Depressive syndrome psychiatry. Symptoms of depression

Most of the problems and diseases of a person are related to his physical health. But there are also those that relate to the psychological component. Among them is depression, one of the most common diagnoses in psychotherapy. And this is not about the usual decrease in psycho-emotional tone or a spoiled mood. Here we consider depression as a serious mental illness.

What it is

Depression (from Latin depressio - “depression”) is considered to be such a mental disorder, which in most cases occurs after various traumatic events in a person’s life, but can also develop without obvious reasons. Seizures tend to recur.

The disease includes a triad of phenomena determined by the slowdown of human activity at different levels:

physical,
mental,
emotional.

Classification

There are a lot of approaches to trying to distinguish types of depression according to various criteria. Let's get acquainted with the main ones.

The reasons

Depression can be triggered by a range of factors, including:

external influences on the psyche (from acute psychological trauma to a chronic state of constant stress);
genetic predisposition;
various endocrine shifts (adolescent, postpartum and menopause);
congenital or acquired over time organic defects of the central nervous system;
somatic (physical) diseases.

In turn, severe psychological trauma can be caused by:

tragedy in personal life (from illness or death of a loved one to divorce and childlessness);
problems with their own health (from severe illness to disability);
cataclysms at work (from creative or industrial failures and conflicts to job loss or retirement);
experienced physical or psychological abuse;
economic troubles (from the transition to a level of security below the usual to financial collapse);
migration (from changing an apartment to another in the same city to moving to another country).

It is believed that it is necessary to seek professional help if:

A person has a depressed mood for more than 2 weeks, there is no tendency to improve.
All the previously helpful ways of relaxing and raising the mood (communication with friends, nature, music, etc.) no longer work.
There were thoughts of suicide.
Family and work social ties are actively collapsing.
The range of interests is gradually narrowing, the taste for life is lost, more and more often there is a desire to "withdraw into oneself."

We will also try to deal with the versatility of the symptoms of severe depression. This type may appear as:

serious physical impairment. These can be malfunctions of the digestive system, pain in the muscles, heart and head, constant drowsiness or insomnia against the background of severe general weakness,
loss of natural desires: complete lack of appetite, sexual desires, loss of maternal feelings,
sudden changes in mood
constant self-flagellation, heightened feelings of guilt, anxiety or danger, uselessness,
lack of work activity, refusal to go to work at all,
slowness of thinking, it becomes very difficult to think and make decisions,
the appearance of indifference to close and previously loved people, the patient understands this and suffers even more,
suicidal thoughts,
inhibition of reactions
and even, in particularly difficult cases, hallucinations, etc.

At the same time, the symptoms in adolescents, women and men also have distinctive features.

gloom, capriciousness, outbursts of hostile aggression directed at parents, classmates, friends;
a sharp decline in performance due to a weakening of the function of attention, increased fatigue, loss of interest in learning;
narrowing of the circle of communication, constant conflicts with parents, frequent change of friends and buddies;
acute rejection of even a minimal amount of criticism, complaints of misunderstanding, dislike for him, etc.;
absenteeism, all kinds of lateness and careless attitude to their personal duties at home and in school;
bodily pains unrelated to organic pathology (headaches, in the abdomen and in the region of the heart), fear of death.

Symptoms of depression in women

Their peculiarity lies in seasonality, a tendency to a chronic course, and a connection with the reproductive cycle. it

pronounced vegetative manifestations (from nausea and suffocation to palpitations and chills);
eating disorders (an attempt to "seize" their problems and a disgusting mood, as well as anorexia).

Features specific to men

attempts to get into alcohol and smoking,
severe fatigue and irritability,
loss of interest in work or hobbies

If a person falls ill with depression, the advice of others will not help him. You can't do without the work of a professional.

Usually, it is not the patients themselves who turn to the psychologist about depression, but their worried relatives, since the patient himself simply does not see the point in treatment and is too immersed in his experiences. You can even turn to a regular therapist who can make a preliminary diagnosis of depression. Clarification is made only by a psychiatrist.

At the first appointment, information is collected about complaints, the history of the current disease, the state of health at the time of admission, the patient's life history, family, and social connections. This is how the type of depression is determined and the question of the need for consultations of other specialists is resolved.

For example, only a psychiatrist in a hospital is engaged in the treatment of severe endogenous depressions, while organic and symptomatic types, together with a psychologist, are supervised by therapists.

For early diagnosis, professionals also use special questionnaires (Beck, Tsung), scales that not only detect the presence of depression in a patient, but also assess its severity, and are also able to further monitor the course of the treatment process.

Hormonal studies and studies of the bioelectrical activity of the brain (electroencephalogram) can also be carried out.

In medical practice, diagnostic criteria are used to accurately diagnose depression. So, the patient for 2 weeks or more, daily, must be exposed to at least 5 of the following symptoms:

Depressed mood, manifested in the form of irritability, tearfulness.
Decline of interests in any field of activity, inability to have fun, apathy.
Unintentional changes in appetite and weight gain or loss.
Insomnia or, conversely, constant drowsiness.
Lethargy or, conversely, a manifestation of excessive psychomotor agitation.
Loss of energy, instant fatigue.
Feeling worthless, guilty.
A drop in concentration and performance, especially in the intellectual spheres.
Having suicidal thoughts and plans.

However, these symptoms cannot be associated with alcohol abuse, physical illness, or loss.

Treatment

In total, there are 4 treatment methods that complement each other:

Medical therapy

It involves the use of drugs that can relieve an acute state of depression:

antidepressants,
tranquilizers,
neuroleptics,
mood stabilizers (mood stabilizers),

Such treatment is selected by the doctor on an individual basis; It is dangerous to use these medicines on your own: they all affect the brain and, if the dosage is incorrect, can cause irreparable harm to a person.

Antidepressants are most often used in the treatment of depression as drugs that can increase the patient's emotional background and restore the joy of life to him. They can only be prescribed by a specialist who will monitor the condition of a person during treatment.

Specificity of antidepressants:

their therapeutic effect begins to appear only after a fairly long period of time after the start of administration (at least 1-2 weeks);
most of their side effects are active in the first days and weeks of admission, and then disappear, or significantly decrease;
when taken in therapeutic doses, they do not cause physical or mental dependence, but they are canceled gradually, not abruptly (because there is a risk of the patient developing a “withdrawal syndrome”);
it is necessary to take drugs for a long time, even after normalization of the condition, for a sustainable effect.

Psychotherapy

Offers a very wide range of different techniques, applied sequentially, in adequate combination with each other. With severe depression, drug treatment complements psychotherapy, with mild depression, only psychotherapeutic methods can be used. The following types of psychotherapy are used:

psychodynamic,
cognitive-behavioral,
trance etc.

The course of treatment consists of consultations with the attending psychotherapist and, as a rule, lasts more than one month.

Physiotherapy

Has an auxiliary value. Various procedures are applied, such as:

light therapy,
color therapy,
aromatherapy,
music therapy,
art therapy,
healing sleep,
massage,
mesodiencephalic modulation, etc.

shock techniques

It happens that the breakage of a long-term and deep depression that is resistant to conventional therapy can be facilitated by the use of techniques that will create a high physical and psychological "hit" for a person, in other words, a shock. However, they are quite dangerous - therefore, they are used only in psychiatric hospitals after the approval of a council of doctors and only with the written informed consent of the patient. You can shock:

Therapeutic starvation (with complete fasting for 1-2 weeks, survival becomes the main goal for the body, all systems are mobilized and apathy disappears);
Sleep deprivation (the patient is asked not to sleep for about 36-40 hours, while the nervous system is disinhibited and activated, thought processes are "rebooted", mood is improved);
Medical shock insulin therapy;
Electro-convulsive therapy, etc.

Forecast and prevention

Perhaps the only plus of depression is that it is successfully cured. 90% of people who turn to doctors for help recover completely. Only a qualified psychologist and psychiatrist can provide comprehensive information on the prevention of depression that can help a particular person. The general recommendations are:

Healthy sleep (for an adult - at least 8 hours a day, for children and adolescents - 9-13 hours).
Proper nutrition (regular and balanced).
Compliance with the daily routine.
Spending time with family and friends (joint walks, going to the cinema, theaters and other places for entertainment).
Great physical activity.
Avoidance of stressful situations.
Time for yourself, for receiving positive emotions.

Remember that depression is the same disease as gastritis or high blood pressure, and it can also be cured. Do not blame yourself for the lack of "willpower", for the inability to pull yourself together. Contacting a specialist without delay and without wasting time is the best way out of the situation.

On the video - explanations of a psychotherapist about the difference between a bad mood and a real illness:

- a mental illness, manifested not only by mental, but also by physical symptoms. In everyday life, depression is called melancholy and lack of desire to be active. But it's not the same. Depression is a serious condition that requires special treatment. Its consequences may be irreparable.

Manic depressive syndrome

Depression in different individuals proceeds with its own specifics. The doctor, establishing the diagnosis of a depressive syndrome, necessarily determines its type. With manic-depressive syndrome, two phases alternate (as the name implies). The intervals between them are called periods of enlightenment. The manic phase is characterized by:

acceleration of thought
excessive use of gestures
excitation of the psychomotor sphere
energy, which may not be inherent in this person during periods of enlightenment
good mood, even revealingly good

This phase is characterized by frequent laughter of the patient, he is in high spirits for no apparent reason, enters into communication with others, talking a lot. In this phase, he can suddenly be convinced of his own exclusivity and genius. Patients present themselves in many cases as talented actors or poets.

After this phase comes manic with the opposite clinic:

longing and
depression for no reason
thought is slow
movements are constrained, insignificant

Mania lasts less time than the phases of the depressive syndrome. It can be either 2-3 days or 3-4 months. Often, with this type of depression, a person is aware of the state he is in, but cannot cope with the pathological symptoms himself.

Astheno-depressive syndrome

This is a mental disorder, the main manifestations of which are:

slow flow of thought
slow speech
slow movements, gestures
rising anxiety
fast onset fatigue
weakness in the body

The reasons can be of two groups:

domestic
external

The first of these groups includes pathologies in the emotional sphere and stresses of various nature. External causes are diseases:

pathology of the heart and blood vessels
infection
received injuries
surgery that went badly
oncology (tumors)

In patients of puberty and at a young age, this depressive syndrome can be very negative. The following symptoms are added:

protests for no reason
increased irritability
manifestations of anger in speech and behavior
rudeness towards others, even to the closest people
constant tantrums

When the disease lasts for a long time, does not go away, then the person may have guilt for what is happening to him (and that he cannot be cured by his own efforts). Then he begins to evaluate his condition extremely gloomily, gets angry at the world and evaluates it negatively.

Astheno-depressive syndrome has a direct reflection on the physical well-being of a person:

decreased libido
violation of the cycle of critical days
sleep disorder
decreased or lack of appetite
diseases of the digestive tract, etc.

It is worth knowing that with this type of depressive syndrome, a person feels better when he is well rested, or when the somatic symptoms of the disease are eliminated. Treatment is selected depending on how severe the pathology is in a particular case. Sometimes just a session with a psychotherapist is enough. But in severe cases of this type of depression, a course of psychotherapy is needed in combination with sedatives and antidepressants.

Anxiety-depressive syndrome

As in previous cases, the features of this type of depression can be understood from the name itself. It is characterized by a combination of anxiety and panic fears. These manifestations are inherent mainly in adolescents, therefore it is not surprising that anxiety-depressive syndrome is most often diagnosed in individuals in the puberty period. The reasons are in the inferiority complex, vulnerability and excessive emotionality characteristic of this stage of personality development.

Manifestations of this type are painful various fears that develop into phobias. Often adolescents with this syndrome are very much afraid of punishment, both for what they have done and for imperfect actions. They are afraid of punishment for insufficient intelligence, talent, skills, and so on.

A person can no longer objectively evaluate the world, his personality with all its characteristics and roles, the situations that occur with him. He sees everything in the darkest colors, perceives with a great deal of hostility. It is likely the formation of persecution mania. Patients in such cases think that someone (most people or all) conspired to frame, deceive, hurt, etc.

With persecution mania, a person may begin to think that there are enemy agents around, monitoring the actions of the patient. A person becomes suspicious (even in relation to the closest people), excessive suspiciousness is characteristic. The patient's energy is spent on confronting the world and those elements that he himself invented. He begins to hide and take other actions to "protect himself from agents." To recover from anxiety-depressive syndrome (and persecution mania), you need to contact an experienced psychotherapist or psychiatrist. He may also prescribe sedatives if he sees the need for them for a particular patient.

Depressed Personalities

Depressive individuals are characterized by:

pessimism (very rarely skepticism)
suppressed actions
slow motion
restraint
quietness
small expectations from life in your favor
lack of desire to talk about yourself
hiding your life

Depressed individuals may hide their character traits with poise. Separately, they consider gloomy-depressive personalities, who, in addition to a depressed state and a negative outlook on the world, have the following features:

sarcasm
grouchiness about and without
obnoxiousness

A depressed personality is not the same as a person with depressive psychosis. Depressive reactions are also not synonymous with this concept. From the point of view of symptoms, the same disorders are depressive character neuroses and depressive personality structure. The difference between depressive neurosis lies in the presence of various mood disorders, which cannot be described with a clear characteristic symptomatology.

Personality becomes depressed due to the predisposition and characteristics of the relationship between the child and parents. A strong attachment to the mother (with ambivalence) is obligatory, which leads to the fact that the child cannot act independently, solve his problems. The child is afraid of losing affection. He has problems with self-determination. The formation of a depressive personality is influenced by the deterioration of relations with herself and her father, conflicts with other close people, and terrible life situations.

Treatment includes:

crowding out
formation of independence
elaboration of the subject of negative transfer

Depressive-paranoid syndromes

Levels of depression (classic development):

cyclomatic
hypothymic
melancholic
depressive-paranoid

When depression stops in its development at any of the above stages, this type of depression is formed:

cyclothymic
subsyndromal
melancholic
delusional

In the cyclomatic stage the patient becomes unsure of himself, evaluates his appearance/professional qualities/personal qualities low, etc. He does not enjoy life. Interests are lost, the person becomes passive. At this stage, there are:

psychomotor retardation
anxiety
affect of anguish
ideas of self-blame
thoughts of committing suicide

What is typical for this stage:

asthenic phenomena
sleep problems
decreased sexual desire

next,hypothymic stage, is special in that a dreary affect appears, moderately pronounced. The patient complains that he is hopeless; the person becomes despondent and sad. He says that a stone lies on the soul, that it does not mean anything for this world, that life has no purpose, and he wasted many years of time in vain. He sees everything as difficulties. The patient begins to think how exactly he can commit suicide, and whether it is worth doing it. Close people and a psychotherapist at this stage can convince a person that in fact everything is not as it seems to him.

The patient's condition at this stage is better in the evenings. He is capable of working and interacting in a team. But these actions require the patient to activate his willpower. Their thought process slows down. The patient may complain that his memory has recently become worse. For some time, the patient's movements may be slow, and then a period of fussiness sets in.

The hypothymic stage is characterized by a typical appearance of patients:

pained facial expression
lifeless person
drooping corners of the mouth
dull look
uneven back
shuffling gait
monotonous and raspy voice
intermittent sweating on the forehead
the man looks older than his age

Vegetative symptoms appear: loss of appetite (as in the previous stage), constipation, lack of sleep at night. The disorder at this stage acquires a depersonalizing, apathetic, anxious or dreary character.

Melancholic stage of depression characterized by the excruciating suffering of the patient, his mental pain borders on the physical. The stage is characterized by a clear psychomotor retardation. A person can no longer conduct a dialogue with someone, the answers to questions become meek, monosyllabic. A person does not want to go anywhere, does nothing, only lies most of the day. Depression becomes monotonous. Appearance features characteristic of this stage:

dryness of mucous membranes
frozen face
devoid of emotions and many intonations voice
hunched back
the minimum number of movements, the almost complete absence of gestures

A person thinks about suicide and tries to realize his plans for such an outcome. The patient may develop melancholic raptus. The person begins to rush back and forth around the room, wringing his hands, trying to commit suicide. Overvalued ideas of low value change to delusional ideas of self-abasement.

A person negatively evaluates his actions, actions in the past. He believes that he did not fulfill his family and professional obligations. And it is no longer possible to inspire them with the opposite. The patient lacks the ability of critical thinking, he cannot look at things and his personality objectively.

Delusional stage of depression has 3 stages. The first is characterized by delusions of self-blame, the second by delusions of sinfulness, the third by delusions of denial and enormity (at the same time, catatonic symptoms develop. The ideas of self-blame are that a person blames himself for everything that happens in the world, with his relatives and children.

Gradually paranoid clinic develops based on the following fears:

get sick and die
commit a crime and be punished for it
impoverish

When a person begins to blame himself even more, he begins to have false recognitions, ideas of a special significance of what is happening. A little later, some catatonic manifestations, verbal hallucinations, illusory hallucinosis appear.

A person in the hospital, at this stage in the development of the disease, begins to believe in many cases that he has been placed in prison. He takes the orderlies for guards. It seems to him that everyone around him is surreptitiously watching and whispering. Whatever the people around him are talking about, he thinks they are discussing his future punishment/revenge. He may consider even small mistakes in the past as his crime, which in fact are not violations of the law or even any rules established in society.

The paraphrenic stage, which comes after the one described above, is characterized by blaming the patient himself for all the sins and crimes that only exist in the world. They think that very soon there will be war all over the world, and the end of the world is near. The sick believe that their torment will be eternal when they are left alone after the war. Probably the formation of a delirium of possession (a person believes that he has reincarnated as a devil, symbolizing world evil).

In some cases, at this stage of depression, the so-called nihilistic delirium of Kotard is formed. At the same time, it seems to a person that they stink of rotting flesh, that everything inside them began to decay, or that their body does not exist. Probably, catatonic symptoms will join.

The depressive-paranoid syndromes described above (which are part of the disease of depression) are formed according to a certain specified image. They are distinct from delusional psychoses, which may be a consequence/manifestation of depression.

Diagnosis of depression in modern classifications (ICD-10) involves the definition of three degrees of severity (by the presence of two or more main and two or more additional symptoms of depression, as well as by assessing social functioning).

As follows from it, severity is determined not so much by clinical "severity" as by impaired social functioning. Meanwhile, these are by no means always coinciding phenomena: in some areas of activity, even subsyndromal disorders can be an obstacle to the implementation of social functions.

It must be admitted that for the initial diagnosis, detection of depression as such, without their clinical differentiation, these operational lists of symptoms are quite convenient.

Depression is characterized by the following groups of symptoms

Emotional disorders. In a depressive syndrome, as in hypomania and manic states, it is customary to single out the corresponding changes in mood as a cardinal sign, in this case, hypothymia in its various variants. At the same time, in relation to affective disorders proper, hypothymia in depression (dreary, anxious, modality), although it is its characteristic manifestation, does not always determine the essence of a depressive disorder.

In recurrent (including bipolar variants) depressive disorders, the modality of hypothymia is in harmony with other symptoms of depression. Undifferentiated hypothymia is possible, where the severity of the pathological mood shift lags behind other depressive manifestations, and its indefinite modality can either characterize the incompleteness, incompleteness, "neurotic" or quasi-neurotic level of affective disorder, more characteristic of chronic depression within the framework of dysthymia, or reflect the stage of formation of the depressive syndrome and “open up” in the future in more specific emotional disorders.

Primary guilt (devoid of any justification and idea development) is a special pathological emotional symptom of depression.

Anhedonia also belongs to emotional disorders. In modern classifications, it is given fundamental importance in the diagnosis of this disease, which generally corresponds to clinical reality. However, it is difficult to agree with the mixing of anhedonia - as the absence of the usual feeling of pleasure - with the experience of loss of interest in ordinary activities, the environment, and activity in general that does not belong directly to the sphere of emotions.

Painful mental anesthesia, "a feeling of loss of feelings" is a characteristic symptom of depression. Basically, it also refers to changes in emotions, since it is experienced as a "feeling of loss of feelings", although it borders on sensory disturbances and probably affects the sphere of cognitive activity.

The most common are experiences of loss of feelings for loved ones. Along with this, the disappearance of the emotional attitude to the environment, indifference to work, any kind of activity, and entertainment is often noted. Equally painful for patients is the loss of the ability to rejoice, to experience positive emotions (anhedonia), and the inability to respond to sad events, the inability to compassion, concern for others. The oppression of "vital feelings" - hunger, satiety, sexual satisfaction is painfully experienced. A common symptom of depression is the loss of the sense of sleep - the lack of a feeling of rest and vigor upon awakening.

Painful mental anesthesia, combined with a feeling of general mental and physical alteration, is usually combined with the concept of depressive depersonalization. Patients characterize these experiences as "depersonalization", the loss of individual qualities. At the same time, it is advisable to separate depressive depersonalization from psychogenic ones, including within the framework of acute stress disorders, and organic forms of depersonalization and derealization, often combined with body schema disorders. Depersonalization in schizophrenia differs from ordinary depressive depersonalization primarily in the vagueness or pretentiousness and variability of descriptions of experiences of alienation and their convergence with the phenomena of mental automatism.

Keep in mind: Depression is a disease that requires qualified help. Mental Health has over 10 years of experience treating depression. The clinic uses only modern and safe methods, and an individual program is selected for each patient, which allows you to cope with depression most effectively.

Vegetative-somatic symptoms Depressions are in many respects no less important than emotional disturbances, both for diagnosis and for therapy and prevention. In this series, first of all, they usually name the diverse unpleasant pseudo-somatic sensations often experienced by patients with depressions of various affiliations. These sensations, as a rule, serve as the main reason for seeking medical help. Apparently, unpleasant bodily sensations are associated with the process of somatization of affect (often anxiety), functional vegetative-somatic changes. At the same time, they are also related to sensory disturbances, or so-called pathological bodily sensations.

Anergy in depression is primary and can by no means be equated with fatigue, although the latter can objectively occur in some forms of depression. Patients, due to the difficulties of subjective differentiation, first of all note just "fatigue", "fatigue", which are not necessarily associated with physical exhaustion. In addition, with severe depression, especially of the anxious type, there may be tension in individual muscle groups, which patients define as an inability to relax, constant and exhausting tension. Anergy, like mood, is subject to diurnal fluctuations with a general decrease in the first half of the day. Sometimes these phenomena are described by patients as "drowsiness", "half-asleep state", paradoxically connecting with anxiety. Both phenomena disappear by the end of the day.

Anergy is often combined with a dreary-apathetic tone of mood, which is the reason for isolating a special type of "apato-adynamic depression". In the framework of affective disorders, independence of this type seems to be problematic: it is usually a stage of prolonged depression, not necessarily poor in its structure. Behind the façade of apathy, one can identify (and for therapeutic purposes even at times actualize) typical symptoms of depression, including elements of anxiety.

Thus, there is a certain direction in changes in autonomic regulation - from autonomic lability to a clear dominance of sympathicotonia, especially with severe depression. In this respect, depression approaches the opposite phases of bipolar disorder. The nature of this kind of similarity remains poorly understood to date. Typical "classic" depressions are characterized by persistent high levels of cortisol or a slight decrease in response to the administration of dexamethasone (the so-called dexamethasone test). This is one of the reflections of the general decrease in reactivity - both psychological and biological.

Sleep disorders in depression are characterized by a reduction in its duration and early awakening. Difficulty falling asleep and daytime sleepiness are often cited as possible symptoms of depression.

General somatic symptoms of depression can be manifested not only by anergy, a general decrease in vital tone, intestinal atony, but also, in extreme cases, trophic disorders of the skin, mucous membranes - their pallor, dryness, loss of skin turgor. In the past, dry, unblinking eyes, characteristic of melancholy, were often described.

Among sensory disturbances in depression, in addition to the tactile, gustatory hypoesthesia noted above, changes in the basic perceptual functions of vision and hearing appear to be peculiar phenomena that are not entirely clear in nature. A typical symptom of depression is the loss of taste sensations, sometimes included in the symptom complex of mental anesthesia as a sign of anesthesia of vital emotions. Subjectively recorded by some patients, hearing loss, visual impairment is not always confirmed by objective studies: the reason is rather a slow reaction to auditory and visual stimuli.

Movement disorders more often expressed by inhibition. Equalization of motor inhibition and excitation in modern diagnostic lists in relation to depression in general, apparently, should be attributed only to anxious depressions or anxiety-depressive states.

With anxious and melancholy-anxious depressions, manifestations of lethargy are often combined with signs of arousal. Possible dysarthria, often associated with dryness of the oral mucosa.

Conative symptoms Depression is natural for its development: these are difficulties in making decisions, reduced motivation for activity, especially in the morning, a decrease or a distinct loss of interest in what is happening around, new impressions, a change of scenery, communication, difficulty maintaining volitional effort. This corresponds to changes in vital desires: decreased libido, appetite with weight loss; in the initial stages of depression and in anxiety-type depressions, an increase in appetite is also possible, which is almost never observed at the height of depression.

At the initial stages, the first manifestations of the extinction of spontaneous activity, a decrease in the motivation of activity, and a narrowing of the sphere of interests are opposed by the not always conscious resistance to the disease. It is expressed in the search for external incentives for any actions, involving in which the patient is able to show sufficient productivity and acquire the usual level of achievement. In his mind, the disease seems to stop for a while.

Conscious resistance to the disease due to volitional effort, for example, focusing on the most significant activity, turning to special exercises, physical activity, can have a positive, but most often only a temporary result. When a depressive syndrome is formed, such efforts ultimately turn out to be unproductive and lead to self-esteem crises with a dramatic awareness of insolvency, “inferiority”. The symptoms of depression only get worse.

Rest as such, with release from habitual loads or special burdensome duties without switching to any other active employment, almost never alleviates the symptoms of depression and does not prevent its development. Just during this period, autochthonous, unrelated to specific circumstances, detailed symptoms of depression are “revealed”.

cognitive symptoms depressions are diverse, but rather homogeneous and interconnected with other changes inherent in depressions. Executive cognitive functions are characterized by lethargy. Registered both objectively and subjectively, they may not be accentuated by patients, but are detected with directed, leading questions. Much also depends on the individual significance of intellectual activity and current professional and other tasks that require intense mental activity. Patients distinguish violations of concentration of attention, less often - memory impairments, difficulty in remembering and reproducing. Difficulties in switching attention and narrowing of its volume are more often detected with typical melancholy depressions with lethargy, and instability of attention - with anxiety. Impairments of memorization and reproduction are expressed moderately and are manifested mainly in the fact that patients give the events a generalized description, omitting the details. A kind of selective hypermnesia is possible, relating to unpleasant or tragic events of the past, sad memories with a constant return to them (the so-called depressive rumination). Situations in which patients emphasize or assume their omissions, blunders, mistakes or direct guilt are especially highlighted. This is related to changes in the course of associations in terms of tempo and volume, and to ideational disorders.

Symptoms of depression in the form ideas of low value, self-accusations constitute the characteristic content of experiences. Feelings of hopelessness, lack of perspective as a whole are characteristic of depressions with any modality of affect, but are more "open" in complaints with melancholy and anxious depressions.

The psychopathological structure of ideas of low value, self-accusation is usually limited to an overvalued level: “calculation of failures”, a kind of search for evidence of one’s insolvency, inability to support loved ones, foresee adverse events, possible harm, inconvenience, damage to others.

depressive delusions- a relatively rare symptom of depression, more often observed in anxious and melancholy states. For the diagnostic assessment of such cases, it is important to establish the leading role of depressive affect (as a combination of hypothymic mood, corresponding somatovegetative, primarily anergy, and motivational-volitional changes), i.e. congruence of pathological ideas to affect. If delirium begins to outpace other symptoms of depression in severity, then it is legitimate to assume at least a schizoaffective, and with good reason - a schizophrenic nature of the disorder. Similar diagnostic doubts should also arise when the reduction of depressive ideas clearly lags behind other manifestations of the depressive syndrome during treatment with antidepressants. Ideas of condemnation in endogenomorphic depression are relatively rare and are usually limited to assumptions about a condescendingly condemning (but not hostile) attitude towards the patient on the part of others, fixing on their sympathetic remarks: "Everyone understands my worthlessness, but no one speaks."

Ideas of accusation, i.e. extrapunitive vector of guilt, not characteristic of depression. Judgmental reproaches of others, resentment against them are inherent in dysthymic disorders.

Ideas of self-blame are often combined with anti-vital experiences - thoughts of death without suicidal intentions. Many patients have the possibility of forming and suicidal ideas. Usually a person finds moral or cultural, in particular religious, even aesthetic alternatives to suicidal actions.

One of the frequent plots of ideation disorders are hypochondriacal ideas. Fixation on well-being, overvalued exaggeration of the severity and dangerous outcomes of certain dysfunctions or diagnosed diseases is a common symptom of depression. Hypochondriacal delusions should be the subject of differential diagnosis due to their likely belonging to schizoaffective disorders or schizophrenia.

Anxious depressions are characterized by obsessive fears and ideas about alleged misfortunes or situations in which the patient can harm not only and not so much himself as others by his actions. Contrasting obsessions are usually associated with anxiety depression. More problematic or relegated to the past is the connection with it of abstract obsessions.

The appeal to the same pessimistic memories - depressive monoideism - is related to changes in the flow of associations in terms of tempo and volume, and to the content of thinking, i.e. to ideational disorders. Depressive monoideism approaches obsessions. These are either recurring memories of unpleasant events, or disturbingly colored representations of supposed misfortunes or adverse situations.

Depressive pessimism- Another phenomenon that can be conditionally attributed to the symptoms of depression, although this is not so much a rational justification for hopelessness as an irrational belief in the failure to change anything. This is a kind of negative belief.

Systemic cognitive functions: the change in criticism in depression is not uniform. Orientation in the environment is fundamentally preserved, but the detachment from what is happening around, indifference to the environment, immersion in one's own experiences, inherent in depression, narrow the scope of perception and, accordingly, make it difficult to accurately reproduce what is happening. With pronounced depressions of the melancholic level, especially at a later age, temporary difficulties in orientation in the environment are possible. The productivity of activity decreases with the deepening of depression, although at the very initial stages and with relatively mild manifestations, volitional effort makes it possible to overcome the existing minor disorders.

Known symptoms of depression in the form of pseudodementia do not so much reflect the severity of the main depressive disorders, but rather indicate a hidden organic "soil", most often vascular. Phenomena of intellectual-mnestic inconsistency are usually detected at a later age.

The article was prepared and edited by: surgeon

DEPRESSIVE SYNDROMES(lat. depressio depression, oppression; syndrome; synonym: depression, melancholy) - mental disorders, the main feature of which is a depressed, depressed, melancholy mood, combined with a number of ideational (thinking disorders), motor, and somatovegetative disorders. D. pages, as well as manic (see. Manic syndromes), belong to the group of affective syndromes - conditions characterized by various painful mood changes.

D. page - one of the most widespread patol. the disorders which are found almost at all mental diseases, features To-rykh are reflected in manifestations of depressions. The generally accepted classification of D. with. no.

D. s. have a tendency to repeated re-development, therefore, they significantly disrupt the social adaptation of some patients, change their life rhythm and in some cases contribute to early disability; this applies both to patients with severe forms of the disease, and to a large group of patients with erased wedges, manifestations of the disease. Besides, D. with. represent a danger in relation to suicide, create opportunities for the development of drug addiction (see).

D. s. can exhaust the entire wedge, the picture of the disease, or be combined with other manifestations of mental disorders.

Clinical picture

Clinical picture D. s. heterogeneous. This is due not only to the different intensity of the manifestations of the entire D. s. or its individual components, but also with the addition of other features included in the structure of D. s.

To the most widespread, typical forms D. of page. are referred to as simple depressions with a characteristic triad of symptoms in the form of a reduced, melancholy mood, psychomotor and intellectual inhibition. In mild cases or in the initial stage of development of D. s. patients quite often experience feeling physical. tiredness, lethargy, fatigue. There is a decrease in creative activity, a painful feeling of dissatisfaction with oneself, a general decrease in mental and physical. tone. Patients themselves often complain of "laziness", lack of will, that they cannot "pull themselves together". Decreased mood can have a variety of shades - from feelings of boredom, sadness, easy fatigue, depression to feelings of depression with anxiety or gloomy gloom. Pessimism appears in assessing oneself, one's abilities, social value. Joyful events do not find a response. Patients seek solitude, they feel not the same as before. Already at the beginning of D.'s development with. persistent disturbances of a dream, appetite, went. - kish are noted. disorders, headaches, unpleasant painful sensations in the body. This is so called. cyclothymic type of depression, characterized by a shallow degree of disorders.

With the deepening of the severity of depression, psychomotor and intellectual retardation increases; melancholy becomes the leading background of mood. In a serious condition, patients look depressed, facial expressions are mournful, inhibited (hypomimia) or completely frozen (amimia). The eyes are sad, the upper eyelids are half-drooped with a characteristic fold of Veraguta (the eyelid is bent at an angle upwards in its inner third). The voice is quiet, deaf, monotonous, slightly modulated; the speech is stingy, the answers are monosyllabic. Thinking is inhibited, with a poverty of associations, with a pessimistic focus on the past, present, and future. Characterized by thoughts about one's inferiority, worthlessness, ideas of guilt or sin (D. s. with ideas of self-accusation and self-abasement). With the predominance of psychomotor retardation, the movements of patients are slow, the look is extinct, lifeless, directed into space, there are no tears (“dry” depression); in severe cases, there is complete immobility, stupor (depressive stupor) - stuporous depression. These states of deep lethargy can sometimes be suddenly interrupted by states of melancholic frenzy (raptus melancholicus) - an explosion of feelings of despair, hopelessness with lamentations, a desire for self-mutilation. Often during such periods, patients commit suicide. A feature of longing is physical. its sensation in the chest, in the heart (anxietas praecordialis), in the head, sometimes in the form of "mental pain", burning, sometimes in the form of a "heavy stone" (the so-called vital feeling of longing).

As in the initial stage, during the full development of D. s. somatovegetative disorders remain pronounced in the form of sleep disturbance, appetite, constipation; patients lose weight, skin turgor decreases, extremities are cold, cyanotic, blood pressure decreases or increases, endocrine functions are upset, sexual instinct decreases, menstruation often stops in women. The presence of a daily rhythm in the fluctuation of the state is characteristic, more often with improvement in the evening. With very severe forms of D. s. daily fluctuations in the state may be absent.

In addition to the most typical forms described above, there are a number of other varieties of D. with., associated with the modification of major depressive disorders. Smiling depression is distinguished, for which a smile is characteristic in the presence of bitter irony over oneself, combined with an extremely depressed state of mind, with a feeling of complete hopelessness and meaninglessness of one's further existence.

In the absence of significant motor and intellectual inhibition, depressions are observed with a predominance of tears - "tearful" depression, "groaning" depression, with constant complaints - "aching" depression. In cases of adynamic depression, the foreground is a decrease in motives with the presence of elements of apathy, feelings of physical. impotence, without true motor retardation. In some patients, a feeling of mental failure may prevail with the impossibility of any intellectual tension, in the absence of lethargy and melancholy. In other cases, a "gloomy" depression develops with a feeling of hostility, an evil attitude towards everything around, often with a dysphoric tinge or with a painful feeling of internal dissatisfaction with oneself, with irritability and gloom.

Are allocated also D. with. with obsessions (see Obsessive states). With shallow psychomotor retardation, D. s can develop. with a "feeling of insensibility", the loss of affective resonance, which consists in reducing the ability to respond to the situation and external phenomena. Patients become, as it were, emotionally "stony", "wooden", incapable of empathy. Nothing pleases them, does not excite them (neither relatives nor children). This condition is usually accompanied by complaints of patients about the loss of emotions, feelings (anaesthesia psychica dolorosa) - D. s. with depressive depersonalization, or anesthetic depression. In some cases, depersonalization disorders can be deeper - with a feeling of a significant change in one's spiritual "I", the entire personality structure (D. with. with depersonalization); some patients complain of an altered perception of the outside world: the world seems to lose its colors, all the surrounding objects become gray, faded, dull, everything is perceived as if through a “cloudy cap” or “through a partition”, sometimes the surrounding objects become as if unreal, inanimate, like as if drawn (D. s. with derealization). Depersonalization and derealization disorders are usually combined (see Depersonalization, Derealization).

A big place among D. with. occupied by anxious, anxious-agitated or agitated depressions. In such conditions, psychomotor retardation is replaced by general motor restlessness (agitation) combined with anxiety and fear. The severity of agitation can be different - from mild motor restlessness in the form of stereotypical rubbing of hands, pulling clothes or walking from corner to corner to sharp motor excitement with expressive pathetic forms of behavior in the form of hand-wringing, the desire to beat your head against the wall, tear your clothes. with groans, sobs, lamentations or the same type of monotonous repetition of a phrase, word (anxious verbigeration).

In severe depression, the development of a depressive-paranoid syndrome is characteristic (see Paranoid syndrome), which is characterized by acuteness, a pronounced affect of anxiety, fear, ideas of guilt, condemnation, delusions of staging, false recognitions, and ideas of special significance. A syndrome of enormity (see Kotard syndrome) with ideas of eternal torment and immortality or hypochondriacal delusions of fantastic content (nihilistic delirium of Kotard, melancholic paraphrenia) may develop. At the height of the disease, oneiroid disorder of consciousness may develop (see Oneiroid syndrome).

Depression can be combined with catatonic disorders (see Catatonic syndrome). With further complication of the clinic D. s. there may be ideas of persecution, poisoning, exposure, or auditory join, both true and pseudo-hallucinations within the framework of the Kandinsky syndrome (see Kandinsky-Clerambault syndrome).

Zattes (H. Sattes, 1955), Petrilovich (N. Petrilowitsch, 1956), Leonhard (K. Leonhard, 1957), Yantsarik (W. Janzaric, 1957) described D. with. with a predominance of somatopsychic, somatovegetative disorders. These forms are not characterized by deep motor and mental retardation. The nature and localization of senestopathic disorders can be very different - from a simple elementary sensation of burning, itching, tickling, passing cold or heat with a narrow and persistent localization to senestopathies with a wide, constantly changing localization.

Along with the above forms D. with. a number of authors distinguish an extensive group of so-called. hidden (erased, larved, masked, latent) depressions. According to Yakobovsky (V. Jacobowsky, 1961), latent depressions are much more common than pronounced ones, and are observed mainly in outpatient practice.

Latent depressions are those depressive states that are manifested primarily by somatovegetative disorders, while typically depressive symptoms are erased, almost completely overlapping with autonomic ones. One can speak about the belonging of these states to depressive states only on the basis of the frequency of these disorders, the presence of diurnal fluctuations, the positive therapeutic effect of the use of antidepressants, or the presence of affective phases in anamnesis or hereditary burden of affective psychoses.

Clinic of larvated D. s. quite different. In 1917, Devo and Logre (A. Devaux, J. B. Logre) and in 1938 M. Montassut described monosymptomatic forms of melancholia, manifested as periodic insomnia, periodic impotence, and periodic pain. Fonsega (A. F. Fonsega, 1963) described a relapsing psychosomatic syndrome, manifested by lumbago, neuralgia, asthma attacks, periodic chest tightness, stomach cramps, periodic eczema, psoriasis, etc.

Lopez Ibor (J. Lopez Ibor, 1968) and Lopez Ibor Alinho (J. Lopez Ibor Alino, 1972) distinguish depressive equivalents that occur instead of depression: conditions accompanied by pain and paresthesia - headaches, toothache, pain in the lower back and other parts body, neuralgic paresthesia (somatic equivalents); periodic mental anorexia (periodic lack of appetite of central origin); psychosomatic states - fears, obsessions (psychic equivalents). Pisho (P. Pichot, 1973) also identifies toxicomaniac equivalents, for example, binges.

The duration of larvated depressions is different. There is a tendency to their protracted course. Kreitman (N. Kreitman, 1965), Serry and Serry (D. Serry, M. Serry, 1969) note their duration up to 34 months. and higher.

Recognition of larvated forms allows applying the most adequate therapeutic tactics to them. Are close on a wedge, to a picture to the latent depressions "depressions without depressions", described by Priori (R. Priori, 1962), and vegetative depressions Lemke (R. Lemke,

1949). Among the "depressions without depressions" the following forms are distinguished: pure vital, psychoaesthetic, complex hypochondriacal, algic, neurovegetative. Lemke's vegetative depressions are characterized by periodic insomnia, periodic asthenia, periodically occurring headaches, pains or senestopathy (see) in various parts of the body, periodic hypochondriacal conditions, phobias.

All of the above varieties of D. s. found in various mental illnesses, not differing in strict specificity. We can only talk about the preference of some types of D. s. for a certain type of psychosis. So, for neuroses, psychopathy, cyclothymia, and some types of somatogenic psychoses, shallow D. s. are characteristic, occurring either in the form of a simple cyclothymoid-like depression, depression with tearfulness, asthenia, or with a predominance of somatovegetative disorders, obsessions, phobias, or unsharply expressed depersonalization derealization disorders.

With MDP - manic-depressive psychosis (see) - the most typical D. s. with a distinct depressive triad, anesthetic depressions or depressions with a predominance of ideas of self-blame, anxious or anxiety-agitated depressions.

At schizophrenia (see) a range of types of D. of page. the widest - from mild to the most severe and complex forms, as a rule, there are atypical forms, when adynamia comes to the fore with a general decrease in all motives or a feeling of hostility, a gloomy-malicious mood prevails. In other cases, depression with catatonic disorders comes to the fore. Complex D. is often noted with. with delusions of persecution, poisoning, exposure, hallucinations, mental automatism syndrome. To a large extent, the features of depression depend on the nature and degree of personality change, on the characteristics of the entire clinic of the schizophrenic process, and the depth of its disorders.

With late involutional depressions, a number of common features characteristic of them are noted - a less pronounced affect of melancholy with a predominance of gloominess and either irritability, grouchiness, or anxiety and agitation. Often there is a shift towards delusional symptoms (ideas of damage, impoverishment, hypochondriacal delirium, delirium of ordinary relationships), due to which the erasure of the wedge, the edges in the description of involutional depression, depression in MDP, schizophrenia or organic diseases is noted. Small dynamics is also characteristic, sometimes a protracted course with a “frozen”, monotonous affect and delirium.

Reactive (psychogenic) depression occurs as a result of mental trauma. Unlike D. page, at MDP here the main maintenance of a depression is filled with a psychoreactive situation, with elimination a cut also depression usually passes; there are no ideas of primary guilt; possible ideas of persecution, hysterical disorders. With a protracted reactive situation D. s. can be protracted with a tendency to its vitalization, to the weakening of reactive experiences. It is necessary to distinguish reactive depressions from psychogenically provoked depressions in MDP or schizophrenia, when the reactive factor is either not reflected at all in the content of the patients' experiences, or occurs at the beginning of an attack, followed by a predominance of the symptoms of the underlying disease.

More and more attention is paid to depressions, which occupy an intermediate position between the so-called. endogenous, basic forms found in MDP and schizophrenia, and reactive depressions. This includes endoreactive Weitbrecht dysthymia, Keelholz wasting depression, background depression, and Schneiderian soil depression. Though all this group of depressions is characterized by the general lines caused by a combination of endogenous and reactive lines, allocate separate a wedge, forms.

Weitbrecht's endoreactive dysthymia is characterized by an interweaving of endogenous and reactive moments, the predominance of senestopathies with asthenohypochondriacal disorders in the clinic, a gloomy, irritable-displeased or tearful-dysphoric mood, often with a vital character, but with a lack of primary ideas of guilt. A slight reflection in the clinic of psychoreactive moments distinguishes endoreactive dysthymia from reactive depressions; unlike MDP, with endoreactive dysthymia there is no manic and truly depressive phase, a weak hereditary burden with affective psychoses is noted in the family. Premorbid faces are dominated by sensitive, emotionally labile, irritable, somewhat gloomy faces.

Kielholz exhaustion depressions are characterized by the predominance of psychoreactive moments; the disease as a whole is regarded as psychogenically caused patol, development.

For depressions of the background and soil of Schneider, as well as for Weitbrecht's dysthymia, the occurrence of affective phases is characteristic in connection with provoking somatoreactive factors, but without reflecting them in the clinic of D. s. Unlike D. s., with MDP there is no vital component, as there is no psychomotor retardation or agitation, as well as depressive delusions.

With symptomatic depression caused by various somatogenic or cerebro-organic factors, the clinic is different - from shallow astheno-depressive states to severe depressions, either with a predominance of fear and anxiety, for example, with cardiac psychoses, or with a predominance of lethargy, lethargy or adynamia with apathy with prolonged somatogenic , endocrine diseases or organic diseases of the brain, then gloomy, "dysphoric" depressions in some types of cerebroorganic pathology.

Etiology and pathogenesis

In the etiopathogenesis of D. s. great importance is attached to the pathology of the thalamohypothalamic region of the brain with the involvement of the cerebral cortex and the endocrine system. Deley (J. Delay, 1953) observed changes in affect during pneumoencephalography. Ya. A. Ratner (1931), V. P. Osipov (1933), R. Ya. Golant (1945), and also E. K. Krasnushkin associated pathogenesis with damage to the diencephalic-pituitary region and endocrine-vegetative disorders. V. P. Protopopov (1955) attached importance to the pathogenesis of D. s. increase the tone of the sympathetic part c. n. With. IP Pavlov believed that depression was based on a decrease in brain activity due to the development of transcendental inhibition with extreme depletion of the subcortex and suppression of all instincts.

A. G. Ivanov-Smolensky (1922) and V. I. Fadeeva (1947) in the study of patients with depression obtained data on the rapidly onset depletion of nerve cells and the predominance of the inhibitory process over the irritable one, especially in the second signal system.

Japanese authors Suwa, Yamashita (N. Suwa, J. Jamashita, 1972) associate a tendency to periodicity in the appearance of affective disorders, daily fluctuations in their intensity with periodicity in the functional activity of the adrenal cortex, reflecting the corresponding rhythms of the hypothalamus, limbic system and midbrain. X. Megun (1958) of great importance in the pathogenesis of D. s. gives the disorder of the activity of the reticular formation.

In the mechanism of affective disorders, an important role is also assigned to metabolic disorders of monoamines (catecholamines and indolamines). It is believed that for D. s. characterized by functional insufficiency of the brain.

Diagnosis

D.'s diagnosis with. is put on the basis of identifying characteristic signs in the form of low mood, psychomotor and intellectual retardation. The last two signs are less stable and show significant variability depending on the nozol, form, within which depression develops, as well as on premorbid features, the age of the patient, the nature and degree of personality change.

Differential Diagnosis

In some cases, D. s. may resemble dysphoria, asthenic condition, apathetic or catatonic syndromes. Unlike dysphoria (see), at D. page. there is no such pronounced malicious intense affect with a tendency to affective outbursts and destructive actions; with D. s. with a dysphoric tint, there is a more pronounced decrease in mood with sadness, the presence of a daily rhythm in the intensity of disorders, improvement or complete recovery from this state after antidepressant therapy. In asthenic conditions (see Asthenic syndrome), increased fatigue comes to the fore in combination with hyperesthesia, irritable weakness, with a significant deterioration in the evening, and with D. s. the asthenic component is more pronounced in the morning, the condition improves in the second half of the day, there are no phenomena of hyperesthetic emotional weakness.

In contrast to the apathetic syndrome (see) against the background of deep somatic exhaustion, with anesthetic depression there is no complete indifference, indifference to oneself and others, the patient experiences indifference hard. With D. s. with abulic disorders, unlike apathetic states in schizophrenia (see), these disorders are not so pronounced. Developing within the framework of D. s., they are not of a permanent, irreversible nature, but are subject to daily fluctuations and cyclical development; with depressive stupor, in contrast to lucid (pure) catatonia (see Catatonic syndrome), patients have severe depressive experiences, there is a sharp psychomotor retardation, and catatonic stupor is characterized by a significant increase in muscle tone.

Treatment

Antidepressant therapy is gradually replacing other treatments. The choice of an antidepressant largely depends on the form of D. s. There are three groups of antidepressant drugs: 1) predominantly with a psychostimulating effect - nialamide (nuredal, niamid); 2) with a wide spectrum of action with a predominance of thymoleptic effect - imizin (imipramine, melipramine, tofranil), etc.; 3) predominantly with a sedative-thymoleptic or sedative effect - amitriptyline (triptisol), chlorprothixene, melleril (sonapax), levomepromazine (tisercin, nosinan), etc.

In depressions with a predominance of psychomotor retardation without a pronounced affect of melancholy, as well as in adynamic depressions with a decrease in volitional and mental activity, drugs with a stimulating effect are indicated (drugs of the first group); in depressions with a predominance of feelings of melancholy, vital components, with motor and intellectual retardation, drugs of the second (sometimes first) group are indicated; with anxious depressions, depressions with irritability, tearfulness and grouchiness without pronounced psychomotor retardation, therapy with drugs with a sedative-thymoleptic or sedative tranquilizing effect is indicated (drugs of the third group). It is dangerous to prescribe antidepressants with a psychostimulating effect for anxious patients - they cause not only increased anxiety, the occurrence of depressive arousal with suicidal tendencies, but also an exacerbation of the entire psychosis as a whole, an increase or appearance of delusions and hallucinations. With complex D. s. (depressive-paranoid, with depression with delusions, hallucinations, Kandinsky's syndrome), a combination of antidepressants with neuroleptics is necessary. Almost all antidepressants have side effects (tremor, dry mouth, tachycardia, dizziness, urination disorders, orthostatic hypotension, sometimes hypertensive crises, transition of depression to mania, exacerbation of schizophrenic symptoms, etc.). With an increase in intraocular pressure, it is dangerous to prescribe amitriptyline.

Despite the widespread use of psikhofarmakol, means, treatment with electroconvulsive therapy is still important, especially in the presence of long-term forms of depression that are resistant to drug effects.

Both in the clinic and on an outpatient basis, therapy with lithium salts is becoming increasingly important, which have the ability not only to influence affective disorders during the depression phase, but also to prevent or delay the onset of a new attack in time and reduce its intensity.

Forecast

With regard to life, it is favorable, with the exception of some somatogenic-organic psychoses, where it is determined by the underlying disease. Regarding recovery, i.e., getting out of a depressive state, the prognosis is also favorable, but some cases of protracted, protracted depressions that last for years must be taken into account. After recovering from depression with MDP, patients in most cases are practically healthy, with full recovery of working capacity and social adaptation, some patients may have residual disorders close to asthenic. In schizophrenia, as a result of an attack, an increase in personality changes with a decrease in working capacity and social adaptation is possible.

The prognosis regarding the recurrence of the development of D. s is less favorable - first of all, this applies to MDP and paroxysmal schizophrenia, where attacks can be repeated several times a year. With symptomatic psychosis, the possibility of repeating D. s. very rare. In general, the prognosis is determined by the disease within which D. develops.

Bibliography: Averbukh E. S. Depressive states, L., 1962, bibliogr.; Sternberg E. Ya. and Rokhlina M. L. Some common clinical features of depression of late age, Zhurn, neuropath, and psychiat., t. 70, century. 9, p. 1356, 1970, bibliography; Shternberg E. Ya. and Shumsky N. G. About some forms of depressions of senile age, in the same place, t. 59, century. 11, p. 1291, 1959; Das depressive syndrome, hrsg. v. H. Hippius u. H. Selbach, S. 403, Miinchen u. a., 1969; Delay J. Etudes de psychologie medicale, P., 1953; Depressive Zustande, hrsg. v. P. Kielholz, Bern u. a., 1972, Bibliogr.; G 1 a t z e 1 J. Periodische Versagenzustande im Verfeld schizophrener Psychosen, Fortschr. Neurol. Psychiat., Bd 36, S. 509, 1968; Leonhard K. Aufteilung der endogenen Psychosen, B., 1968; Priori H. La depressio sine dep-ressione e le sue forme cliniche, in Psychopathologie Heute, hrsg. v. H. Kranz, S. 145, Stuttgart, 1962; S a t t e s H. Die hypochondrische Depression, Halle, 1955; Suwa N.a. Yamashita J. Psychophysiological studies of emotion and mental disorders, Tokyo, 1974; Weit-b r e c h t H. J. Depressive und manische endogene Psychosen, in Psychiatrie d. Gegenwart, hrsg. v. H. W. Gruhle u. a., Bd 2, S. 73, B., 1960, Bibliogr.; a.k.a. Affektive Psychosen, Schweiz. Arch. Neurol. Psychiat., Bd 73, S. 379, 1954.

V. M. Shamanina.

These syndromes include depressive and manic, which are characterized by a triad consisting of mood disorders, motor disorders and changes in the course of associative processes. However, this triad does not exhaust the clinical picture of both depressive and manic states. Disturbances of attention, a dream, appetite are characteristic. Autonomic disorders are most typical for emotional endogenous disorders and are characterized by signs of an increase in the sympathetic tone of the autonomic nervous system, which are more pronounced in depression, but also occur in manic syndromes.

depressive syndrome

Typical depressive syndrome. Depressive syndrome is characterized by a depressive triad: hypothymia, depressed, sad, melancholy mood, slowing down of thinking and motor retardation. The severity of these disorders is different. Range hypothymic disorders great - from mild depression, sadness, deprivation to deep melancholy, in which patients experience heaviness, chest pain, hopelessness, worthlessness of existence. Everything is perceived in gloomy colors - present, future and past. Longing in a number of cases is perceived not only as mental pain, but also as a painful physical sensation in the region of the heart, in the chest “precordial longing”.

Slowdown in the associative process manifests itself in the impoverishment of thinking, there are few thoughts, they flow slowly, chained to unpleasant events: illness, ideas of self-blame. No pleasant events can change the direction of these thoughts. Answers to questions in such patients are monosyllabic, there are often long pauses between the question and the answer.

Motor retardation manifests itself in slowing down movements and speech, speech is quiet, slow, facial expressions are mournful, movements are slowed down, monotonous, patients can remain in one position for a long time. In some cases, motor inhibition reaches complete immobility (depressive stupor).

Motor retardation in depression

play a protective role. Depressive patients, experiencing a painful, painful state, hopeless longing, hopelessness of existence, express suicidal thoughts. With pronounced motor inhibition, patients often say that it is so hard for them that it is impossible to live, but they have no strength to do anything, to kill themselves: “Someone would come and kill, and that would be wonderful.”

Sometimes motor inhibition is suddenly replaced by an attack of excitement, an explosion of anguish (melancholic raptus - raptus melancholicus). The patient suddenly jumps up, beats his head against the wall, scratches his face, can tear out his eye, tear his mouth, injure himself, break glass with his head, throw himself out of the window, while the patients scream heart-rendingly, howl. If the patient manages to be restrained, then the attack weakens and motor retardation sets in again.

With depression, diurnal fluctuations are often observed; they are most characteristic of endogenous depressions. In the early morning hours, patients experience a state of hopelessness, deep melancholy, despair. It is during these hours that patients are especially dangerous for themselves, suicides are often committed at this time.

The depressive syndrome is characterized by ideas of self-accusation, sinfulness, guilt, which can also lead to thoughts of suicide.

Instead of experiencing longing, depression can lead to a state of “emotional insensitivity”. Patients say that they have lost the ability to experience, have lost their feelings: “My children come, but I don’t feel anything for them, this is worse than longing, longing is human, and I am like a piece of wood, like a stone.” This condition is called painful mental insensitivity (anaesthesia psychica dolorosa), and depression anesthetic.

Depressive syndrome is usually accompanied by severe vegetative-somatic disorders: tachycardia, discomfort in the heart area, fluctuations in blood pressure with a tendency to hypertension, disorders of the gastrointestinal tract, loss of appetite, weight loss, endocrine disorders. In some cases, these somatovegetative disorders can be so pronounced that they mask the actual affective disorders.

Depending on the predominance of various components in the structure of depression, sad, anxious, apathetic depression and other variants of the depressive state are distinguished.

In the affective link of the depressive triad, O. P. Vertogradova and V. M. Voloshin (1983) distinguish three main components: melancholy, anxiety, and apathy. Violations of the vdeatoric and motor components of the depressive triad are represented by two types of disorders: inhibition and disinhibition.

Depending on the conformity of the nature and severity of ideational and motor disorders to the dominant affect, harmonious, disharmonious and dissociated variants of the depressive triad are distinguished, which are of diagnostic value, especially at the initial stages of depression development.

Ideas of self-blame in depressive syndrome sometimes reach the severity of delirium. Patients are convinced that they are criminals, that their whole past life is sinful, that they have always made mistakes and unworthy deeds, and now they will face retribution.

Anxious depression. It is characterized by a painful, painful expectation of an inevitable specific misfortune, accompanied by monotonous speech and motor excitement. Patients are convinced that something irreparable must happen, for which they may be to blame. Patients do not find a place for themselves, walk around the department, constantly turn to the staff with questions, cling to passers-by, ask for help, death, beg to be let out on the street. In a number of cases, motor excitation reaches frenzy, patients rush about, groan, groan, lament, shout out individual words, and may injure themselves. Such a state is called "agitated depression".

apathetic depression. For apathetic, or adynamic, depression, a weakening of all impulses is characteristic. Patients in this state are lethargic, indifferent to the environment, indifferent to their condition and the situation of their loved ones, are reluctant to make contact, do not express any specific complaints, often say that their only desire is not to be touched.

masked depression. Masked depression (laurel depression without depression) is characterized by the predominance of various motor, sensory or

vegetative disorders of the type of depressive equivalents. The clinical manifestations of this depression are extremely diverse. Often there are various complaints of disorders of the cardiovascular system and digestive organs. There are attacks of pain in the heart, stomach, intestines, radiating to other parts of the body. These disorders are often accompanied by sleep and appetite disturbances. Depressive disorders themselves are not clear enough and are masked by somatic complaints. There is a point of view that depressive equivalents are the initial stage in the development of depression. This position is confirmed by observations of subsequent typical depressive attacks in patients with previously masked depression.

With masked depression: 1) the patient is treated for a long time, stubbornly and to no avail by doctors of various specialties; 2) when using various research methods, a specific somatic disease is not detected; 3) despite failures in treatment, patients stubbornly continue to visit doctors (GV Morozov).

depressive equivalents. Under depressive equivalents, it is customary to understand recurrent conditions characterized by a variety of complaints and symptoms of a predominantly vegetative nature, replacing bouts of depression in manic-depressive psychosis.

8.4.1.1. Comparative age features of depressive syndrome

In preschool children, depression is manifested by vegetative and motor disorders, since these forms of response are characteristic of this age.

At an earlier age, depression is even less reminiscent of depression. Children are lethargic, motor restless, appetite is disturbed, weight loss, sleep rhythm disturbances are observed.

Depressive states can occur with emotional depression, depriving the child of contact with the mother. For example, when a child is placed in a medical institution, at first he experiences a state of motor excitation with crying, despair, then lethargy, apathy, refusal to eat and play, a tendency to somatic

diseases. Such states are more often referred to as "analytical depression".

Analytical depression occurs in children aged 6-12 months, separated from their mother and in poor living conditions, manifested by adynamia, anorexia, a decrease or disappearance of reactions to external stimuli, a delay in the development of the psyche and motor skills.

In young children, adynamic and anxiety depressions are distinguished. Adynamic depression is manifested by lethargy, slowness, monotony, bleak mood, anxiety - tearfulness, capriciousness, negativism, motor restlessness (V. M. Bashina).

At preschool age, vegetative and motor disorders predominate, but the appearance of children indicates a low mood: a pained facial expression, posture, and a quiet voice. At this age, daily fluctuations in well-being are noted, hypochondriacal complaints of discomfort in various parts of the body appear. There are several variants of depression, depending on the prevailing disorders.

In children of primary school age, behavioral disorders come to the fore: lethargy, isolation, loss of interest in games, difficulties in mastering school material. Some children have irritability, resentment, a tendency to aggression, absenteeism from school. Complaints of melancholy in children can not be identified. There may be "psychosomatic equivalents" - enuresis, loss of appetite, weight loss, constipation.

At puberty, a depressive effect is already detected, which is combined with pronounced vegetative disorders, headaches, sleep disturbances, appetite, constipation, and persistent hypochondriacal complaints. In boys, irritability often predominates, in girls - depression, tearfulness and lethargy.

At puberty, the clinical picture of depression approaches depressive states in adults, but ideational (associative) inhibition is less distinct. Patients quite actively express ideas of self-accusation and hypochondriacal complaints.

Features of depressive syndromes of late age are associated with changes in the mental activity of a person and are due to the biological processes of age-related involution. Late-life depression is characterized by its

figurative “reduction and refinement” of disorders, the absence of depressive self-esteem and depressive reassessment of the past (the past is perceived more often as prosperous and happy), the prevalence of fears for health, fear of material difficulties. This reflects the age-related “revaluation of values” (E. Ya. Sternberg).

At a later age, simple depressions with lethargy and anxiety are distinguished. Simple depressions are less common with age, and the number of anxiety-hypochondriac and anxiety-delusional states increases. The greatest number of depressive conditions with anxiety falls on the age of 60-69 years.

In all variants of depressive states, there are sleep disturbances, appetite, changes in body weight, constipation, etc.

Often, patients with depression at a later age experience a “sense of self-change”, however, in older people, complaints usually relate to somatic changes.

Signs of mental anesthesia are more often observed in persons who fell ill before the age of 50, compared with patients of a later age.

Severe motor retardation is not typical for depressive states of late age, depressive stuporous states almost never occur. Anxiety-agitated depressions are observed both in involutionary and late ages.

In patients at a later age, hypochondriacal disorders occupy a large place in the clinical picture of depression, however, more often than hypochondriacal delusions (Cotard's syndrome), there are disturbing fears of hypochondriacal content or fixation on various somatic complaints.