Components of the pathopsychological diagnosis
Limitation of life is treated as a "deviation from the norm of human activity due to a violation of health ...". When the diagnosis is made, the main categories of vital activity are evaluated, the most important for the social sufficiency of a person - the ability to self-service and independent movement, to learn and control their behavior, work and orientation in the environment, to communicate. The limitations of certain categories of life activity or their totality depend on the nature of health disorders, the type and degree of functional disorders, psychological, social factors.
The degree of severity of disability can vary. Classification of life limitations provides for their ranking on three degrees of severity , depending on the ability of the patient to perform a particular category of vital activity and the conditions necessary for this - moderately expressed, expressed and significantly expressed.
Consideration of the patient's personality through an integral assessment of the limitation of vital activity led to the fact that when the pathopsychological diagnosis is established, both the violations of the operational level (memory, attention, thinking, speech, perception) are taken into account, as well as the emotional-volitional and personal levels of a person's psychological status . When distinguishing the psychological component of various spheres of life, three levels (components) assess the psychological status of the patient: functional, emotional-volitional, personal.
Functional level includes the state of higher mental functions - memory, attention, thinking, perception; specific cortical functions; dynamics of mental processes.
Emotional-volitional level includes feelings, affects, emotions, mood, will. The content component of the emotional-volitional level reflects the subjective reaction to reality (determined by individual orientation - selectivity), on the one hand, and reality (as it appears to the person) on the other.
The personal level reflects a set of internal conditions through which external influences are refracted and the way the patient interacts with the environment is determined. At the heart of the formation of personality is the motivational sphere. The structure of the motivational sphere, value orientations, needs influences and determines social behavior. In the real life of a person, the motivational sphere is determined by self-awareness, self-esteem of the individual. The person attains the highest stage of the development of personality when he comes to a true understanding of himself, his social essence, awareness of his own merits and demerits, including those caused by illness or a defect.
Thus, from the standpoint of psychology when formulating the limitations of life activity, the personal approach comes first, considering the features of a sick person in a diverse unity.
We list the psychological criteria of life limitations, reflecting three degrees of defect severity.
Psychological criteria of limitations of various spheres of life
Restriction of orientation in the environment:
- moderately expressed: short-term episodic difficulties in orientation, caused by moderately pronounced violations of cognitive functions (memory, thinking, speech, perception), emotional-volitional disorders (instability, propensity to affective outbreaks);
expressed: a general decrease in the ability to self-orientation, due to persistent, pronounced impairment of attention, memory, thinking; disturbances in the dynamics of mental activity (stiffness, inertia or pathological lability of mental processes); persistent emotional (emotional rigidity, increased distractibility of external stimuli) and personality changes (motivational-personal fixation, increased suggestibility) individually or in different states;
- Significantly: frequent cases of disorganization against the background of a general decline in self-orientation. They are caused by marked violations of higher mental functions, dynamics of mental activity and emotional-volitional sphere.
Limiting control over your behavior:
- moderately expressed: episodic cases of decreasing control over one's behavior, caused not by sharp or moderately expressed disturbances in the function of attention and emotional-volitional disorders (instability, difficulty in forming and retaining strong-willed efforts);
- expressed: a decrease in control over their behavior in certain spheres of life. It is caused mainly by a pronounced deformation of the personality (features of value orientations);
- significantly expressed: general, covering all spheres of life, loss of control. It is caused by persistent, marked impairments of cognitive functions (thinking, memory, attention, speech, perception), emotional-volitional spheres (excitability, difficulties in forming and retaining strong-willed efforts), personality defects (infantilism, uncriticality, inadequate self-esteem). Limit learning ability:
- moderately pronounced: difficulties in learning, requiring an individual mode of educational activity. They are mainly due to moderately pronounced disturbances in the dynamics of mental activity (lability, slowness in the general darkness of mental activity, exhaustion of mental processes), emotional-volitional disorders (satiety, increased distractibility, emotional rigidity);
expressed: a decrease in the ability to master certain subjects or master more complex knowledge and skills. It is caused mainly by pronounced violations of some higher cortical functions (speech, writing, reading, counting, gnosis), expressed violations of cognitive processes (memory, thinking), features of the motivational sphere (self-esteem, level of aspiration);
- significantly expressed: the total loss of the ability to learn. It is caused by significant violations of cognitive processes (memory, attention, thinking, speech), emotional-volitional (field behavior, excitability) and personal changes (personal infantilism, features of the motivational sphere).
Limiting the ability to communicate:
- moderately pronounced: reduction of quantitative and (or) qualitative characteristics of communication (speed, volume of information, duration of continuous communication, formality, conflict). Quantitative restrictions are due to severe memory, attention, thinking, disturbances in the dynamics of mental activity (slowing down, exhaustion of mental processes). Qualitative violations of the communication process are mainly due to expressed emotional-volitional (anxiety, tension, excitability, rigidity) and personality
(egocentrism, infantilism, knowledge of communication skills) changes;Expressed: a persistent general narrowing of the sphere of communication, caused by marked violations of higher mental functions (thinking, speech, memory, attention), expressed or marked by disturbances in the dynamics of mental activity (stiffness, inertia, exhaustion), significantly expressed emotionally-volitional rigidity, field behavior, anxiety) and personal changes (violation of the need for communication, infantilism, self-esteem, lack of communication skills). A special organization of the communication process is necessary (specially prepared partner, specially created environment, ancillary tools system;
- significantly expressed: the inability of independent spontaneous communication. It is caused by the total loss of higher cortical functions, a profound defect in mental development, marked impairment of the emotional-volitional sphere and personality.
Limitation of the ability to work:
- Moderately expressed: the performance of work is difficult in full or at the same level of qualification. Difficulties in labor activity are caused by moderately pronounced disturbances in the dynamics of mental activity (slowed-down general pace of mental activity, inertia, exhaustion of mental processes, pathological lability) and sensory-motor reactions, moderately pronounced violations of cognitive functions (memory, attention, thinking, perception), moderately severe disorders emotional-volitional sphere (increased distraction, satiety, emotional rigidity, emotional-volitional instability), z is lowered self-esteem;
- expressed: persistent significant narrowing of the range of available professions and a marked decrease in the ability to learn new skills and knowledge. It is caused by pronounced violations of cognitive functions (attention, namyat, perception, thinking, speech), higher cortical functions (account, letter, praxis, gnosis), expressed disturbances in the dynamics of mental activity (stiffness, inertia, exhaustion of mental processes) and sensorimotor reactions, emotional-volitional sphere (satiety, affective instability, conflict), personal deformation (inadequate self-esteem, features of the motivational sphere);
- significantly expressed: the inability to perform work. It is caused by pronounced impairments of cognitive processes and higher cortical functions, marked disturbances in the emotional-volitional sphere and markedly expressed personality disorders.
- moderately expressed: self-service is possible only with the help of auxiliary tools or with a longer time, fractionality and volume reduction. It is caused by pronounced violations of cognitive processes (thinking, memory, attention), expressed violations of higher cortical functions, expressed disturbances in the dynamics of mental activity (exhaustion, inertia, impulsivity), expressed disturbances in the emotional-volitional sphere (difficulties of motivation);
- expressed: self-service in the control and organizing assistance of others (not only as physical participation of them). The need for organizing, corrective and monitoring assistance can be caused by an intellectual defect, expressed by violations of the emotional-volitional sphere and expressed violations of the need-motivational sphere;
- Significantly expressed: the impossibility of self-service, caused by severe motor impairments and (or) profound violations of the cognitive sphere and personality.
Limitation of mobility:
- moderately expressed: the ability to perform the appropriate type of vital activity in the patient is preserved, the existing violations only complicate all implementation. Psychological impairments are reversible and are amenable to psychological correction or are leveled as the patient's physical condition improves. The existing limitations of vital activity can be minimized by compensating for impaired mental functions at the expense of safe or due to the patient's motivational-volitional efforts and the creation of a special mode of carrying out vital activity. As a result, restrictions in this or that sphere of life activity are reduced and manifested only in the additional efforts of the patient. In this case, the rehabilitation forecast is positive;
- expressed: the corresponding kind of vital activity can be realized only in a limited volume, the quality of its implementation is reduced. Psychological abnormalities have acquired a persistent character and can be corrected only partially and with considerable expenditure of efforts by a specialist psychologist. The final effectiveness of the patients performing the corresponding activity remains moderately reduced, even with the use of the entire arsenal of corrective methods. Rehabilitation forecast uncertain;
- significantly expressed: the corresponding sphere of life is almost completely inaccessible to the patient. Mental abnormalities have become irreversible, their correction is impossible or extremely ineffective. Since violations affect a number of mental functions, the possibility of compensating certain functions at the expense of others is reduced. The special organization of vital activity also only slightly increases the effectiveness. As a result, the corresponding sphere of life is almost completely inaccessible to the patient, and the rehabilitation forecast is negative.
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