Symptoms of depression. Syndromes of emotional disorders Depressive syndrome psychiatry

Depressive syndromes (lat. depressio depression, oppression; synonym: depression, melancholy)

psychopathological conditions characterized by a combination of depressed mood, decreased mental and motor activity (the so-called depressive triad) with somatic, primarily vegetative, disorders. They are common psychopathological disorders, second in frequency only to asthenia (see Asthenic syndrome) . Approximately 10% of those suffering from D. s. commits suicide.

For mild depression or initial stage further becoming more complex D. s. Along with depressed mood, somatic disorders often occur. It decreases, patients stop feeling food, dyspeptic disorders appear - belching, flatulence. in patients, haggard, aged. They fall asleep with difficulty, the night is superficial, intermittent, accompanied by disturbing and painful dreams, typically early awakening. In a number of cases, patients experience loss of sleep: objectively they are sleeping, but they claim that they have not slept a wink all night. In the morning they feel lethargic, depressed, and tired. It takes willpower to get up, wash, and prepare food. The coming day worries patients, they experience vague or specific painful forebodings. What needs to be done during the day seems complicated, difficult to accomplish, and beyond personal capabilities. I don't want to leave the house. It's hard to think and focus on one issue. Absent-mindedness and forgetfulness appear. Mental activity slowed down and impoverished, the figurative component of thinking weakens or is completely lost. The mind is dominated by involuntarily arising thoughts that are painful in content, in which the past and present are presented only as failures and mistakes, and the future seems aimless. People of intellectual work feel significantly stupid; Those engaged primarily in physical labor often report physical weakness. Uncertainty about your capabilities appears. In all cases it decreases, sometimes sharply. For minor reasons, patients experience painful doubts; they make decisions with some difficulty and after hesitation. They continue to somehow carry out their usual work, but if they need to do something new, they usually cannot imagine how to take on it. Patients are often painfully aware of their inadequacy and usually regard it as a manifestation of laziness, lack of will, and inability to pull themselves together. They are annoyed at their condition, but are unable to overcome it. In the initial period of D. s. various external motivations, for example those related to communication, the need to do something at work, etc., weaken existing disorders for some time. Patients often say that it is easier at work because they “forget.” As soon as the external incentives disappear, the temporary improvement in the condition disappears. Spontaneous complaints about the bad in the initial period do not exist in all cases. Often, patients with an undoubted depressive state, when asked directly what their mood is, define it as normal. A more detailed questioning usually makes it possible to find out that they experience lethargy, apathy, loss of initiative, anxiety, and it is often possible to identify such definitions of their mood as sad, boring, depressed, depressed. A number of patients primarily complain of a feeling of internal trembling in the chest or in various areas of the body.

Mild depression is often called subdepression, or cyclothymic (cyclothyme-like) depression. In such patients, facial reactions are slow and impoverished. Depending on the predominance of certain psychopathological symptoms in the structure of mild depression, several forms are distinguished. Thus, depression accompanied by irritation, dissatisfaction, and resentment is called grouchy, or dysphoric, depression (see Dysphoria) . In cases where weakness of motives, lack of initiative, and passivity predominate, they speak of adynamic depression. The combination of depression with neurasthenic, hysterical and psychasthenic symptoms allows us to distinguish neurotic depression. If combined with easily occurring reactions of weakness, they speak of tearful depression. , combined with pathological sensations of mental origin, is called senestopathic, and in those cases when it suggests that he has some kind of internal organs, talk about hypochondriacal depression. Depression in which only low mood, is called hypothymic. Others are also highlighted.

As depression deepens, patients begin to complain of melancholy. Many people experience painful sensations in the chest, upper abdomen, and less often in the head. Patients define them as a feeling of tightness, constriction, compression, heaviness; in some cases they complain about what they cannot do with their full breasts. With further intensification of depression, to describe the feeling of melancholy, patients resort to such expressions as “the soul hurts,” “the soul is crushed,” “the melancholy crushes,” “the soul is torn apart by melancholy.” Many patients begin to talk about experiencing a feeling of pain in the chest, but not physical pain, but some other pain, which they usually cannot define in words; some patients call it moral pain. Such conditions are defined as depression with precordial melancholy.

Already with subdepression, patients experience a decrease in affective resonance - a state in which their previous interests, attachments, and desires have become dulled to some extent. Subsequently, against the background of a pronounced melancholy mood, a painful, often painful feeling of indifference is noted, reaching in some cases a feeling of internal emptiness (of all feelings) - the so-called mournful mental insensibility. When describing it, patients often resort to figurative comparisons: “stupid, numb, callous, ruthless,” etc. Mental insensibility can be so intense that patients complain only about this disorder, not to mention melancholy, and even more so depression. It is especially painful in relation to loved ones. Depression with mental insensibility is called anesthetic. In other cases, patients talk about a feeling of change in the surroundings: “it became dark, the foliage faded, the sun began to shine less brightly, everything moved away and froze, time stopped” (the so-called depression with melancholic derealization). Depersonalization and derealization disorders are often combined with depression (see Depersonalization-derealization syndrome) . With further deepening of depression, various contents arise, primarily depressive, delusional ideas. Patients accuse themselves of various offenses (selfishness, cowardice, callousness, etc.) or of committing crimes (debauchery, betrayal, deceit). Many demand a “fair trial” and “deserved punishment” (self-incrimination). Other patients say that they are unworthy of attention, that they are wasting space in the hospital, that they look dirty, that they are disgusting (delusions of self-deprecation). A type of depressive delusion is delirium of ruin and impoverishment; It is especially often observed in elderly and old age(“there is not enough money for living, it is being spent uneconomically, the economy has fallen into disrepair”, etc.).

Hypochondriacal delusions are very common in depression. In some cases, this is a delusion of illness (the patient believes that he has tuberculosis, etc.) - hypochondriacal delusional depression, in others - an unshakable conviction in the destruction of internal organs (the lungs have atrophied, rotten) - depression with nihilistic delusions. Often, especially in old age, depression occurs, accompanied by delusions of persecution and harm (paranoid depression).

In some cases, stuporous depression occurs - distinct movement disorders reaching the intensity of substupor and, occasionally, stupor. The external appearance of such patients is characteristic: they are inactive, silent, inactive, and do not change posture for a long time. The facial expression is mournful. Eyes are dry and inflamed. If patients are asked a question (often repeated several times), they answer in monosyllables, after a pause, in a quiet, barely audible voice.

Symptoms of depression (in mild cases and less often in severe cases) are especially intense in the morning; in the afternoon or evening, the condition of patients, both objectively and subjectively, can improve significantly (by five o'clock in the afternoon, as French psychiatrists put it).

Exists big number depression, in which there is primarily a lack of motor, less often speech. They are called mixed depression - a depressed or melancholy mood is accompanied by speech and motor excitement (agitation). At the same time, depression also changes; usually it is complicated by anxiety, less often by fear (anxious-agitated or agitated depression with fear). In this state, patients are haunted by painful premonitions of impending misfortune or catastrophe. In some cases it is pointless, in others it is specific (arrest, trial, death of loved ones, etc.). The patients are extremely tense. can’t sit, can’t lie down, they are constantly “tempted” to move. Anxiety with motor agitation very often manifests itself in the incessant appeals of patients to the staff with the same requests. Speech, as a rule, is manifested by groans, groans, monotonous repetition of the same words or phrases: “scary, scary; I ruined my husband; destroy me”, etc. (the so-called alarming). Anxious agitation can give way to melancholic raptus - a short-term, often “silent” frantic excitement with the desire to kill or mutilate oneself. Anxiety-agitated depression may be accompanied by depressive delusions of various contents. With them, Kotara most often occurs - a fantastic delirium of enormity and denial. Denial can extend to universal human qualities - moral, intellectual, physical (for example, there is no conscience, knowledge, stomach, lungs, heart); to the phenomena of the external world (everything is dead, the planet has cooled down, there are no stars, no Universe, etc.). Nihilistic or hypochondriacal-nihilistic delirium is possible. With delusions of self-blame, patients identify themselves with negative historical or mythical characters (for example, Hitler, Cain, Judas). Incredible forms of retribution for what was done are listed, including immortality with eternal torment. Kotara appears in its most pronounced form in adulthood and old age. Some of its components, for example, the idea of universal destruction, can arise at a young age.

Depression is also complicated by the addition of various psychopathological disorders: obsessions, overvalued ideas, delusions, hallucinations, mental automatisms, catatonic symptoms. Depression can be combined with shallow manifestations of psychoorganic syndrome (so-called organic depression).

A special version of D. s. are hidden depressions (synonym: autonomic depression, depression without depression, masked depression, somatized depression, etc.). In these cases, subdepressions are combined with pronounced, and often dominant, clinical picture vegetative-somatic disorders. Hidden depression, which occurs almost exclusively in outpatient practice, exceeds ordinary depression in frequency by 10-20 times (according to T.F. Papadopoulos and I.V. Pavlova). Initially, such patients are treated by doctors of various specialties, and if they go to a psychiatrist, it is usually a year or several years after the onset of the disease. hidden depressions are varied. Most often they occur with disorders of the cardiovascular system (short-term, long-term, often in the form of paroxysms painful sensations in the area of the heart, radiating, as happens with angina pectoris, various disorders rhythm of cardiac activity up to attacks of atrial fibrillation, fluctuations) and digestive organs (decreased appetite up to anorexia, constipation, flatulence, pain along the way gastrointestinal tract, attacks of nausea and vomiting). Unpleasant pain is often experienced in various areas body: paresthesia, migrating or localized pain (for example, characteristic of, dental,). There are disorders resembling bronchial asthma and diencephalic paroxysms, and very often various sleep disorders. Autonomic-somatic disorders observed in latent depression are called depressive equivalents. Their number is increasing. Comparison of the symptoms of latent depression with the onset of a wide variety of D. s. reveals certain similarities between them. And ordinary D. s. often begin with somatic disorders. For hidden depression long time(3-5 years or more) no deepening occurs affective disorders. Hidden depression, like depressive syndromes, is characterized by periodicity and even seasonality of occurrence. The psychological conditionality of somatic pathology in latent depression is also evidenced by their success with antidepressants.

Depressive syndromes occur in all mental illnesses. In some cases they are their only manifestation (for example, schizophrenia, manic-depressive psychosis), in others - one of its manifestations (traumatic and vascular lesions of the brain, brain, etc.).

Mild forms of depression are treated on an outpatient basis, severe and severe forms are treated in a psychiatric hospital. Tranquilizers are also prescribed. With the complication of D. s. delusional, hallucinatory and other deeper psychopathological disorders are added. For anxiety-agitated depression, especially accompanied by deterioration of the somatic condition, as well as for depression with a long-term adynamic component, Electroconvulsive therapy is indicated . For the treatment and prevention of some D. s. use lithium salts (see Manic-depressive psychosis) . Due to the possibility of treatment, severe D. s., for example, with Cotard's delirium, are extremely rare; Mostly they occur in undeveloped forms. "Shift" D. s. towards subdepression is an indication for mandatory use, especially in conditions outpatient treatment, psychotherapy (Psychotherapy) , the form of which is determined by the structure of the d. and the personality of the sick person.

The prognosis depends on the development of D. s., which can be paroxysmal or phasic, i.e. occurs with remissions and intermissions. The duration of attacks or phases ranges from several days to 1 year or more. Attacks or can be single throughout life or repeated, for example annually. With multiple attacks or phases of D. s. often occur at the same time of year. Such seasonality with other equal conditions is favorable factor, because allows you to begin treatment before the onset of painful disorders and thereby smooth out the intensity of the manifestation of depressive syndrome. In old age D. s. often have chronic course. Therefore, in these patients, the issue of prognosis should be addressed with caution. D. syndromes that can lead to death, such as malignant presenile psychoses, have practically disappeared (see Presenile psychoses) . The main danger of D. s. lies in the possibility of suicide attempts by patients. More often they tend to commit suicide at the beginning of development and with a pronounced reduction in depressive disorders. Therefore, it is not recommended to discharge such patients prematurely; it is better to “overstay” them in the hospital. In a hospital setting, suicide attempts are typical for patients with agitation, anxiety and fear.

Bibliography: Anufriev A.K. Hidden endogenous depression. Message 2. Clinical, Journal. neuropath. and psychiat., vol. 78, no. 8, p. 1202, 1978, bibliogr.; Vovin R.Ya. and Aksenova I.O. Protracted depressive states, L., 1982, bibliogr.; Depression (

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To make a correct diagnosis, the characteristics of the syndrome play a very important role. Despite the fact that in other diseases it is most important to determine the cause of the pathology, in psychiatry this is not so important. In most cases, it is not possible to determine the cause of a mental disorder. Based on this, the emphasis is on identifying the leading signs, which are then combined into a syndrome typical for the disease.

For example, for deep depression thoughts of suicide are common. At the same time, the doctor’s tactics should be aimed at attentive attitude and, in the literal sense, supervision of the patient.

In patients with schizophrenia, the main syndrome is considered to be contradiction, or schizis. This means that a person’s external emotional state does not coincide with his internal mood. For example, when a patient is happy, he cries bitterly, and when he is in pain, he smiles.

In patients with epilepsy, the main syndrome is paroxysmalness - this is the sudden appearance and equally sharp extinction of symptoms of the disease (attack).

Even the international classification of diseases - ICD-10 - is based not so much on psychiatric diseases as on syndromes.

List of major syndromes in psychiatry

Syndromes associated with hallucinations and delusions.

Hallucinosis is the presence of a variety of hallucinations related to either hearing, vision, or tactile sensations. Hallucinosis can occur in acute or chronic form. Accordingly, with auditory hallucinosis, the patient hears non-existent sounds, voices addressed to him and forcing him to take some action. With tactile hallucinosis, patients feel some kind of non-existent touch on themselves. With visual hallucinosis, the patient may “see” something that is not actually there - these can be inanimate objects, or people or animals. This phenomenon can often be observed in blind patients.
Paranoia syndrome is a primary delusional state that reflects the surrounding reality. May be initial sign schizophrenia, or develop as an independent disease.
Hallucinatory-paranoid syndrome is a diverse combination and presence of hallucinations and delirious state having general pathogenesis development. A variation of this syndrome is Kandinsky-Clerambault mental automatism. The patient insists that his thinking or ability to move does not belong to him, that someone from the outside automatically controls him. Another type of hallucinatory-paranoid syndrome is Chikatilo syndrome, which is the development in a person of a mechanism that begins to guide his behavior. The syndrome worsens over a long period of time. The discomfort that arises in the patient gives impetus to the commission of sadistic crimes based on sexual weakness or dissatisfaction.
Pathological jealousy syndrome is a form of obsessive and crazy ideas. This condition are divided into several more syndromes: the “existing third” syndrome (with truly inherent jealousy and passion, turning into reactive depression), the “probable third” syndrome (with obsessive states associated with jealousy), as well as the “imaginary third” syndrome (with delusional jealous fantasies and signs of paranoia).

Syndromes associated with impaired intellectual development.

Dementia syndrome, or dementia, is a persistent, difficult to compensate loss mental abilities, so-called intellectual degradation. The patient not only refuses and cannot learn new things, but also loses the previously acquired level of intelligence. Dementia may be associated with certain medical conditions such as cerebral atherosclerosis, progressive paralysis, syphilitic brain damage, epilepsy, schizophrenia, etc.

Syndrome associated with a state of affect.

Manic syndrome is characterized by a triad of symptoms such as a sharp increase in mood, accelerated flow of ideas, and motor-speech agitation. As a result, there is an overestimation of oneself as an individual, delusions of grandeur and emotional instability arise.
A depressive state, on the contrary, is characterized by low mood, slow development of ideas and motor-speech retardation. Effects such as self-deprecation, loss of aspirations and desires, “dark” thoughts and a depressed state are observed.
Anxious depressive syndrome is a combination of depressive and manic states that alternate with each other. Motor stupor may occur against the background of increased mood, or physical activity simultaneously with mental retardation.
Depressive paranoid syndrome can manifest itself as a combination of signs of schizophrenia and other psychotic conditions.
Asthenic syndrome is characterized increased fatigue, excitability and instability of mood, which is especially noticeable against the background autonomic disorders and sleep disorders. Typically, the signs of asthenic syndrome subside in the morning, appearing with new strength in the second half of the day. Asthenia is often difficult to distinguish from depressive state, therefore, experts identify a combined syndrome, calling it asthenic-depressive.
Organic syndrome is a combination of three symptoms, such as deterioration in the memory process, decreased intelligence and the inability to control emotions. This syndrome has another name – the Walter-Bühel triad. At the first stage, the state reveals itself general weakness and asthenia, instability in behavior and decreased performance. The patient's intelligence suddenly begins to decline, his range of interests narrows, and his speech becomes poor. Such a patient loses the ability to remember new information, and also forgets what was previously recorded in memory. Often the organic syndrome turns into a depressive or hallucinatory state, sometimes accompanied by attacks of epilepsy or psychosis.

A syndrome associated with impaired motor and volitional functions.

Catatonic syndrome has typical symptoms such as catatonic stupor and catatonic agitation. Such states appear in stages, one after another. This psychiatric syndrome is caused by pathological weakness of neurons, when completely harmless stimuli cause an excessive reaction in the body. During stupor, the patient is lethargic and shows no interest in the world around him or himself. Most patients simply lie with their heads against the wall for many days and even years. A characteristic sign of an “air cushion” is that the patient is lying down, and at the same time his head is raised above the pillow. The sucking and grasping reflexes, which are characteristic only of infants, are restored. Often at night, the manifestations of catatonic syndrome weaken.
Catatonic excitement manifests itself both motor and emotional excited state. The patient becomes aggressive and negatively disposed. Facial expressions are often two-sided: for example, the eyes express joy, and the lips are clenched in a fit of anger. The patient can either remain stubbornly silent or speak uncontrollably and meaninglessly.
A lucid catatonic state occurs in full consciousness.
The oneiric catatonic state manifests itself with depression of consciousness.

Neurotic syndrome

Neurasthenic syndrome (the same asthenic syndrome) is expressed in weakness, impatience, depleted attention and sleep disorders. The condition may be accompanied by headaches and problems with the autonomic nervous system.
Hypochondriacal syndrome is manifested by excessive attention to one’s body, health and comfort. The patient constantly listens to his body, visits doctors for no reason and tests a large number of unnecessary analyzes and studies.
Hysterical syndrome is characterized by excessive self-hypnosis, egoism, imagination and emotional instability. This syndrome is typical of hysterical neuroses and psychopathy.
Psychopathic syndrome is a disharmony of emotional and volitional state. It can occur in two scenarios - excitability and increased inhibition. The first option implies excessive irritability, a negative mood, a desire for conflict, impatience, and a predisposition to alcoholism and drug addiction. The second option is characterized by weakness, sluggishness of reaction, physical inactivity, decreased self-esteem, and skepticism.

When assessing mental state It is important for the patient to determine the depth and scale of the detected symptoms. Based on this, syndromes in psychiatry can be divided into neurotic and psychotic.

Psychopathological signs:

Sadness, melancholy, joylessness, loss of pleasure.

Feelings of loss of senses (mental anesthesia, devastation, or petrification). A heavy burden. Vital fatigue, depression, despair, hopelessness, pessimism, disappointment, feelings of guilt, fear, low value, suicidal thoughts.

Hypochondria

In this case, fear, assumption or confidence in the presence of the disease arises. Bodily manifestations can be observed with increased attention, anxiety and concern and overestimated.

Thinking

Thinking in circles, philosophizing, obsessive philosophizing, indecisiveness, mental emptiness, poverty, inability to think, decreased level of thinking, inability to make a decision and implement an intention.

Time moves slowly or stops, but it can also rush by.

Depressive mood causes anxiety and leads to delusional fears and beliefs:

bodily illness, destruction, death (hypochondriacal delirium, delirium of death): “I am rotting, I am drying up, I have already completely disintegrated inside.”

Delusions of guilt, sin, damnation: guilt due to violation of the law or religious and moral institutions.

Perception

Everything becomes gray, pale, boring, lifeless. The patient himself feels lifeless and unreal, and the environment may look the same. Such a decrease in the intensity of perception can cover all its spheres.

Hallucinations

In severe melancholia, optical symptoms occur, in many cases with the character of pseudohallucinations. Patients see shadow images of death, a devil, a skeleton.

Motor skills

On the one hand, motor retardation and deceleration, numbness up to stupor and. However, patients in a state of agitation are in constant restlessness, run back and forth, scratch themselves and stereotypically lament. Adynamic and agitated depression.

Somatic symptoms

Corresponds to vital decline: lack of vitality, fatigue, lethargy, impotence, sleep disturbances, decreased appetite, decreased salivation with dry mouth, weight loss. Patients look older than their age, skin tone decreases. Hair looks greasy and dull. Loss of libido. Amenorrhea.

Bodily complaints.

Headaches, pain in the back of the head and back, a feeling of a lump in the throat, squeezing of the chest, pain in the heart, difficulty breathing, shortness of breath, distension of the abdomen, fullness, a feeling of overstretching of the internal organs.

Occurs

With endogenous depression within the framework of unipolar endogenous depression, involutional depression

Depression in schizoaffective mixed psychoses Depression in

Organic depression with cerebral structural changes

Symptomatic depression as a concomitant phenomenon in various somatic diseases, metabolic disorders and pharmacogenic depression.

Neurotic depression

depression with prolonged affective stress.

Psychoreactive depression as a direct reaction to difficult life experiences.

Diagnosis of depression in modern classifications (ICD-10) involves determining 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 impairments in 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 initial diagnosis, identifying depression as such, without their clinical differentiation, these operational lists of symptoms are quite convenient.

The following groups of symptoms are characteristic of depression:

Emotional disturbances. In the depressive syndrome, as in hypomania and manic states, it is customary to identify corresponding mood changes as a cardinal sign, in this case - hypothymia in its different options. At the same time, in relation to affective disorders themselves, hypothymia in depression (sad, anxious, modality), although it is its characteristic manifestation, but does not always determine the essence of depressive disorder.

In recurrent (including bipolar variants) depressive disorders, the modality of hypothymia is harmoniously combined with other symptoms of depression. Undifferentiated hypothymia is possible, where the severity of pathological mood shifts lags behind others depressive symptoms, and its vague modality can either characterize the lack of development, 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 “reveal” subsequently in more specific emotional disorders.

To special pathological emotional symptoms Depression includes a primary feeling of guilt (devoid of any justification and ideational development).

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 confusion of anhedonia - as the absence of the usual feeling of pleasure - with the experience of loss of interest in ordinary activities, in the environment, and in activity in general, which does not directly belong to the sphere of emotions.

Painful mental anesthesia, “feeling of loss of senses” - characteristic symptom 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 area of cognitive activity.

The most common experience is the loss of feelings for loved ones. Along with this, there is often a disappearance of the emotional attitude towards the environment, indifference to work, any type of activity, and entertainment. Equally painful for patients is the loss of the ability to rejoice and experience positive emotions (anhedonia), as well as the lack of response to sad events, the inability to compassion, and concern for others. The oppression of “vital feelings” - hunger, satiety, sexual satisfaction - is painfully experienced. A common symptom of depression is loss of the sense of sleep - a lack of feeling rested and alert when waking up.

Painful mental anesthesia in combination with a feeling of general mental and physical alteration is usually combined with the concept of depressive depersonalization. Patients characterize these experiences as “depersonalization,” a 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 disturbances in the body diagram. Depersonalization in schizophrenia differs from ordinary depressive depersonalization primarily in the vagueness or pretentiousness and variability of descriptions of the 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 them to cope with depression most effectively.

Vegetative-somatic symptoms Depression is in many ways no less important than emotional disorders - both for diagnosis and for therapy and prevention. In this series, first of all, they usually name the variety of unpleasant pseudosomatic sensations often experienced by patients with depression of various types. 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 (usually anxious), 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 cannot at all 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 “fatigue”, “fatigue”, which are not necessarily associated with physical exhaustion. In addition, with severe depression, especially the anxiety type, tension in certain muscle groups may occur, which patients define as an inability to relax, constant and debilitating tension. Anergy, like mood, is subject to daily fluctuations with a general decrease in the first half of the day. Sometimes these phenomena are described by patients as “drowsiness”, “half-asleep”, paradoxically combined with anxiety. Both phenomena disappear by the end of the day.

Anergy is often combined with a melancholy-apathetic tone of mood, which serves as a reason for identifying a special type of “apathetic-adynamic depression.” Within the framework of affective disorders, independence of this type seems problematic: usually this is a stage of prolonged depression, not necessarily poor in structure. Behind the facade of apathy can be revealed (and in therapeutic purposes even at times actualize) typical symptoms of depression, including elements of anxiety.

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

Sleep disorders in depression are characterized by a reduction in sleep duration and early awakening. Difficulty falling asleep and daytime sleepiness are often referred to as possible symptoms depression.

General somatic symptoms of depression can manifest not only as anergy, a general decrease in vital tone, intestinal atony, but also, in extreme cases, trophic disorders skin, mucous membranes - their pallor, dryness, loss of skin turgor. In the past, the characteristic features of melancholy were often described as “cooked,” chapped lips, parchment-like skin, and dry, unblinking eyes.

Among sensory disturbances in depression, in addition to the tactile and 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. Typical symptom depression is the loss of taste, sometimes included in the symptom complex of mental anesthesia as a sign of anesthesia of vital emotions. Decreased hearing and decreased vision recorded subjectively by some patients are not always confirmed by objective studies: the reason is rather a slow reaction to auditory and visual stimuli.

Movement disorders are more often expressed by inhibition. Equating motor inhibition and excitation in modern diagnostic lists in relation to depression in general, apparently, it is advisable to relate only to anxious depression or anxiety-depressive states.

With anxious and melancholy-anxious depression, manifestations of inhibition are often combined with signs of excitement. Dysarthria is possible, often associated with dry mouth.

Conative symptoms Depression is natural for its development: difficulties in decision-making, decreased motivation to activity, especially in the morning, decreased or distinct loss of interest in what is happening around, new impressions, change of environment, 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, decreased motivation for activity, and narrowing of the sphere of interests are countered by not always conscious resistance to the disease. It is expressed in the search for external incentives for any actions, by engaging in which the patient is able to demonstrate sufficient productivity and achieve the usual level of achievement. In his mind, the disease seems to stop for a while.

Conscious resistance to illness through volitional effort, for example, focusing on the most significant activities, turning to special exercises, physical activity, may have a positive, but most often only temporary result. When a depressive syndrome has developed, this kind of effort ultimately turns out to be unproductive and leads to crises of self-esteem with a dramatic awareness of failure, “inferiority.” The symptoms of depression only get worse.

Rest as such, with release from habitual stress or special burdensome responsibilities without switching to any other active employment, almost never alleviates the symptoms of depression or prevents its development. It is during this period that the autochthonous, unrelated to specific circumstances, developed symptoms of depression are “revealed.”

Cognitive symptoms Depressions are varied, but quite homogeneous and interrelated with other changes inherent in depression. Executive cognitive functions are characterized by inhibition. Registered both objectively and subjectively, they may not be emphasized by patients, but are revealed with directed, leading questions. Much depends on the individual significance of intellectual activity and current professional and other tasks that require intense mental activity. Patients note disturbances in concentration, and less often - memory disturbances, difficulties in remembering and reproducing. Difficulties in switching attention and a narrowing of its volume are more often detected in typical melancholy depressions with lethargy, and instability of attention - in anxious ones. Impairments in memorization and reproduction are moderate and manifest themselves mainly in the fact that patients give generalized descriptions of events, omitting 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). Particularly highlighted are situations in which patients emphasize or suggest their omissions, mistakes, mistakes or direct guilt. This relates to changes in the flow of associations in tempo and volume, and to ideational disorders.

Symptoms of depression in the form ideas of little value, self-accusations constitute the characteristic content of experiences. Experiences of hopelessness and lack of perspective are generally characteristic of depression with any modality of affect, but are more “open” in complaints in melancholy and anxious depression.

The psychopathological structure of ideas of low value and self-blame is usually limited to a super-valuable level: “calculation of failures,” a peculiar search for evidence of one’s inadequacy, inability to support loved ones, to foresee unfavorable events, possible harm, inconvenience, damage to others.

Depressive delusions- relatively rare symptom depression, more often observed in anxious and melancholy states. For a 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 with affect. If delusions begin to outstrip other symptoms of depression in severity, then it is reasonable to assume that at least, schizoaffective, and with good reason - the schizophrenic nature of the disorder. Similar diagnostic doubts should 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 condescending (but not hostile) attitude towards the patient on the part of others, fixation on their sympathetic remarks: “Everyone understands my worthlessness, but no one speaks.”

Ideas of accusation, i.e. extrapunitive vector of guilt, not typical for depression. Judgmental reproaches from others and resentment towards 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 are likely to develop suicidal ideation. Usually a person finds moral or cultural, in particular religious, even aesthetic alternatives to suicidal actions.

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

Anxious depression is characterized by obsessive fears and ideas about supposed misfortunes or situations in which the patient can, through his actions, harm not only and not so much himself as others. Contrastive obsessions are usually associated with anxious depression. The connection with her abstract obsessions is more problematic or relegated to the past.

Appeal to the same pessimistic memories - depressive monoideism - is related to changes in the flow of associations in pace and volume, and to the content of thinking, i.e. to ideation disorders. Depressive monoideism comes close to obsessions. These are either repeated memories of unpleasant events or anxiously colored images of perceived misfortunes or unfavorable situations.

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

Systemic cognitive functions: Changes in criticism in depression are heterogeneous. Orientation in the environment is fundamentally preserved, but the detachment from what is happening around, indifference to the environment, and 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 severe depression of a melancholic level, especially at a later age, temporary difficulties in orientation in the environment are possible. Productivity decreases as depression deepens, although at the very initial stages and with relatively mild manifestations, volitional effort allows one to overcome existing mild disorders.

The 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. The phenomena of intellectual-mnestic failure are usually detected at a late age.

The article was prepared and edited by: surgeon

Depressive syndrome is characterized by the depressive triad: hypothymia, depressed, sad, sad mood, slow thinking and motor retardation. The severity of these disorders varies. The range of hypothymic disorders is large - from mild depression, sadness, depression to deep melancholy, in which patients experience heaviness, chest pain, hopelessness, and worthlessness of existence. Everything is perceived in gloomy colors - the present, the future and the past. Melancholy in some 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 melancholy.”

A slowdown in the associative process is manifested in 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. The answers to questions in such patients are monosyllabic; there are often long pauses between question and answer.

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

Motor retardation during depression can play a protective role. Depressed patients, experiencing a painful, painful state, hopeless melancholy, hopelessness of existence, express suicidal thoughts. With severe motor retardation, patients often say that it is so hard for them that it is impossible to live, but they do not have the strength to do anything, to kill themselves: “If only someone would come and kill them, that would be wonderful.”

Sometimes motor retardation is suddenly replaced by an attack of excitement, an explosion of melancholy (melancholic raptus - raptus melancholicus). The patient suddenly jumps up, hits his head against the wall, scratches his face, can tear out an eye, tear his mouth, injure himself, break glass with his head, jump out of the window, while the patient screams and howls heart-rendingly. If the patient can be restrained, the attack weakens and motor retardation sets in again.

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

Depressive syndrome is characterized by ideas of self-blame, sinfulness, and guilt, which can also lead to thoughts of suicide.

Instead of experiencing melancholy, depression may result in a state of “emotional insensitivity.” Patients say that they have lost the ability to worry, have lost feelings: “My children come, but I don’t feel anything for them, it’s worse than melancholy, melancholy is human, but I’m like wood, like stone.” This condition is called painful mental insensibility (anaesthesia psychica dolorosa), and depression is anesthetic.

Depressive syndrome is usually accompanied by severe vegetative-somatic disorders: tachycardia, unpleasant sensations in the heart area, fluctuations in blood pressure with a tendency to hypertension, gastrointestinal disorders, 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, melancholy, 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. Disturbances in the deatorial and motor components of the depressive triad are represented by two types of disorders: inhibition and disinhibition.

Depending on the correspondence of the nature and degree of expression of ideational and motor disorders The dominant affect is distinguished by harmonious, disharmonious and dissociated variants of the depressive triad, which have diagnostic significance, especially in the initial stages of the development of depression.

Ideas of self-blame in depressive syndrome sometimes reach the level of delusion. Patients are convinced that they are criminals, that all of them past life It’s sinful that they have always made mistakes and unworthy actions and now they will face retribution.

Anxious depression. It is characterized by a painful, painful expectation of an inevitable concrete misfortune, accompanied by monotonous speech and motor agitation. Patients are convinced that something irreparable is about to happen, for which they may be to blame. Patients cannot find a place for themselves, walk around the department, constantly turn to the staff with questions, cling to passersby, ask for help, death, and beg to be let out into the street. In some cases, motor excitement reaches a frenzy, patients rush about, groan, moan, lament, shout out individual words, and can cause harm to themselves. This condition is called “agitated depression.”

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

Masked depression. Masked depression (lavaged, depression without depression) is characterized by a predominance of various motor, sensory or autonomic disorders according to the type of depressive equivalents. The clinical manifestations of this depression are extremely varied. Various complaints of disorders of the cardiovascular system and digestive organs are common. 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.

For masked depression:

the patient is treated for a long time, persistently and to no avail by doctors of various specialties;
when used various methods the study does not reveal a specific somatic disease;
despite failures in treatment, patients stubbornly continue to visit doctors (G.V. Morozov).

Depressive equivalents. Depressive equivalents are usually understood as periodically occurring conditions characterized by various complaints and symptoms of a predominantly vegetative nature, replacing attacks of depression in manic-depressive psychosis.