN SYNDROMES.

They are the result of anatomopathological alterations of brain tissue within its meningeal structures.

Their injuries are irreversible, and their main symptom is intellectual capacity disorders and progressive deterioration of personality.

It is subdivided into the following sub syndromes: • Dementia

• Oligophrenic •
Confabulatory
amnestic.

DEMENTIA SYNDROME.
It is the global or late loss of intellectual capacity, aptitudes, capacities and skills.
Difficulties: ÿ
Abstract thinking. ÿ In understanding.
ÿ Memory (altered) ÿ
Distractibility.

From an affective point of view, the following are manifested: irritability, aggressiveness, emotional lability, among other alterations.

Habits, dreams and sexuality deteriorate. This syndrome is characteristic of senile dementia.

OLOGOPHRENIA: It
is the congenital or early acquired decrease of intellectual capacities.
In this syndrome, the patient is observed to be: ÿ
Distracted. ÿ
Careless in his presence. ÿ Concrete
thinking. ÿ Mechanical memory. ÿ
Without sensory-perceptual
alterations. ÿ Has childish responses with intolerance
to frustrations and is dependent.

The causes of this syndrome can be: prenatal, perinatal, postnatal, genetic. For example: it occurs in patients suffering from cerebral
palsy and in various forms of mental retardation.

CONFABULATORY AMNESIC: It manifests

itself with: ÿ Significant
amnesia. ÿ Careless ÿ
Distracted ÿ
Difficulties in
fixation memory ÿ Preserved orientation.

In this syndrome, the patient's development is striking due to: • Memory impairment. • Decreased
intellectual capacity.

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From an emotional point of view, he has rigidity, apathy and lability.

MOST COMMON CAUSES IN ACUTE AND CHRONIC SYNDROMES.

ÿ Intra and extra cranial infections.
ÿ Drug, poison, alcohol poisoning.
ÿ Head trauma.
ÿ Circulatory, convulsive and metabolic disorders.
ÿ Intracranial neoplasms.

TEACHING TASKS.
1. Create a summary table showing the common syndromes in medical practice.
for which you must take into account:

a) Psychic syndromes:

• Functional: anxious, hypochondriac, neurasthenic, and depressive.

• Organic brain: acute and chronic.

b) The psychological symptoms that characterize them.

c) Their psychological level of functioning.

2. Analyze the following situation:

Male patient with a medium level of education, married with 2 children, works as a lathe operator. He comes to the clinic
because of frequent headaches and dizziness.
He says that at home he has arguments with his wife about the management of his children, which causes him anxiety;
he feels a state of restlessness. Without knowing the cause, his hands sweat and he has digestive disorders.

He performs simultaneous activities without being able to complete any of them and has skin lesions, so he considers
himself to be ill and seeks medical help.

Reply:

a) Explain the psychic syndrome that the patient presents, taking into account the alterations
psychic.
b) Identify the patient's level of psychological functioning.
c) State the characteristics of this level of functioning.

Literature.
Syndromology article. “Psychology and health” brochure.

CONCLUSIONS.
1. Functional psychic syndromes are manifested by alterations in the functions
and psychic processes.
2. Organic psychic syndromes can be acute and chronic and are accompanied by
alterations in brain tissue.
3. Patients with mental disorders may have functional impairments at a
deficient, psychopathic, neurotic or psychotic.

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