Лекция "Патология сознания и памяти" со слайдами 2018. Проф. каф. психиатрии РязГМУ Меринов А.В.

Today we have our next lecture. The topic on the slide is the pathology of memory and consciousness. Well, more precisely, the consciousness of memory, but I wrote it like this. We'll start with consciousness, and then move on to memory. An interesting topic. And it concerns each of you in one way or another. Especially memory. So, what are we going to talk about today? Well, first of all, we'll talk about what consciousness is, right? And you'll notice that the word is written with a hyphen, right? That is, consciousness. Perhaps this already reveals the essence of the phenomenon to some extent. Why consciousness? I think you all know the word "knowledge," right? And the prefix "co" or "ko"—you remember the Latin language—does it mean anything? And today we'll talk about how our consciousness switches off. Today we'll talk a little about how it becomes clouded. We'll talk about dreams with aneroids. We'll talk about mentia, we'll talk about odyliria. And words that, in principle, are already familiar to you in one way or another. Well, the second part of the lecture is the final one, it will be devoted more to the problems of memory pathology. What is memory, how to improve it? And so on. Well, we will also touch on the properties of memory. Ah, the task is very simple. Look at how we test memory. Very simple. Look, the methodology is very banal. 10 words are written on a slide. These are the 10 words that our clinical psychologists regularly, well, in one sequence or another, present to our patients to test memory. These are the 10 words, nothing complicated. So, let's begin the lecture. And what is consciousness? What is consciousness? I'm about to say some rather grandiose things, but nevertheless, I want this topic to be understandable for you. So, if you open some trendy, modern textbook on psychiatry, or even worse, philosophy—it's written even more complexly there—you'll find that our definition of consciousness is, well, the highest form of reflection of objective reality. But if you look at thinking and perception, you'll, unfortunately, see a very similar definition. The question is simply, which is higher? So, today we'll try to figure out what consciousness is. When we say that a person is conscious—where are you from, from your second year, probably, from the propaedeutics course—you write that a person is in a clear state of consciousness, right? And you write about this main mantra of consciousness: that a person is correctly oriented from the outside. Write, write. And that's what we'll be doing today. That's it. And with consciousness, everything here is very interesting. I mean, I'll get to that now. The thing is, I showed you this in the lecture about the pathology of sensations and perception. The brain, the areas of the brain that, when stimulated, can trigger certain hallucinatory or psychosensory phenomena. We know—we'll be talking about memory today—we know more or less the locations in the brain, the areas where we need to tinker to disrupt a particular form of memory. We can basically say the same about thinking. We know how to trigger certain aphasias, we know how to trigger sensory semantic impairments. We also know which areas of the brain are responsible for this. So, in terms of areas, areas of the brain. But if we approach consciousness, it turns out that there's no single anatomical basis or substrate for what you might call "this thing responsible for clarity of consciousness." That is, the brain, it either functions correctly—and we'll get to this now—fully and adequately reflects what's happening around it, correctly correlates facts and establishes connections between them, this is thinking, correlates them with memory traces, and recognition occurs. And we can create something new. And we can focus our attention on something. This something is emotionally charged, and this something allows us to act in some way. That is, the volitional component is activated. Whatever we take, we will have something like a butt for every creature. That is, we will have perception, thinking, memory, consciousness, and so on. When all this works together, when it all works together, and in concert, when it works correctly, that's precisely when we say a person is in a state of lucid consciousness. So it turns out that consciousness itself is not a substantive phenomenon as such, right? There are things that are responsible for the level of visibility, the level of wakefulness, the retinal formation, but nevertheless, a healthy, properly functioning brain is the basis for your consciousness and the correct reflection of everything around you. What is clear consciousness? The slide lists the criteria for its clarity, right? So, let's quickly go over them. It is a clear perception of objects, correct, referential, just as other people perceive them. This is a consistent connection. This is consciousness. That is, when I know that I know and perceive this myself, that this is my personal structure, these are my consistent thoughts, and so on. That's it. And this is a clear limitation of myself from the surrounding world, that is, self-awareness. I understand that I did this, that these thoughts are mine, that I am responsible for these actions. This is mine, this is me. That is, I separate myself from the objective world. And reflection is a special combination of mental processes, their understanding, a sense of your own active position in this world, the fact that you are capable of changing it, that you are capable of receiving this knowledge, again, consciousness. So there you have it. Well, and, uh, acquiring knowledge with the understanding that you are the one participating in establishing the discovered connections and, uh, characteristics. That is, consciousness is an integrative function. A healthy, functioning brain, a function of self-awareness. That is, we will begin with this. This is a function of consciousness. And this is the first function of self-awareness. That is, this ability to distinguish yourself from the environment, to understand that it was you who woke up in the morning, so that you understand that you are not in the matrix, brothers in Achevski, that you are not that battery that generates energy for something big, big, but a supercomputer. Here's an example, an example, and a description is given, well, a description is given, and a violation of self-awareness. Please fix the door so that it is open. Aa, damage the violation of self-awareness. And this is what begins with elements of derealization, depersonalization, and leads to complete alienation of the self, when a person is no longer able to distinguish between "I" and "not I." Subjective and objective space. And the energetic function of consciousness. The energetic function of consciousness, that is, the level of wakefulness in which you find yourself at the current moment. There you have it. Well, and Ivan Petrovich Pavlov's definition on the slide. Consciousness is the area of the brain with optimal excitability. So, and below is a picture like this. And now I'll try to use it as an example to explain the various types of impaired consciousness that generally occur. So, let's recall, let's recall our high school physics course. A light bulb is a rheostat, a battery, right? That is, a rheostat increases resistance, according to Ohm's law. That is, if you increase the resistance, the light bulb, which gradually begins to glow, becomes gas. Is everyone clear? Clear, right? We have the following standard situation. We don't touch the rheostat; it has minimal resistance. The light bulb glows brightly, without flickering. This is the equivalent of clear consciousness. This is clear. That is, the light bulb glows. Now imagine that you begin to slowly, slowly move the rheostat and increase the resistance in the circuit. What begins to happen? The light bulb gradually begins to dim. That is, it begins with a minimal switching off of consciousness.

memory. An interesting topic. And it concerns each of you in one way or another. Especially memory. So, what are we going to talk about today? Well, first of all, we'll talk about what consciousness is, right? And you'll notice that the word is written with a

hyphen, right? That is, consciousness. Perhaps this already reveals the essence of the phenomenon to some extent. Why consciousness? I think you all know the word "knowledge," right?

And the prefix "co" or "ko"—you remember the Latin language—does it mean anything? And today we'll talk about how our consciousness switches off. Today we'll talk a little about how it becomes clouded. We'll talk about dreams with aneroids. We'll talk

about mentia, we'll talk about odyliria . And words that, in principle, are already familiar to you in one way or another. Well, the second part of the lecture is the final one, it will be devoted more to the problems of memory

pathology. What is memory, how to improve it? And so on. Well, we will also touch on the properties of memory.

Ah, the task is very simple. Look at how we test memory. Very simple. Look, the methodology is very banal. 10 words are written on a slide. These are the 10 words that our clinical psychologists regularly, well, in one

sequence or another, present to our patients to test memory. These are the 10 words, nothing complicated. So, let's begin the lecture. And what is consciousness? What is consciousness?

I'm about to say some rather grandiose things, but nevertheless, I want this topic to be understandable for you. So, if you open some trendy, modern textbook on psychiatry, or even worse, philosophy—it's written even more complexly there—you'll find that our

definition of consciousness is, well, the highest form of reflection of objective reality. But if you look at thinking and perception, you'll, unfortunately, see a very similar definition. The question is simply, which is higher? So, today we'll try to

figure out what consciousness is. When we say that a person is conscious— where are you from, from your second year, probably, from the propaedeutics course—you write that a person is in a clear state of consciousness, right?

And you write about this main mantra of consciousness: that a person is correctly oriented from the outside.

Write, write. And that's what we'll be doing today. That's it. And with consciousness, everything here is very interesting. I mean, I'll get to that now. The thing is, I showed you this in the lecture about the pathology of

sensations and perception. The brain, the areas of the brain that, when stimulated, can trigger certain hallucinatory or psychosensory phenomena. We know—we'll be talking about memory today—we know more or less the locations in the brain, the areas where we need to tinker to

disrupt a particular form of memory. We can basically say the same about thinking. We know how to trigger certain aphasias, we know how to trigger sensory semantic impairments.

We also know which areas of the brain are responsible for this. So, in terms of areas, areas of the brain. But if we approach consciousness, it turns out that there's no single anatomical basis or substrate for what you might call "

this thing responsible for clarity of consciousness." That is, the brain, it either functions correctly—and we'll get to this now—fully and adequately reflects what's happening around it, correctly correlates facts and establishes connections between them, this is thinking, correlates them with

memory traces, and recognition occurs. And we can create something new. And we can focus our attention on something.

This something is emotionally charged, and this something allows us to act in some way. That is, the volitional component is activated. Whatever we take, we will have something like a butt for every creature. That is, we will have perception, thinking, memory,

consciousness, and so on. When all this works together, when it all works together, and in concert, when it works correctly, that's precisely when we say a person is in a state of lucid consciousness. So it turns out that

consciousness itself is not a substantive phenomenon as such, right? There are things that are responsible for the level of visibility, the level of wakefulness, the retinal formation, but nevertheless, a healthy, properly functioning brain is the basis for your

consciousness and the correct reflection of everything around you. What is clear consciousness? The slide lists the criteria for its clarity, right? So, let's quickly go over them.

It is a clear perception of objects, correct, referential, just as other people perceive them. This is a consistent connection. This is consciousness. That is, when I know that I know and perceive this myself, that this is my personal structure,

these are my consistent thoughts, and so on. That's it. And this is a clear limitation of myself from the surrounding world, that is, self-awareness. I understand that I did this, that these thoughts are mine, that I am responsible for these actions

. This is mine, this is me. That is, I separate myself from the objective world. And reflection is a special combination of mental processes, their understanding, a sense of your own active position in this world, the fact that you are capable of changing it,

that you are capable of receiving this knowledge, again, consciousness. So there you have it. Well, and, uh, acquiring knowledge with the understanding that you are the one participating in establishing the discovered connections and, uh, characteristics. That is, consciousness

is an integrative function. A healthy, functioning brain, a function of self-awareness. That is, we will begin with this. This is a function of consciousness. And this is the first function of self-awareness. That is, this ability to distinguish yourself

from the environment, to understand that it was you who woke up in the morning, so that you understand that you are not in the matrix, brothers in Achevski, that you are not that battery that generates energy for something big

, big, but a supercomputer. Here's an example, an example, and a description is given, well, a description is given, and a violation of self-awareness.

Please fix the door so that it is open. Aa, damage the violation of self-awareness. And this is what begins with elements of derealization, depersonalization, and leads to complete alienation of the self, when a person is no longer able to distinguish

between "I" and "not I." Subjective and objective space. And the energetic function of consciousness. The energetic function of consciousness, that is, the level of wakefulness in which you find yourself at the current moment. There you have it. Well, and

Ivan Petrovich Pavlov's definition on the slide. Consciousness is the area of the brain with optimal excitability. So , and below is a picture like this. And now I'll try to use it as an example to explain the various types of impaired

consciousness that generally occur. So, let's recall, let's recall our high school physics course. A light bulb is a riostat, a battery, right? That is, a triostat increases resistance, according to Oba's law. That is, if you increase the resistance, the light bulb

, which gradually begins to glow, becomes gas. Is everyone clear? Clear, right? We have the following standard situation. We don't touch the rheostat; it has minimal resistance. The light bulb glows brightly, without flickering . This is the equivalent of clear

consciousness. This is clear. That is, the light bulb glows. Now imagine that you begin to slowly, slowly move the rheostat and increase the resistance in the circuit. What begins to happen? The light bulb gradually begins to dim.

That is, it begins with a minimal switching off of consciousness, then self-noise, stupor, and eventually we switch it off when the light bulb goes out—this is a coma. This is clear.

That is, the degree of increasing, switching off of consciousness. If you invite some trendy DJ who starts twitching the rheostat like this, the light bulb begins to light up, then flicker, then do something else, then change colors—this is the equivalent

of so-called altered consciousness. This is delirium, this is amentia, this is anerole. And there's the final option, the fourth one, when you move the rheasat so quickly that the light bulb, in principle, goes out, but it goes out for such a short period of

time that even your consciousness doesn't have time to register that it happened. This is a paroxysmal disorder of consciousness. We'll come back to this later. And the function of goal-setting. Goal-setting of activity.

That is, when you carry out any activity, ideally, that is, you don't carry it out by inertia, that is, you weigh your motives. Yesterday we talked about emotional volitional disorders and the work of the will. That is, you

weigh what will happen. You make a decision, you perform a meaningful act, and you perceive the result of it—you either like it or you don't. All of this is carried out under the control of our consciousness. The characteristics of consciousness are on

the slide. The level of its clarity, we just talked about this, its struggle, is volume, the ability to encompass as many manifestations of the surrounding world as possible. This is the continuity of consciousness, that's clear. And this is orientation, which,

in fact, I deliberately placed at the very end, because, well, despite the fact that you used it in the description of the present status, nevertheless, that is, in my opinion, it is not the main characteristic. And the definition, another definition of

consciousness that I found, it is also given on the slide. So, consciousness-switching syndromes, when we smoothly, smoothly, smoothly, smoothly, smoothly, uh, increase the resistance with our rheostat. The first , uh, syndrome is confusion.

Consciousness is not yet switched off. In principle, one could say that a person is conscious, but in a certain sense, uh, they have lost the quality of contact with reality. Something has happened that causes a feeling of bewilderment, or, well, confusion. And

this wandering gaze—it's a kind of detachment, when a person doesn't quite understand what's happening to them.

Nothing terrible has happened to them yet. The next option is rausch or stupefaction. Here, everything is a little more severe. That is, low mobility, and spontaneity, and oligopsychia, a lack of spontaneous speech. So there. Well, and then they

distinguish dubillation. So, it's like, well, it's translated as cloudiness. So , the person is kind of sitting, he seems to be visually with you, but his state is such that he's flown away somewhere behind a cloud. This is this

veil of consciousness. This is somnolence. The next option is pathological drowsiness. That is, when the degree, uh, of suppression of consciousness is higher. So there. Well , and, accordingly, the person, uh, simply switches off, is capable of falling asleep mid-sentence. So there.

But we are still able to awaken it in response to extreme stimuli like, um, pain, sharp cracks. Sopor, accordingly, is an even deeper degree of consciousness shutdown, the response to pain is still preserved. Control over the sphincter muscles is lost, but

reflexes are still intact. And finally, there's coma, that is, a state of unconsciousness. So, our light bulb has definitely grown. There. And he identifies several forms of coma by depth, depending on the shutdown of the reflex sphere. Here they are on the

slide. The slide is more of an informational one, since you should already know all this. And moderate coma, and deep coma, and terminal coma, which is followed by clinical death. In fact, in fact, that is, if you look at

the descriptions of the various types of coma, you will discover the fact that, in both cases, consciousness is essentially absent, it is completely switched off. They differ only in the extinction, the degree of extinction of the body's vital functions. Ah,

apoplexy syndrome, I think this is familiar to you from your neurology course. You must have certainly taken it. Described by Kretschmer. This is a waking cat. And this condition arises, uh, as a result of traumatic pathology, as a result of certain cerebrovascular

accidents. And the essence of apoplexy syndrome comes down to the fact that, uh, the cortex is separated at the physiological, uh, we're cutting, hopefully, at the physical, physiological level from the nutrition.

Here's a description of a person with apoplexy on the slide. Formally, he's alive, formally he has some wandering eye movements, formally he has some movements. There. But we clearly see that the patient is inaccessible to any productive contact, the patient has no

emotional resonance. What's going on inside the patient, we don't know. But some elementary automatisms are activated. Grasping, early automatism, and impaired autonomic function. And the prognosis for opolytic syndrome, well, it's far from always good, unfortunately. Everything really depends on its cause, what triggered it

. So, the syndromes of consciousness shutdown. The summary table is on the slide. It's all simple and easy. And three criteria by which we can, in fact , easily distinguish which type of consciousness shutdown we are currently facing. We're just repeating this now,

because I hope you all know all this very well. And in the photographs, patients are stupefied; in the middle, there's sopor, and the coma is insulin coma. So, at one point, we treated our patients this way. And we'll certainly

return to this in the lecture on treatment. Clouding of consciousness syndrome. This is when we experience chaotic movement of the rheostat handle . The slide shows Karl Jaspers's four criteria, which psychiatrists around the world have used for over 100 years

to diagnose clouded consciousness. The first criterion, which I think is perfectly clear, is the patient's detachment from the outside world, which prevents our patient from fully perceiving what's happening around them and from fully reacting to what's happening to them. Ah, well, that's

enough. The second is that very disorientation, both of time and of one's own personality. Either autopsychic or auppsychic. This is a change in thinking that prevents our patients from drawing correct conclusions, making correct judgments, and reacting appropriately. And the

fourth is amnesia during the clouded consciousness period. It doesn't always occur, it's not always complete, but one way or another, it's almost always present to some degree. So, the syndrome of clouded consciousness.

We'll start with amentia. Amentia was described quite a long time ago, by Melner in 1878 under the title "Acute hallucinatory confusion." Acute hallucinatory confusion. And the clinical picture is briefly described on the slide. What can I say for myself

? Amentia. Amen is almost always a manifestation of some very serious pathology, either intracerebral or systemic, which somehow affects our brain. And if you see amentive syndrome , and this is a reason for the most intensive and urgent medical measures,

you may well be losing the patient. So, what does the patient look like? What does this uncrossed pose or the crucified pose mean? That is, the patient usually lies down; if they're in a bed, they lie in their own bed,

with their arms outstretched, making undirected movements, sometimes in a hospital-like fashion, that is, throwing their arms in different directions, sometimes turning over, and sometimes throwing something off.

There's no speech or eye contact with the patient in Amenza. The eyes move chaotically, and sometimes there's an element of rotatory nonstagmus. That's it. And from the speech production, we hear what's called incoherence. We talked about this in the previous

lecture. Isolated sounds, isolated words, isolated phrases, perhaps, but not connected to each other, simple phrases. And, as I already said, contact with the patient is impossible.

Sometimes so-called asteric lacunae appear when the patient returns to us for a short period of time, and especially, well, we would like it to be as a result of our treatment. That's it. But here are the laconas, they

exist on their own. The patient suddenly feels better, begins to recognize others for a short period of time, speech contact is restored, and then the person again plunges into an animate state. Lacons are completely unnecessary. So. Oh, yes, if the

patient begins to operate, that is, if the patient begins to—we've already talked about this, the cophrology syndrome—the patient begins to remove things from himself, toss them aside, and so on, things are really bad. And the rural doctors of the 19th and early

20th centuries always said that if a patient in this unconscious state, uh, without contact, without speech, starts to mumble something under his breath and even starts yelling, this is a very bad prognostic sign. It was believed that the patient would most likely die.

We're now in the 21st century, and I hope that most situations you might encounter, specifically those involving mental illness, can be treated, and the patient's life can be saved. Well, actually, the patient in the photo I posted—I won't lie. I'm not sure he's

an amintimate patient, he's not our patient, but visually, he looks exactly like this. In textbooks, you might find a term, which not everyone interprets correctly for some reason, that says priority arousal is limited to the confines of the bed. That is, it's

clear that he doesn't get up or move around. If he does move, he usually remains in the same place where he was lying before. In fact, I think most of you are familiar with this word. And we live in an interesting country where a

drunkard with delirium tremens isn't something rare or exclusive. It was described in 1866 by Liebermeister under the name "White Burning Drunkard.

" The name "delirium" is quite interesting. It's a word without the particle "lyra," and in Latin or Greek —I can't remember right now—it means "a path or a furrow." So, a person in delirium strays from this path or this furrow of delirium. Uh,

we'll now analyze it for clarity using the example of alcohol delirium. They are very similar in dynamics, but nevertheless, alcohol delirium is, well , probably the most common, the most indicative in this regard. So, almost any delirium always goes through a

process. Ah, three stages. Three stages , they are shown on the slide. And the first stage is the initial one, that is , the stage of emotional disturbances, when our intoxicant—not necessarily an alcoholic, like someone poisoned by atropine, but like someone poisoned by

lead tetradir, or by many psychoactive substances—that is, a very large amount—causes delirium. That's it.

And then he begins to experience some kind of anxiety, a feeling that something is about to happen to him, something is about to happen. Patients begin to become anxious, they rush about, and they are usually unable to explain what is happening to them at

this stage. That is, they have this feeling of some kind of impending catastrophe, or even non-catastrophe, they sometimes become pathologically cheerful, manic, disinhibited, but anxiety sets in, hyperesthesia appears, that is, ordinary sounds, ordinary colors for the patient begin to become

super-bright, super-impressive. And this gradually transitions into the second stage. This stage is called paroidolosis. We also talked about paroidolosis in the lecture, when the patient begins to see some kind of pictures, drawings on the wallpaper, in cracks in the pavement or on the walls.

It's usually something frightening, but not yet hallucinatory in nature, since the patient shakes their head, it seems to pass, begins to look closely, and then it appears again. There. Ah, and the third stage. The third stage is delirium proper. This is a fully

developed stage, when the patient experiences a massive influx of hallucinations. There. And the nature of the hallucinations, as described on the slide, is that they are completely assimilated into the surrounding environment, meaning they are as real as a table, a chair, and they are not

indifferent to the patient. Often, if we take alcoholic delirium tremens, they are zoooptic in nature. Yes, indeed, they are often green or brown.

Yes, indeed, they are often frightening . Well, as I already mentioned in the previous lecture, sometimes pleasant, alluring hallucinations appear, which tell the patient something good. And here, a logical question should arise: Alexey Vladimirovich, why are you discussing delirium tremens (DTs) in

the section on pathology of consciousness? Now you're talking more about hallucinations, and it seems to be hallucinosis, but there's a big "but " here that puts everything in its place. The thing is, with hallucinosis, which we discussed, consciousness isn't

clouded. But with delirium tremens (DTs ), the main criterion for delirium is that the patient experiences a clouded consciousness and loses orientation both to time and to the present, but almost never loses orientation within their own personality. That is, a

kaleidoscopically changing picture of hallucinatory phenomena unfolds around them. And the patient, like a theater spectator, watches it all from the outside. Less common are DTs of a fantastical nature, very clearly fantastical DTs. That is, when patients see, well, how they are killed, that is

, from the outside, well, they see themselves lying in the morgue, but this is more of an exception to be corrected. There are severe forms of delirium, I'll mention them now, so I don't forget them later during the

lecture on alcohol addiction. And this is what is called muttering and professional delirium. Muttering and professional. That's it. And muttering delirium is precisely muttering delirium, a severe form of delirium.

And somewhere on the border between Amene and Lyrium. Ah, but the question is about preserving some sense of self-orientation. Patients can also rely on this, and there is nothing good in muttering delirium either. That is, we see that delirium progresses and

somatic and intracerebral disorders increase. That is, we need to urgently take some urgent measures, otherwise we will lose the patient. Professional delirium is a delirium that's even deeper, or they alternate somewhere.

And I've seen, unfortunately, both, and fortunately, both, and both variations of this and that, and that from professional to professional, from professional to professional, from professional to professional. Well, my colleagues might disagree with me, but nevertheless, professional delirium is

when the patient has already departed from us quite deeply. And their only motor activity is performing some actions from their former professional activities. That is, if they're a driver, they're trying to imitate driving. If they're, uh, a professional

boxer, they're probably waving their hands, an accountant calculating something. A lathe operator is trying to twist something, handles. Well, that's a sign that things are really bad and we need to try really, really hard to save the patient. Professional

delirium with muttering is practically unheard of these days. And the last time I saw one was quite a while ago.

And abortive delirium. Abortive delirious delirium. This is any delirious delirium that has fully developed, ending within 24 hours. It usually reaches the very beginning of the full-blown stage, with isolated, fragmentary hallucinatory phenomena appearing, but it never develops into

such a large-scale delirium, with or without our help. The prognosis is favorable. The most characteristic thing is that there will be a table further down. Patients, in general, remember their delirium quite well.

They vividly recount the images I showed you in the lectures on the pathology of perception, where we discussed hallucinations. There were many images of our alcoholics who had experienced alcohol-induced delirium.

Aneroid. Aneroid, or dreamlike clouding of consciousness. Dreamlike clouding of consciousness. It was described by Mayer Grosz in 1924. So, this is a disorder of consciousness, which is most common in schizophrenia. The thing is, most of the disorders of

consciousness we've talked about up to this point are more common with exogenous factors: intoxication, trauma , epilepsy, and some other brain disorders, vascular or otherwise. So, aneroid daze is still more common in endogenous diseases, in the schizophrenic process, in the catatonic

form. So, what does it look like? And if I were to describe it briefly, have any of you seen colorful dreams? Well, most of you have. And there is, uh, this feeling that sometimes there are such moments with dreams, that you seem

to be so immersed in them, yes, that when you wake up, you cross yourself and say: "Thank God it was only a dream ." Yes, for a while you doubt that you woke up and think: "Oh, my God, my God.

" That's it. There's a pathological, pro-solar state. It's associated with exceptional conditions in forensic psychiatric practice, where a person hasn't fully woken up, and, in fact, has played out what happened to them in a dream with real people. If they were

defending themselves against witches, ghouls, and so on, then, ah, this image is superimposed on reality. For some time, several minutes, probably up to tens of minutes, the person behaves in accordance with the dream picture, but hasn't fully woken up. That's a

pathological pro-solar state. That's it . And so, uh, patients enter this state , only not for 5 minutes, not 10, and they're not even asleep. That's the simplest description. That is, the patient is like in a dream, but they're

not sleeping, they're awake. When patients emerge from the aneroid, they describe it all with these vivid images . That is, just like in a dream. That is, red is very red, very vivid images.

Very...That is, unlike delirium, unlike delirium, almost always, in addition to autopsychic, autoclassical orientation, that is, a disturbance of orientation both in time and in general, the most common disturbance is one's own orientation. A patient with aneroid is not a spectator. A patient with aneroid

is a participant in this theatrical production. That is, he is completely immersed in what is happening around him. He can be an active participant, he can be passive, but in any case, he has entered into an aneroid state. He

is part of this aneroid. And the stages of the unfolding of the aneroid state are given, there are actually more of them. That's how I presented it. Here, uh, what's most interesting is, as it were, in the aneroid images, that is,

patients in an aneroid state. A patient in an aneroid state is, uh, also most often in bed, like a patient with Samoyedic insomnia, only his posture is non-raskristvo, that is, he is completely detached from us. He can make some movements, but they are very

slow, very slow. His eyes may be open, he may see something, he may utter fragmentary words, something, yes, but he is not with us. He is not with us.

And at the initial stage, when the patient is just entering the aneroid, when this image that surrounds him still coexists in reality, the neroid one is superimposed, and these certain themes are superimposed on what is around him, and there is a short period

when the ae patient has a dual orientation: toward the aneroid, in reality, and then he goes there. If he is standing by the window in the department and looking out it, and then you ask him what he is at that moment

—standing there for an hour, two, three, looking somewhere. Then you learn that he made an intergalactic leap at superluminal speeds. He flew, he saw stars, he saw, uh, alien ships, or he took part in some kind of battle

scene. That is, it's some kind of, uh, war of the worlds or something. I mean, well, he was, I mean, they usually have a fantastic, rote, beautiful character, aneroids. So. Uh, and when patients emerge from them, then usually, in

principle, uh, in most cases, they have clear memories of what happened, something is lost, but, in principle, patients talk about their aneroid states quite well. And here on the slide, there's another point, so to speak. Uh, this word "game."

Psychiatrists really love this word. And just when aneroids unfold, not necessarily roids, even just delusional stagings at this stage, if it can stop due to paranoid schizophrenia, otherwise it's very interesting.

Patients say they've developed a feeling—it's not so much, it doesn't necessarily have anything to do with chmeroid, of course—they've developed a sense that some kind of game is happening around them, that people are doing something on purpose, that

there's some hidden meaning hidden from the patients, and they just can't seem to figure it out, to unravel its tangle . That's what aneroli is. That's anerolitis, basically. Ah, I can't say it's a particularly malignant condition , that is, it's very beautiful, it's

very figurative, and very interesting for demonstrating to students. Well, basically, this form of schizophrenia usually has a fairly benign course.

Syndromes of consciousness reversal, paracysmal disorder. We'll go over this now and take a break. Ah, so, the phenomena you've probably heard about in your neurology course—déjà vu, jamais—have already been seen, and never seen before. And this line can

continue. And it could even be "andyu," "zhamanyu," that is, audible, unheard, recontezha, and zhama, that is, already done and never done or experienced. So, these are the kinds of phenomena that fall under the category of paroxysmal disorders of consciousness. We see this

most often, a, in patients with epilepsy, which is why it's listed under paroxysmal disorders of consciousness. Not only because it all kicks in quickly, as I said at the beginning. This is also a plus: it often occurs as non-convulsive

paroxysms in epilepsy. And ambulatory automatisms. Ambulatory automatisms, that is, they are distinguished, a, two variants. This is the Pitrans fugue.

Petrantz. And the description, uh, it's on the slide, that is, it's a suddenly emerging state when a person disconnects from us. There. And the patient continues, well, the person continues for some short or long time to perform certain actions, most often

habitual in the case of a trance, ah-ah , inexplicable from the outside, incomprehensible to the surroundings.

What does a classic fugue look like? Well, imagine, that is, a person is sitting in the theater, at a performance, and at the moment when the music in the ballet reaches some climax , he suddenly gets up and begins

carefully combing his hair. Then he sits down, and he doesn’t remember it , he has amnesia for this moment.

That’s what a fugue is. That is, he made some kind of meaningful movement against the backdrop of some kind of great emotional experience. Fogues are short-lived, that is, a few seconds, a few minutes. But trances, trances of an

organic nature most often, or hysterical trances, that’s a long-lasting state. That is, it can last for several hours, sometimes days.

Trance states have been described, lasting up to several weeks, when a person, having entered this trance state, outwardly behaves, well, relatively orderly. That is, we see that something is wrong with the person , but the person basically maintains

even verbal contact. He travels somewhere, behaving a little awkwardly. And when the person comes to on another continent, a case was described of a woman traveling from the New World to the Old World—that is, she arrived in the Old World in 1800, some year 1950

—and she was very surprised, because, to put it mildly, she hadn't planned to go there. And a very interesting trance was written in the late 1980s. A responsible employee of the Central Committee was sent to Uzbekistan for an

inspection. She recovered safely, and she suffered from epilepsy, and she safely, uh, fell into a trance state upon boarding the plane. She'd had similar experiences before, but they were short-lived. She flew to Uzbekistan, where she was met. She did

everything she was supposed to do there for 5-7 days. She stayed in a hotel, ate, and socialized. Yes, people who interacted with her said she seemed a little distant, not like they usually knew her. But she did something, signed

some documents, then got on a plane and flew to Moscow. In Moscow, the trance state at home ended. She suddenly realized, looking at her watch—I mean the date—that she hadn't visited Uzbekistan. In a panic, she bought tickets and flew back there, where she

was met again. And there they said, " Miss, here's your signature, here's what you did." Unfortunately, she didn't remember anything, right? That's what a trance is, it starts suddenly, it's a practice. It also ends suddenly, and usually without any external

influence. Samnombulism. Samnombulism, yes, it's a state. It comes in two types: neurotic and organic, most often epileptic. And epileptic looks like this: a person gets up at night, a child, well, not necessarily a grown child, performs some relatively

meaningful actions, goes somewhere, does something there, but he looks, of course, very, very strange. In my opinion, if it's true samombulism, the patient is not distracted or distracted . So. Uh, it usually all ends with him turning around and going back to where

he was, sometimes falling asleep somewhere else. They usually don't do anything dangerous to themselves. And so there's this myth that's being spread that a patient with self-somnobulism went out at night and walked somewhere along the edge of the

ledge, or something like that, well, it's probably just someone's fantasy. That is, patients usually don't fall out of windows. They reach their destination, they resist. See, he's standing. You can gently turn him, and he'll reach it safely. In the morning,

this period will be amnestic. This is the truth of self-somnobulism. He won't remember walking. They don't know this with hysterical neurotic self-somnobulism, that is, against the background of severe nervous overload.

And such patients—not sick ones, but such people—can be woken up while they're still there. They wake up, they look confused, surprised, and we put them to bed. Ah, they remember being woken up, because they're the first ones, generally speaking, you can shake

them. Uh, we had quite a few monobulistic patients in our departments back in the day. They don't react much, well, you can, of course, shake them hard, and they come to. But until this paroxysm ends, they're essentially disconnected from us.

That's it. It's easier to just put them back where they belong. Well, I won't tell you about auras now. I mean, ah, about auras, I think you all know everything. The course on nervous diseases, too. And some psychiatrists

classify the onset of a seizure as a syndrome of switching off, clouding of consciousness, and similar to paroxysms . A break. And the syndrome of altered consciousness, twilight clouding of consciousness, twilight. A very interesting condition isn't very common

, but when a person—as if suddenly— their perception becomes fragmented due to a disturbance of consciousness, and they begin...ah, this is probably a bad one, I'll give you an example now, but nevertheless, it's clear, they begin...

well, you've probably heard, probably a course of nervous diseases, binocular vision. Well, that is, when a person sees a certain segment. And this, of course, is not twilight now, this is not a disorder like binocular vision, but reality begins to be perceived very

fragmentarily, selectively. Plus, some kind of, uh, distortions interfere with this reality, some kind of halucinatory phenomena interfere, ah, some kind of delusional moments. And, uh, the patient's behavior is a paroxysmal disorder, that is, it begins suddenly, that is, it is dictated by those, uh,

emotional, evolutionary experiences that have happened to them. That is, their external behavior completely reflects what is happening to them internally. Outwardly, a patient with paroxysmal twilight, or rather, disorder of consciousness, appears relatively normal. That is, he performs certain actions, he tries to do

something, and, uh, he, well, I mean, he does something, but almost all of these actions are dictated by what's going on in his head. And, ah, reality is included in the twilight, quite bizarrely, that is, he doesn't bump

into trees, he doesn't bump into other people, that is, they are part of this twilight, yes, but everything else is added by these experiences. Most often, twilight states of consciousness are frightening to the patient, that is, some things happen there, scenes of

murder, and other manifestations of new and different cruelty, and very often towards the sick. So, ah, how does it end? I mean, it usually doesn't last very long and ends critically. That is, the patient emerges from the twilight

state of consciousness just as he entered it. He emerges, and at that moment, he feels a powerful asthenia.

Posttectal sleep sets in, after which the patient awakens. Typically, he may not remember anything that happened during the twilight convulsions. Or the memories are very fragmentary, meaning he says something, but he can't recount it with any certainty. And this duality

of orientation, in quotes, yes, when the patient is both delirious, hallucinating, and in reality, is a very unique state. It also qualifies as an exceptional condition in forensic psychiatric practice. Patients who have committed, some dangerous acts, or those that have led to, and some

unpleasant consequences, if they are declared insane, not responsible for what they did. And this is a summary table of disorders of consciousness, which lists the main reference features for distinguishing between trees, ameroids, twilight, and amecia. So, this is orientation, you see, right?

That is, and in the twilight, this orientation, yes, it is also so ambiguous. A person cannot understand where he is. Either in this experience in which he suddenly found himself, or he, or it is he, or it is not he. So.

Well, and amnesia, these plus-minus, diliria-they remember everything. Aneroid. Well, here I would say that with aneroid, there is more of a plus.

They remember more than they don’t remember. And twilight, and the memories, they are very gappy, but the general outline of what happened, this plot of twilight, it is still remembered. So. And amentia, I would say that it is more of a minus.

Patients do not remember what happened to them as a result of amentia. You need to draw a bigger minus. And more often than not, everything is erased from the pale. That is, they do not remember what happened to them. Memory,

the physiology of memory, and memory in pathological conditions. The definition of memory on the slide is a mental process that involves capturing, retaining, and reproducing information about what's happening around you. And the physiology of memory. It's probably hard to see the number on the slide.

And here are the anatomical structures responsible for various types of memory . Then, you can see this presentation; everything will become clearer there.

It's the same thing, the same neuronal structures, neuroanatomical ones, that are responsible for our memory. And the types of memory and the kinds of memory . Let me say right away that memory is a truly amazing thing, one that never

ceases to amaze me, to arouse my interest, and so on. The thing is, there's a method for reviving memory traces, such as hypnosis. Regressive hypnosis, a regressive form of hypnosis , where we can, well, take a person back several years, several decades in

their life. And we can revive memories of that day, let's say, the day you, uh , went to school on September 1st. Not everyone can recall right now, uh, the color of the shoes or boots you were wearing. Not everyone will remember the

name of their first teacher. Who remembers the name of their first teacher? Well done. Well, I'll also do a little research, just in case. So, I remember, uh, in a state of this hypnotic transference, aggressively, we can, in principle, extract a fairly

large amount of information that is considered lost, which we wouldn't recall under normal circumstances. What does this mean? It means that if a person hasn't yet reached a certain age , when certain age-related changes appear that begin to reduce our ability

to remember, to store information— that is, until the organic process of erasure has begun—our brain stores a colossal amount of information. Despite the number of neurons, the discomillions, that we know about, it's all stored somewhere. You're probably all familiar with the concept of

archiving—yes, an archiver, a computer, etc.—which compresses our Word files, with some success, with less success. It compresses graphic files, yes, it allows us to save space on the hard drive. So, imagine the degree of archiving. It doesn't matter

what system is in place: RNO, DNA, protein retention, and long-term memory . Just imagine how compactly it all gets compressed, so that, in principle, we can retrieve it all at almost any point in our lives. At the same time,

our cranium throughout life—well, in an adult it doesn't grow—while simultaneously accumulating information . That's all true. Just imagine the brain, right? You've seen the brain on the heart. We don't have much brain.

But it's colossal, and the amount of information stored there is simply hard to imagine. So, what kind of memory: mechanical and logical. And remember how you memorized some anatomy terms when you came, and why did you immediately remember such faces? So

there's the mechanical part, that is, when they tell you that repetition is the mother of learning, right? And, uh, and the svoslovaya part, that is, when you don't just drum information into yourself, yes, when you simply try to

find some logical connection with something else. You find an association based on similarity or something else, yes, that is, and you remember how to say to a Russian girl: "And I love you, yes?" The teacher tells you: "You say

yellow bus." Yes, and you say: "I love you." There. And I love you. There. Ah, but you remembered how to say in Russian: "I love you." It's not very similar, but somehow they sound similar , and a Russian girl who doesn't know

what a yellow bus is might understand. So, uh, by contrast, by adjacency, by similarity—that is, we connect, that is, we connect, ah, these establishments of internal connections, and we remember something this way, right? You memorized this a lot in

anatomy too, when you tried to associate some complex anatomical name and understand how it works. And then you could memorize some chemical transformations; yes, that's definitely logical and meaningful. You could simply memorize where in the textbook, how something is written, but you might

not understand where the hydrogen atom goes, where the oxygen is added, how it all oxidizes. You could write it down without memorizing it. And some people sit during an exam and write, ah, a chain of transformations, while others,

closing their eyes, recall the place in the textbook where it was drawn, and the person simply reproduces this formula from visual memory, yes. These are different types of memory, and they differ in energy capacity, that is, mechanics. Well, you understand

perfectly well that, ah, genetically, we are all different in terms of memory traces. Some have a strong mechanical memory, while others are more focused on the logical, semantic component of memorization. Ah, and which is better?

I won't argue now. It's better when these two types of memory work together . There are three types of memory: short-term, operational, and long-term.

The first is provided by circulation, and the electrical impulse is counted in a circle, not by the neuronal formations I showed you. Temporal memory is already being archived; well, it's currently the main theories for storing gram-size structures, that is,

memory traces. And RNA, the DNA model, is more than RNA. So, using four nucleotides, we encrypt not only the human genome, but also our memories.

And if we're talking about short-term memory, I would distinguish two different types. And the first is instant memory. Remember how you multiplied or divided in a column. Or rather, multiplied, right? So you multiplied eight, write two where? In

your head. I write three, one in your head. If you were asked literally five seconds later what was in your mind at the first stage of the operation, someone would remember, of course, and someone would say, "Why do I need this

two? I already added it to the next elements of the mathematical operation, right? And there used to be phones without a call-back function." And people would call information and ask, "How do I call the guard at this building?" And they would tell you six

or seven digits in Moscow, or about five small towns. You would dial the number, the dialer would turn the dial, those five digits, and there you would hear a busy signal. And exactly three seconds after you dialed, you

remembered, you dialed, you remembered these five or six digits, but in your head you need to call for information again, you didn’t write it down on paper. That is, this instant memory, that is, how it works, you don’t need

it. These intermediate actions, you don’t remember them, they are of no use. But true short-term memory, this is what I believe it looks like, ah, in the following way. You are studying for an exam and, like, uh, a decent student

, not so decent a student, you have given yourself a whole day and one night to master some complex subject.

And you sit down, and you know that your mechanical memory is quite developed. You can learn Chinese in three hours. And you study this Chinese . In the morning, you are in a state of Marxist disorder with yourself. If you

go and you don’t understand who you are and where such twilight. You come to the exam. I'm joking, of course. You come to the exam, you answer something, and it's something else, something more or less similar to what you read last

night. Then you have a surge of hypersensitivity. That is, when you leave the exam, you suddenly remember everything well, absolutely everything, and are ready to learn. You have all these formulas, they just appear in your mind. You are ready to tell

everything, but notice, it all appears in your mind and flies away. Three days pass. That's why I say that this approach to learning is bad, unsystematic, unsystematic. 3-4 days or even 2 months pass, and they ask you, do you remember that thing you told me

so well after the exam, right, you remembered? Go ahead, tell me the Creps cycle. Where did that come from? I know that you can all write the Creps cycle.

It's the tonose phosphate cycle. I'm sure of it. That's it. And vitamin B12, I always like this formula. It's such a big, beautiful formula. Here. Ah, that is, some things are retained for a fairly short time. No, these, of course

, were retained, but some are short-lived. The person left and forgot . That's short-lived. And what was recorded is what you really need, what will be useful in your practice. And if you work as a biochemist or a lab

technician, of course, you will need all these chemical chains. You must understand how it all works. So, what am I getting at? What influences memorization? It is influenced by the emotional significance of the information you receive, and subjective

significance for you, how much you imagine, how often you will need it in the future, right? And memorization is greatly influenced by repetition. It's not for nothing that they say the mother of learning. That is, the more often you encounter some information,

the deeper it settles in your next box. There. Uh, that's what memory is all about. Memory by the senses. We agreed that we have five of them. Here, yes, and here there are six. And in fact, in fact, the types of memory are the upper

ones, not by the five senses, yes, we all know that there is visual, there is auditory, and auditory memory. And you all know very well that each of you remembers better than others. That is, they must see everything they see; they

remember it, they read it themselves. Some are auditory, that is, they perceive it by ear. This is the leading , so to speak, representative modality.

And a person can read anything they want, but they won't remember it. But if they listen to something, they remember it very well. There. And there are some aestheticians who also need to touch it all. People won't understand

it initially. So they read and looked. But until you touch the skull, it has all these pits, where the zachia is, what the jaw is like, the mandible— they'll tell you when they study it and touch it, they remember it all very

well. Olfactory memory, yes. It's hard to fool you with pleasant and unpleasant smells. You recognize them, you remember them, yes, you have them catalogued. And gustatory memory is the same. Tasty, not tasty. Yes, if I ask you to remember the taste of pineapple,

and most of you have tried it, yes, and you wouldn't confuse it with the taste of mango or the taste of something else . And emotional memory, that's the memory of certain events that happened in your life. Were they somehow

emotionally charged, positively or negatively. And every time you come across something similar in your life, something that you've already had colored, you...your girlfriend had her first boyfriend who dumped her, his name was Vasya. And every time someone says to her, "Meet Vasya, he's a

wonderful man. You're so...Yeah, great. " So you have this...Well, psychoanalysis calls this transference. But we call it emotional memory in psychiatric propaedeutics. You're like, "Yeah, nothing good will come from Vasya, I'm waiting for the girl to change her mind about Vasya." Well,

memory can be voluntary and involuntary , right? There are things that are remembered regardless of our desires.

And there are things that we purposefully try to remember using the goal-setting function of consciousness.

Why do we need memory functions? There are three of them. There are three of them. And, actually, looking ahead, I can say that all memory disorders, they all, relate to one of these three elements. Either a person has poor

memorization, poor retention, or poor reproduction. That's logical. Oh, well, I won't explain it, right? Memorization , preservation or retention, reproduction or retrieval. That's clear . The properties of memory, they're on the slide. This is memory capacity.

This is speed, the speed of reproduction, ah, memorization and the speed of reproduction. That is, how quickly I can remember, ah, some information presented to me. And it is also the speed with which I can extract this information from the depths of my

memory. So, imagine that you are a very encyclopedic person and you arrive on a program, well, I don't know, some kind of, when they hit the button, you have to answer quickly, there are a lot of them now, ah, right away. And you know

the answer, you hit the button, and you say: "Right now, an hour and I'll tell you exactly." And someone just presses it, yes, and they already have an answer ready, they already answer.

Although we will be absolutely sure that both of them know it. It's just that one person quickly recalls it all, while the other does. Well, there is a density, but very slowly. Durability is precisely the ability to retain

information for a long time. Accuracy. Accuracy. I'll talk about accuracy separately. I really like this point, because in life I constantly encounter people who, uh, remember something that supposedly happened, or who so bizarrely transform what happened. And when you tell them, guys, why did you

say that you called me there? You already begin to doubt your memory, you think: "Maybe you called?" And then it turns out that the person forgot to call, but is absolutely sure that he did. There you go. And our psyche

sometimes strangely imposes even on healthy people ours, and these are some kind of memories, well, some kind of subjective, some kind of subjective smears. There you go. Well, and the ability to recall the requirements in a timely manner. That is, if he comes to

the exam, then we expect you to remember it during the exam, and not afterward. Aribot...Ribot's law, Theodore Ribot, and he described the law of progressive amnesia, that is, how, in the case of some progressive brain process, traces are erased from

our memory. And in short, simply put into Repo's law, it sounds like this: from the present to the past, from the complex to the simple. That is, first of all, events related to the present begin to fade from memory. And then the

process continues further and further and further. And a 90-year-old grandfather sitting on a bench next to his house can talk perfectly about the Great Patriotic War or the Civil War, if he captured it. And you can say, "

Well, that's some memory Grandpa has." But Grandpa, unfortunately, doesn't remember anything after 1924. He doesn't even remember his name. Well, maybe he does, but he can't remember where he lives. He doesn't know what date it is or who our president is.

This information, in turn, is short, unfortunately, no longer available. Although his memories of the earliest events are very well preserved, and he can recount them vividly. Exactly, exactly, exactly. Exactly. And accordingly, complex things, the most difficult ones, begin to fade in the

earliest periods, while the most basic ones—our skills, and the knowledge we remember—remain until the very last moment. Well, for example, what is repeated most often in life is often the last to be erased. For example, even severely demented patients can

often tie their shoelaces. That is, if you give them shoelaces, and they have this mechanical memory, they remember how to do it, how to zip up a zipper, if they used Belunka zippers, that is, they can do that too. So. And the

professional trees we talked about in the first part of the lecture, yes, professional actions. That is, the person is so unconscious, their consciousness is clouded, but their movements are the same ones they've been making every day for 30-40 years.

So they become vivid in their memory. That's why they become these automatic movements. So, this, this, this quantitative memory impairment. They can be qualitative and quantitative.

Let's start with quantitative ones, that is, an increase or decrease in the ability to remember, to reproduce and store information. Hypermnesia is an increased improvement in the disease, yes, an improvement in memory. It sounds a little ridiculous, but

nevertheless. That is, it occurs during some kind of disease processes, during intoxication, and, and, sometimes against the background of a high temperature, and, uh, in manic patients . That is, suddenly, memory begins to pull things out of the pins from

somewhere that you thought you had long forgotten. This is what we were talking about, but with a different flow. So, a person starts speaking a language they learned in school, a language they thought they'd completely lost. They know German, and only two words in

German. And suddenly they realize they can speak it at a high school level. And then they remember a poem they learned in first, second, and third grade, which, of course, you all remember, about a bunny, about bunnies.

So. And they remember moments from their life that the patient thought they wouldn't remember either. This is hypernesia. Selective hypernesia is vindictiveness, but it's more of a personality trait of a person who can't get rid of their memories for a long,

long time. Hypomnesia, on the other hand, is a decline. There can be a decline in all three components of memory: accumulation, retention, and retrieval. That is, a weakening of memory, difficulty in retrieval, and retention of retrieval. Recalling retention and reproduction. Here. And

here's anecphoria on the slide. Acphoria. And this is such an interesting phenomenon. It sometimes occurs at the onset of severe, uh, forms of memory loss, intellectual, mystical. Ah, when you have difficulty recalling information you know, sometimes it happens against the

background of nervous overload in neurotic individuals. That is, you know the actor's last name for sure, and before, you recalled it, said it with ease, and now you say this. I know, I can tell you for sure now, this

phenomenon appears, that is, it's on the tip of your tongue, that is, you now, right now I know for sure, yes, and you really know, when a person calms down, when this, uh, some external pressure, the need for this

quick recall, it disappears. The person says: "Ah, well, yes, that last name was Ivanov, I remember it, I remember it well. Now I can even tell you his entire biography." But at the moment when it was needed, the person couldn't

. This is the vascular origin of vascular lesions of the brain. And once again, in a person who is, uh, too anxious, or has too many problems in life, and, ah, the brain is thinking a little about something else. Amnesia,

that is, it is the erasure of certain events from your life from your memory.

There are two types. Type A and type B. The first is organic. The second, in our case, is psychogenic, hysterical.

The first most often begins with subtle , metaphorical things. Then, according to Rubaud's law, the person begins to poorly remember what happened yesterday . Then all this begins to shift further and further, until total amnesia, when the person turns into, well, basically,

a completely spa-like person. And these are various progressive, dystrophic brain processes, degenerative dystrophic. That's it. Or perhaps these are some kind of brain accidents, vascular or otherwise, which, in principle, have a character, albeit reversible. But most often, organic

amnesias are often undiagnosed. And type B is psychogenic amnesia, meaning it can be total or it can affect a specific period of your life, and it occurs against the backdrop of some severe psychotraumatic situation. Well, for example, I'll give a simple example

. For example, a victim of physical or sexual abuse. After some time, this information is erased from memory, and the person completely forgets it and says it never happened to them, that it never happened to them. There. Ah, what

else can I say about amnesias? We'll probably talk about amnesias again, if there's time, in the lecture on addictive behavior, chemical and non-chemical dependencies. Well, let's remember alcohol intoxication. So, alcohol intoxication probably causes a very large number of non-organic

intoxication amnesias, which aren't mentioned here. So, imagine someone drank a lot of alcohol. And then some interesting memory phenomena arise.

Well, firstly, the phenomenon of final amnesia can occur. Final amnesia. That is, when a person remembers everything up to a certain point, but then the memory of that part that ended your party is completely lost. And in the

morning, you'll have friends who will point at you, tell you stories, and you'll stare at them, wondering which of those things actually happened and which didn't, right? That's it. Another option, alcohol-induced intoxication amnesia, is so-called blackouts or fractional amnesia, in bits and pieces.

So, here I remember everything perfectly, but that moment is erased from my life. I remember this one again . Here, too, another blackout, meaning I don't remember it. Here I remember, here I don't. And it's believed that a

blackout is more of a psychogenic amnesia than an intoxication-related one. And this is explained by the fact that during blackouts, patients under the influence of alcohol often commit not-so-good deeds, which are then amnesicized. That is, the person doesn't want to remember what they did

in the morning. There's a phenomenon called alcoholic polympsists. Well, some call blackouts polympsists. Well, as far as I remember, the person who described polympsists—well, in patients with alcoholism—described the following phenomenon. That is, the person drank heavily the night before,

and in order to cure his hangover in the morning, he hid the last money he had, which he hadn't spent on drink. He hid it from his wife somewhere with the holy purpose of waking up in the morning, finding the money, and going

to the store. And then, morning. And he remembers everything that happened yesterday perfectly. Moreover, he even remembers that he hid the money, but, unfortunately, he doesn't remember where. That's it. And at that moment, he realizes that a tragedy has happened

, the money is gone, and somehow he's there, I don't know, his neighbor Serdoboy or someone else is helping him get over his hangover. And as soon as the alcohol intoxication returns, his memory returns. And suddenly, he's like

, "oops," and he goes to that chair, unscrews that leg, and takes out 100, well, whatever, some rubles. That's the last thing on the slide, and this is a phenomenon, a symptom of ecomnesia. It occurs precisely in progressive amnesia

in the elderly, when, according to Ribot's laws, they lose the last years of life, sometimes decades, sometimes 20, 30, 40 years, and are transported to some time that, well, they once experienced, and in which they subtly relate themselves to. And an

eighty-five-year-old woman, a grandmother, is absolutely certain that she is 30 years old. She acts like she's 30, goes to the mirror and says, "Who's that old woman over there?" And the events in her life that she experienced at 20 come to life again,

now at 30. And she may be getting ready to get married. She is certain that now her husband, who, well, maybe, unfortunately, has already died, will enter this room. This is called phenomenonesia. And in this gymnastic movement, they move closer and closer

and closer, well, not quite to birth. Usually, this is some age between 20 and 30. So, by direction, by direction, all amnesias are divided into retro, antera, retroantera, congrade amnesia, and infectious amnesia. The slide clearly shows how they differ from each

other. So, let's take a motorcyclist, the motorcyclist is riding, and the motorcyclist falls, the motorcyclist hits his head. Well, that's a common story. And when they bring him to the hospital, he doesn't remember a few hours before hitting his head on

something hard. What kind of amnesia is that? Pregrade amnesia. If our motorcyclist, uh, comes to, talks to the doctors for a few hours, then sleeps, wakes up, wide-eyed, and doesn't remember those few hours, and after admission, even though he seemed

to, uh, participate in the conversation , establish contact, it's a blur. And that's anterograde amnesia. Something very interesting happens in postoperative patients after anesthesia . That is, when they come out of anesthesia, they communicate perfectly with their relatives, like, eat that

orange that their relatives brought us. And then, after they've slept for a few hours, the relatives are sitting there, the patient wakes up, comes out completely, and under this anesthetic, he looks at his relatives and talks about his watch, about his relatives,

and says, "What kind of people are you? You had the operation this morning, and it's already the next morning that you've only just arrived." They tell him, "Wait, how can that be?""And there are orange peels." He says, "I don't

know anything, you weren't here yesterday." That is, she also erased the period after he had already come out of anesthesia. Anterograde amnesia, accordingly, is a combination of two options: before the exposure factor, such as anesthesia or motorcyclist injuries, and after. Contragrade

amnesia is amnesia of the period of the condition. Motorcyclist is not suitable here. But when a person was under anesthesia, most often...and now there are many studies that people remember everything that happens under anesthesia. But still, if we take this,

so to speak, established opinion, traditional, and if the anesthesia is really high-quality, then people don't remember the few hours they spent under anesthesia, when they, for example, had surgery. It's congratulatory, that is, they don't remember. This moment, when

a person is in a twilight state, if they don't remember how they were in this twilight of theirs, they too, this is also congratulatory. Pathological intoxication, pathological affect in the state when a person was there, he also communes, and a major epileptic

seizure. That is, he doesn't remember those few minutes either. This is ictal amnesia, but it is also congrade, since it concerns the period of exposure to the factor or when the person was in this painful state. So. Well,

accordingly, after congrade amnesia, nothing prevents the development of retrograde and anterograde amnesia, for example, and fixation amnesia. Fixation amnesia concerns precisely the first, uh, element of our memory-the imprinting of information. That is, a person stops recording, remembering what is happening to him right now. And

it happens, uh, with a whole range of conditions, but the most significant condition of such syndromes is Korsov syndrome, which you should know, and this is our Russian psychiatrist Sergei Sergeyevich Korsakov. And in 1898, he, uh, uh, defended his dissertation, then

wrote A monograph specifically about alcoholic polyneurotic amnestic psychosis. In fact, it wasn't just about alcoholics, but also about, uh, people in labor, uh, with feverish postpartum symptoms, where he also observed similar situations. But he still went down in history as the

person who described this alcoholic polyneurotic amnestic syndrome, which is now called Korsakoff's morbus, Korsakoff's disease. And what is the meaning of this condition? It's an encephalopathy, that is, a severe disorder of the brain. And usually we encounter Korsakoff's syndrome directly

when a person drank, drank, drank, and suddenly, uh, they transition to a state of Korski's syndrome. No, most often, Korski's encephalopathy develops after some other psychotic, uh, condition, uh, in alcoholics. That is, after delirium tremens, after, uh, some

other encephalopathies, uh, it turns out The patient has recovered, that is, he looks healthy, that is, his psychotic symptoms have disappeared, but suddenly you notice that he stops remembering what happens to him. He develops an element of fixation amnesia

. He remembers what happened to him before. He remembers where he worked, what he did. But, unfortunately, from the moment the encephalopathy began, he no longer remembers. This is a very difficult condition to treat.

Korzikov's syndrome and Korsikov's disease are very difficult to treat. And it is both alcoholic and non-alcoholic. And since a fixation disorder appears, that is, pain lasts for several days, weeks, he stops remembering what happens to him. What do such patients look like? I will now

return to the second two components of this syndrome, because they are still determined by the first. And the patient looks decent on the outside, but cannot answer any questions that concern his present. You ask what he ate for breakfast. He does not He

remembers. He doesn't remember what happened this morning. He doesn't remember what he was wearing an hour ago. And fixation amnesia is tested very simply. That is, you ask some questions that the patient must answer.

Well, for example, you ask: "What is your doctor's name?" He says: "I don't remember, he didn't introduce himself to me." You say: "Ivan Ivanovich, what year is it now?" He says: "Well, you say, it's 2018. It's, well, the month

is summer, you say, well, not summer, it's September. You have a good memory. " He says: "Excellent." So 2-3 minutes pass, and you immediately ask: "What's your doctor's name?" Or me, well, who is interviewing the patient? He, and

you told me what month, week it is, he doesn't remember any of this. And this goes on for quite a long time. Let's say two patients with Korsovsky syndrome are sitting in the ward playing a game of mineshaft. They get

up, go to the bathroom, come over to the other side of the table, each sits down and continues playing beautifully.

They know how to play, but they don't remember which game each played. The person ends up in the ward, so how do they find the bathroom by smelling the ward? Where to? They reach the bathroom , go, relieve themselves, and leave.

But the problem of finding a bed is enormous. They don't remember where they came from. These patients constantly get lost if they're near home. So, it's a serious condition.

I've also described how it's quite difficult to treat. Against the background of this fixation amnesia, pseudoreminescence, or conformations, appears. I'll talk about them later. In other words, these are false memories.

If we're talking about pseudoreminescence, we're talking about a person's real memory, something that happened to them in the past, which they use to fill this amdistic gap that they've developed over the past few days or months. And you ask the patient

, "What did you eat today?" He says, " Well, in the ward." He says, "Porridge.

" Well, they give you porridge all the time. In fact, there were boiled eggs, but he says, "Porridge, because he ate porridge." You say, "Okay, so what did you do this morning?" He says, "What, did you go to work? I'm on a machine,

I'm a milling machine operator, turning parts." He says, "Well, you're in the hospital, isn't he?" No, at least to work. "That is, he rearranges what happened to him. It's as if his memory is trying, our psyche is trying, well,

how to help him and says, well, you don't remember anything at all, but at least it sings to you in the morning on your way to work. This is reminescence, pseudo-reminescence. But conflation is borrowing someone else's information.

That is, the same thing. There are holes in memory that a person is trying to remember. And you ask him:" Here you are, Ivan Ivanovich, lying in the department. What did you do today during the day? "" And he watched a

program about a flight to Venus. He says: "Well, I flew to Venus." That's it. Or his neighbor told him how he caught fish, that he's a fisherman, he likes to fish. He says: "Well, of course, I went fishing today." That is,

he takes and borrows something. Sometimes these configurations or false memories, they are absolutely bizarre and fantastic. That is, then you look at this and say: "Yes, this is, of course, noticeable, but that something is wrong with the person." But if they

are so realistic, that is, you may not immediately understand completely whether this happened to the person or not. And thirdly, anistic disorientation. But since he doesn't remember anything, then how can we talk about orientation in the time of the

month? It is in himself. That is, it is autopsychic. And everything else for him is, you know, you wake up every time. There is a movie like that. And on Look at Nanto, there's a guy there, when he woke up, he had a piece of

paper in the morning, he had a girl lying next to him, he said, my name is John Smith. This is Jana, I love her, don't kick her out. Here's Jana, I love her. Jana, wake up. He doesn't remember

anything. So, if we're talking about alcohol syndrome, then these are the three, these are the three signs plus alcoholic lower polyneuropathy. This is Kors 'disease. If the syndrome occurs with tumors, with other diseases, sometimes with vascular ones, these are

the three signs without polyneuropathy. And this is Korsakov, this is Korsakov's journal. These are aphasias, this is just for information, since these aphasias are definitely also related to memory processes in a certain sense. This is a course on

nervous diseases. I think you remember, this is braka, braka aphasia. There you go. Well, I've already said this qualitatively about paramnesia. Now, I literally just talked about confabulation for two minutes. That is, these are false and memories that a

person never had, but he believes that they did in his life. Pseudo-reminesence is something that happened, but rearranged in time. And cryptonesia is appropriation, the certainty that some events, some works that belong to completely different people, a person in all seriousness,

not being feeble-minded, with serious memory loss, he appropriates them. Absolutely certain that it happened with them. That is, for example, if you wake up in the morning and you realize that you have never written poetry, but in the morning you take a pen, take a

sheet of paper, and start writing. You are overcome with inspiration, you write: "I remember a wonderful moment, it appeared before me.""Holy." And you go to the newspaper, what's the name of your newspaper? Hello. You come and say: "I wrote a poem, can we

publish it?" And you give it to the editor. The editor looks and says: " Listen, you wrote a poem." It was Pushkin who wrote it. He says: "Which Pushkin?" There. That is, at that moment, when they open a volume of

Pushkin for you, you look and understand that for some amount of time you were absolutely sure that this was yours, yours. There. Well, and ehnasiy- God bless them. That is, it is precisely this feeling that what is happening once upon a time was

encountered in your time. There. And thank you for your attention. And one last thing. Do you see the question on the slide? Well, I think that with the collective mind, everyone remembered one word, we will be able to recall it. Thank you very

much.