is a group of mental disorders characterized by a change in emotional state towards depression or upliftment. Includes various forms of depression and mania, manic-depressive psychosis, affective lability, increased anxiety, dysphoria. Mood pathology is accompanied by a decrease or increase in the general level of activity and vegetative symptoms. Specific diagnostics include conversation and observation by a psychiatrist, experimental psychological examination. Treatment uses pharmacotherapy (antidepressants, anxiolytics, mood stabilizers) and psychotherapy.

ICD-10

F30-F39 Mood disorders [affective disorders]

General information

Synonymous names for affective disorders are emotional disorders, mood disorders. Their prevalence is very widespread, since they form not only as an independent mental pathology, but also as a complication of neurological and other somatic diseases. This fact causes difficulties in diagnosis - people attribute low mood, anxiety and irritability to temporary, situational manifestations. According to statistics, emotional disorders of varying severity occur in 25% of the population, but only a quarter of them receive qualified help. Some types of depression are characterized by seasonality, most often the disease worsens in winter.

Reasons

Emotional disorders are provoked by external and internal reasons. In origin they are neurotic, endogenous or symptomatic. In all cases, there is a certain predisposition to the formation of an affective disorder - imbalance of the central nervous system, anxious, suspicious and schizoid character traits. The reasons that determine the onset and development of the disease are divided into several groups:

• Psychogenic adverse factors. Emotional disturbances can be triggered by a traumatic situation or prolonged stress. Among the most common reasons are the death of a loved one (spouse, parent, child), quarrels and domestic violence, divorce, loss of financial stability.
• Somatic diseases. An affect disorder may be a complication of another illness. It is provoked directly by dysfunction of the nervous system, endocrine glands that produce hormones and neurotransmitters. Deterioration in mood also occurs due to severe symptoms (pain, weakness), unfavorable prognosis of the disease (probability of disability, death),
• Genetic predisposition. Pathologies of emotional response can be caused by hereditary physiological reasons - structural features of brain structures, speed and purposefulness of neurotransmission. An example is bipolar affective disorder.
• Natural hormonal changes. Affect instability is sometimes associated with endocrine changes during pregnancy, after childbirth, puberty, or menopause. An imbalance in hormone levels affects the functioning of the parts of the brain responsible for emotional reactions.

Pathogenesis

The pathological basis of most emotional disorders is dysfunction of the pineal gland, limbic and hypothalamic-pituitary systems, as well as changes in the synthesis of neurotransmitters - serotonin, norepinephrine and dopamine. Serotonin allows the body to effectively resist stress and reduce anxiety. Its insufficient production or decreased sensitivity of specific receptors leads to depression. Norepinephrine maintains the body's wakeful state, the activity of cognitive processes, helps cope with shock, overcome stress, and respond to danger. A deficiency of this catecholamine causes problems with concentration, anxiety, increased psychomotor irritability and sleep disturbances.

Sufficient dopamine activity ensures switching of attention and emotions, regulation of muscle movements. A deficiency is manifested by anhedonia, lethargy, apathy, an excess – by mental tension, excitability. An imbalance of neurotransmitters affects the functioning of brain structures responsible for the emotional state. In case of affective disorders, it can be provoked by external causes, for example, stress, or internal factors - diseases, hereditary characteristics of biochemical processes.

Classification

In psychiatric practice, the classification of emotional disorders from the point of view of the clinical picture is widespread. There are depressive, manic and anxiety spectrum disorders, bipolar disorder. The fundamental classification relies on different aspects of affective reactions. According to it, they distinguish:

1. Disturbances in the expression of emotions. Excessive intensity is called affective hyperesthesia, weakness is called affective hypoesthesia. This group includes sensitivity, emotional coldness, emotional impoverishment, apathy.
2. Violations of the adequacy of emotions. With ambivalence, multidirectional emotions coexist simultaneously, which prevents a normal response to surrounding events. Inadequacy is characterized by a discrepancy between the quality (orientation) of affect and the influencing stimuli. Example: laughter and joy in the face of tragic news.
3. Violations of emotional stability. Emotional lability is manifested by frequent and unreasonable mood swings, explosiveness is manifested by increased emotional excitability with a vivid uncontrollable experience of anger, rage, and aggression. With weakness, fluctuations in emotions are observed - tearfulness, sentimentality, capriciousness, irritability.

Symptoms of mood disorders

The clinical picture of disorders is determined by their form. The main symptoms of depression are depression, a state of prolonged sadness and melancholy, and a lack of interest in others. Patients experience a feeling of hopelessness, meaninglessness of existence, a sense of their own insolvency and worthlessness. With a mild degree of the disease, there is a decrease in performance, increased fatigue, tearfulness, instability of appetite, and problems falling asleep.

Moderate depression is characterized by the inability to perform professional activities and household duties in full - fatigue and apathy increase. Patients spend more time at home, prefer loneliness to communication, avoid any physical and emotional stress, women often cry. Periodically, thoughts of suicide arise, excessive drowsiness or insomnia develops, and appetite is reduced. With severe depression, patients spend almost all their time in bed, are indifferent to current events, and are unable to make an effort to eat or perform hygiene procedures.

Masked depression is distinguished as a separate clinical form. Its peculiarity lies in the absence of external signs of emotional disorder, denial of pain and low mood. In this case, various somatic symptoms develop - headaches, joint and muscle pain, weakness, dizziness, nausea, shortness of breath, changes in blood pressure, tachycardia, digestive disorders. Examinations by somatic doctors do not reveal diseases, and medications are often ineffective. Depression is diagnosed at a later stage than the classic form. By this time, patients begin to feel vague anxiety, anxiety, uncertainty, and decreased interest in their favorite activities.

In a manic state, the mood is unnaturally elevated, the pace of thinking and speech is accelerated, hyperactivity is noted in behavior, facial expressions reflect joy and excitement. Patients are optimistic, constantly joke, make wisecracks, devalue problems, and cannot tune in to a serious conversation. They gesticulate actively, often change their position, and get up from their seats. The focus and concentration of mental processes is reduced: patients are often distracted, ask questions again, and abandon the task they have just started, replacing it with something more interesting. The feeling of fear is dulled, caution is reduced, a feeling of strength and courage appears. All difficulties seem insignificant, problems seem solvable. Sexual desire and appetite increase, the need for sleep decreases. With severe disorder, irritability increases, unmotivated aggression appears, and sometimes delusional and hallucinatory states appear. The alternating cyclical occurrence of phases of mania and depression is called bipolar affective disorder. When symptoms are mild, they speak of cyclothymia.

Anxiety disorders are characterized by constant worry, feelings of tension, and fears. Patients are in anticipation of negative events, the likelihood of which is usually very low. In severe cases, anxiety develops into agitation – psychomotor agitation, manifested by restlessness, “wringing” of hands, and pacing around the room. Patients try to find a comfortable position, a quiet place, but to no avail. Increased anxiety is accompanied by panic attacks with vegetative symptoms - shortness of breath, dizziness, respiratory spasm, nausea. Obsessive thoughts of a frightening nature are formed, appetite and sleep are disrupted.

Complications

Long-term affective disorders without adequate treatment significantly worsen the quality of life of patients. Mild forms interfere with full-fledged professional activity - in case of depression, the volume of work performed is reduced, in manic and anxiety states - the quality. Patients either avoid communication with colleagues and clients, or provoke conflicts against the background of increased irritability and decreased control. In severe forms of depression, there is a risk of developing suicidal behavior with suicide attempts. Such patients require constant supervision of relatives or medical personnel.

Diagnostics

A psychiatrist conducts a study of medical history and family predisposition to mental disorders. To accurately clarify symptoms, their onset, and connections with traumatic and stressful situations, a clinical interview is performed with the patient and his immediate family, who are able to provide more complete and objective information (patients may be uncritical of their condition or excessively weakened). In the absence of a pronounced psychogenic factor in the development of the pathology, in order to establish the true causes, an examination by a neurologist, endocrinologist, or therapist is prescribed. Specific research methods include:

• Clinical conversation. During a conversation with the patient, the psychiatrist learns about disturbing symptoms and identifies speech characteristics that indicate an emotional disorder. With depression, patients speak slowly, sluggishly, quietly, and answer questions in monosyllables. When manic, they are talkative, use bright epithets, humor, and quickly change the topic of conversation. Anxiety is characterized by confusion of speech, uneven tempo, and decreased focus.
• Observation. Natural observation of emotional and behavioral expression is often carried out - the doctor evaluates facial expressions, gestural features of the patient, activity and purposefulness of motor skills, and vegetative symptoms. There are standardized expression monitoring schemes, such as the detailed Facial Expression Analysis Technique (FAST). The result reveals signs of depression - drooping corners of the mouth and eyes, corresponding wrinkles, a mournful expression on the face, stiffness of movements; signs of mania - smiling, exophthalmos, increased tone of facial muscles.
• Psychophysiological tests. They are produced to assess mental and physiological stress, the severity and stability of emotions, their direction and quality. The color test of relations by A. M. Etkind, the method of semantic differential by I. G. Bespalko and co-authors, and the method of conjugate motor actions by A. R. Luria are used. Tests confirm psycho-emotional disorders through a system of unconscious choices - color acceptance, verbal field, associations. The result is interpreted individually.
• Projective techniques. These techniques are aimed at studying emotions through the prism of unconscious personal qualities, character traits, and social relationships. Thematic apperception test, Rosenzweig frustration test, Rorscharch test, “Drawing of a person” test, “Drawing of a person in the rain” test are used. The results make it possible to determine the presence of depression, mania, anxiety, a tendency to aggression, impulsivity, asociality, frustrated needs that caused emotional deviation.
• Questionnaires. The methods are based on self-report – the patient’s ability to assess his emotions, character traits, health status, and characteristics of interpersonal relationships. The use of narrowly focused tests for diagnosing depression and anxiety (Beck questionnaire, Depressive Symptoms Questionnaire), complex emotional and personal techniques (Derogatis, MMPI (SMIL), Eysenck test) is widespread.

Treatment of mood disorders

The treatment regimen for emotional disorders is determined by the doctor individually, depending on the etiology, clinical manifestations, and nature of the course of the disease. The general treatment regimen involves relief of acute symptoms, elimination of the cause (if possible), psychotherapeutic and social work aimed at increasing adaptive abilities. An integrated approach includes the following areas:

• Drug treatment. Patients with depression are advised to take antidepressants - medications that improve mood and performance. Anxiety symptoms can be treated with anxiolytics. Drugs in this group relieve tension, promote relaxation, and reduce anxiety and fear. Normotimics have antimanic properties, significantly soften the severity of the next affective phase, and prevent its onset. Antipsychotic medications eliminate mental and motor agitation, psychotic symptoms (delusions, hallucinations). In parallel with psychopharmacotherapy, family meetings are held at which they discuss the need to maintain a rational regimen, physical activity, good nutrition, gradually involving the patient in household activities, walking together, and playing sports. Sometimes there are pathological interpersonal relationships with household members that support the disorder. In such cases, psychotherapeutic sessions aimed at solving problems are necessary.

Prognosis and prevention

The outcome of affective disorders is relatively favorable in psychogenic and symptomatic forms; timely and comprehensive treatment contributes to the reverse development of the disease. Hereditary affect disorders tend to be chronic, so patients need periodic courses of therapy to maintain normal well-being and prevent relapses. Prevention includes giving up bad habits, maintaining close, trusting relationships with relatives, maintaining a proper daily routine with adequate sleep, alternating work and rest, and setting aside time for hobbies and hobbies. In case of hereditary burden and other risk factors, regular preventive diagnostics by a psychiatrist is necessary.

Affective (emotional) syndromes- psychopathological conditions in the form of persistent changes in mood, most often manifested by its decrease (depression) or increase (mania).

Depression and mania are the most common mental disorders. In terms of frequency, they occupy first place in the clinic of major psychiatry and are very common in borderline mental illnesses. Affective syndromes are constantly encountered at the onset of mental illnesses; they can remain the predominant disorder throughout their entire course, and when the disease becomes more complicated, they can coexist for a long time with various other, more severe psychopathological disorders. When the disease pattern reverses, depression and mania are often the last to disappear.

DEPRESSIVE SYNDROME(syn.: depression, melancholy) - a combination of depressed mood, decreased mental and motor activity with somatic, primarily autonomic, disorders.

In mild cases of depression or in the initial stages of its development, somatic disorders are constant: sweating, tachycardia, fluctuations in blood pressure, sensations of heat, cold, and chilliness. Appetite decreases, food seems tasteless. Constipation appears. More significant dyspeptic disorders may also occur - heartburn, belching, flatulence, nausea. Patients look haggard, mature people look aged. Night sleep becomes shallow, intermittent, accompanied by disturbing dreams and early awakening. There may be loss of the sense of sleep. The coming day is exciting. In the morning they feel lethargic and tired. It takes a strong will to force yourself to stand up. Experience vague fears or specific painful forebodings. What needs to be done seems complex, difficult to accomplish, and beyond personal capabilities. It's hard to think and focus on one issue. They experience absent-mindedness and forgetfulness, and their self-confidence drops. For minor reasons, doubts arise, decisions are made with some difficulty and after hesitation. Habitual work, especially one that does not require mental effort, is still somehow accomplished. If you have to do something new, you often have no idea how to approach it. Patients are well aware of the very fact of their failure, but usually regard it primarily as “lack of will, laziness, inability to pull themselves together”; They are annoyed with their condition, but are unable to overcome it. True, being among people, in particular at work, they often “forget” and feel better for a while. When the patients are again left to their own devices, this improvement disappears.

Spontaneous complaints of bad mood do not always exist. Patients often say that their mood is normal. Nevertheless, upon questioning, it is possible to find out that patients experience “lethargy, apathy, loss of stimuli, anxiety, mental discomfort,” and often one can find such definitions of their condition as sadness, boredom, depression, depression. Many patients complain of a constant feeling of trembling. Upon questioning, it turns out that this is an internal sensation, and not trembling in the usual sense. Often such tremors are localized in the chest, but can be localized throughout the body. Sometimes patients note a constant feeling of irritation, dissatisfaction, an increased tendency to tears and resentment. This type of depression is called hypothymic or cyclothymic. Depending on the predominance of certain disorders, various types of mild depression (subdepression) are distinguished.

If depression is accompanied by a decrease in motivation, it is called adynamic; the presence of irritability and dissatisfaction in the structure of depression is characteristic of “grumpy” (grumpy) depression; when depression is combined with neurasthenic or hysterical disorders, they call it neurotic depression; depression with symptoms of obsession is defined either as neurotic or anankastic depression; depression, combined with easily occurring reactions of weakness, is called “tearful” depression; in cases where the clinical picture of depression is dominated by somatic, primarily vegetative, disorders, and altered affect recedes into the background, we speak of various variants of latent depression (see below); depression, combined with pathological sensations of mental genesis, is called senestopathic, and if at the same time the patient has an assumption that he is physically ill, we are talking about hypochondriacal-senestopathic depression; Depression in which only mild depression predominates is called mild or dull.

As the low mood deepens, patients begin to complain of melancholy. At the same time, many people experience painful sensations in the chest, upper abdomen, and less often in the head. They are defined as a feeling of tightness, constriction, compression, heaviness; They often talk about the inability to take a deep breath. With further intensification of depression, complaints appear about “aching melancholy”, about the fact that “the soul is being squeezed, aching, burning, tearing into pieces.” Many patients begin to talk about feeling pain, but not physical pain, but some other kind. Some patients call this pain moral pain. This is pre-heart melancholy. Some psychiatrists identify depression with precordial melancholy as a separate type.

Already with mild, hypothymic depression, patients begin to complain about a disturbing decrease in affective resonance - a variety of events lose interest for them, they don’t want anything, nothing excites desires. With a distinct melancholy affect, a painful feeling of indifference appears, reaching in pronounced cases a painful feeling of internal emptiness, loss of all feelings - anaesthesia psychica dolorosa. This disorder is a form of melancholic depersonalization. When describing mental anesthesia, patients often say that they “have become petrified, stupefied, become wooden,” etc. In these cases we talk about anesthetic depression. The intensity of mental anesthesia can be so significant that patients cease to feel melancholy and complain only of painful insensibility. There may be a feeling of change in the surroundings - it loses color, clarity, becomes frozen, distant, perceived “as if through a veil.” There are frequent complaints about the slow passage of time, about the feeling that it has stopped and even disappeared completely (melancholic derealization).

With further deepening of depression, delusional ideas of various contents arise. In some cases, this is depressive delirium in the strict sense of the word - delirium of self-abasement and self-blame. The first occurs in its most developed form in patients of mature and late age. Delusions of self-blame have now become less common. But delusions of accusation (condemnation) began to be observed more often in depression. Depressions in which such delusions occur are often complicated by other psychopathological disorders (see Depressive-paranoid syndrome). Hypochondriacal delusions are very common in depression. In some cases, this is delirium of illness. A depressed patient is unshakably convinced that he has a specific incurable disease - hypochondriacal delusional depression; in others, a delusional belief in the destruction of internal organs appears—depression with nihilistic delusions. Nihilistic delusions can be combined with delusions of enormity and denial - Cotard's syndrome (see below). Often, especially in adulthood and late age, depression occurs, accompanied by delusions of persecution, poisoning or harm - paranoid depression. Its peculiarity lies in the fact that the delusional ideas that arise usually come to the fore here and thereby attract the main attention of psychiatrists, while depressive disorders are often underestimated. The danger of such paranoid depression, often not accompanied by ideomotor inhibition, is a high risk of suicide.

In some cases, the intensity of ideomotor inhibition in depression is so significant that depressive stupor develops (see Syndromes of movement disorders).

There is a significant number of depressions, especially in mature and elderly patients, in which there is not just a lack of ideomotor inhibition, but long-term speech motor excitation. In these cases, the depressive affect is complicated by anxiety and less often by fear. Therefore, such depressions are called agitated, anxiety-agitated, or agitated depression with fear. With agitated depression, patients are haunted by painful premonitions of impending misfortune or simply a catastrophe; they often cannot say which one specifically; there are only vague assumptions about them. Only one thing is clear: something terrible is about to happen. In other cases, anxiety is associated with certain facts: awaiting trial, torture, execution, death of loved ones, etc. Patients are under extreme stress and cannot find a place for themselves. They cannot sit or lie down, they are constantly “tempted” to move. Patients want a lot, persistently turn to the staff and others with some kind of request or remark, sometimes they stand at the doors of the department for hours, shifting from foot to foot and grabbing the clothes of those passing by. Agitation does not always manifest itself as pronounced motor agitation. Sometimes patients sit motionless in one place for a long time, and only the constant movement of their fingers and hands indicates their lack of motor inhibition. Speech arousal in agitated depression is often manifested by groans, groans, lamentations, anxious verbalization - monotonous, repeated repetition of the same short phrases or words: “I buried my husband alive,” “kill me,” “I’m dying,” etc. Complex forms of depressive delirium, for example, Cotard's delirium, as a rule, occur not with inhibited depression, but with agitated depression.

Agitation, both pronounced and subtle, can easily be replaced by melancholic raptus (melancholic violence) - short-term, often “silent”, frantic excitement with the desire to kill or mutilate oneself. An increase in agitated depression in mature patients often occurs due to additional reasons - after conversations with a doctor, medical procedures, various types of movements within the department - a symptom of adaptation disorder (Charpentier's symptom). If depression in general and with distinct ideomotor inhibition in particular usually intensifies in the first half of the day, then anxiety-agitated depression often becomes more pronounced in the evening.

Among patients with depression treated in psychiatric hospitals, patients with agitated depression most often commit suicide attempts. Patients with “smiling depression” often make suicide attempts within the walls of the hospital. Psychiatrists use this term in cases where depressive affect in patients is combined with a mournful or ironic smile. Such patients are usually quiet and inconspicuous, although they often lack distinct motor inhibition. With their behavior they do not attract the attention of the staff, but the patients themselves are able to notice everything that is happening in the department, and, choosing the right moment, commit suicide.

Anxiety-agitated depressions reach their greatest complexity when they are complicated by Cotard's syndrome.

Cotard's syndrome(melancholic paraphrenia, melancholic; delusion of imagination, megalo-melancholic delirium) - a combination of anxious-agitated depression with hypochondriacal-depressive delirium of denial and enormity, extending to the moral and physical properties of the individual, various phenomena of the surrounding world, or to all at the same time. Symptom complex in the 80s. XIX century described by J. Cotard; Russia - V.P. Serbsky (1982). With Cotard's syndrome, a fantastic delusion of denial and enormity occurs. Partial denial usually concerns individual universal human qualities - moral, intellectual, physical (no feelings, conscience, compassion, knowledge, ability to think; no stomach, intestines, lungs, heart, etc.). They may talk not about the absence, but about the destruction of internal organs (the brain has dried out, the lungs have shrunk, the intestines have atrophied, there is feces in the rectum, etc.). The idea of ​​denying the physical self is called hypochondriacal-nihilistic or simply nihilistic delusion. Individual personal categories may be denied (no name, age, education, profession, family, never lived). Denial can extend to various concepts of the external world, which can be dead, destroyed, lose their inherent qualities or disappear altogether (the world is dead, the planet has cooled down, there is no one in the world, there are no seasons, stars, centuries). The patient may claim that he is left alone in the entire Universe - depressive solipsistic delirium.

Fantastic depressive delirium is accompanied by self-blame for world cataclysms that have already occurred or for possible future ones. Patients identify themselves with negative mythical or historical characters (Antichrist, Judas, Hitler, etc.) and list the incredible forms of retribution they expected and deserved for their deeds. Depressive fantasy delusions of self-blame can become retrospective. Statements about eternal torment and the impossibility of dying are common. Torment awaits the sick, even if their physical self disappears - “the body will be burned, but the spirit will remain tormented forever.” Ideas of immortality can be combined with delusions of metamorphosis - transformation into an animal, a corpse, metal, wood, stone, etc.

The combination of depressive delusions of denial and enormity with hypochondriacal-nihilistic delusions characterizes full or full-blown Cotard's syndrome. If any one of these components predominates, they speak of the corresponding variants of Cotard's syndrome - nihilistic or depressive. According to developmental characteristics, acute (mainly with paroxysmal psychoses) and chronic (with the continuous development of psychosis) Cotard syndrome are distinguished. This syndrome in its expanded form occurs mainly in elderly and senile people; In some cases of schizophrenia, quite pronounced Cotard's syndrome may appear already at a young age or even in adolescence. Some manifestations of Cotard's syndrome have been described in children 6-7 years old (M.S.Vrono, 1975).

Depression is complicated by the addition of a variety of productive disorders: obsessions, overvalued ideas, delusions, hallucinations - verbal and occasionally tactile; mental automatisms; catatonic symptoms, oneiric stupefaction. Depression can be combined with shallow manifestations of psychoorganic syndrome (organic depression) and initial symptoms of dementia, often accompanied by psychopathization.

Questioning patients with depression is difficult in cases where depression is either very mild and accompanied by a variety of somatic disorders, or when depression becomes complex due to the fact that it is combined with more severe productive disorders - delusions, hallucinations, mental automatisms, catatonic symptoms. Usually, patients with more or less distinct depression, when questioned, talk quite well about most of the disorders that exist in them. If there is noticeable ideational inhibition, it is better to initially ask patients about their physical well-being and thereby try to “talk” them. In other cases, questions may be asked directly regarding specific psychopathological symptoms. Some of them are features of depressed mood, pre-heart melancholy, self-reproach, difficulties in mental activity, etc. - patients usually describe it quite clearly. Others, such as mild melancholic depersonalization, may be reported somewhat inconsistently.

Patients usually do not talk about suicidal thoughts in the present and in the past, and especially about previous suicidal attempts, but if asked, they most often answer as it is or was in reality. You should ask about suicidal tendencies when the patient has either started talking, or the doctor has a definite assessment of the patient’s existing disorders and knows how to act. This usually happens in the second half of the conversation. You should not ask questions about suicidal tendencies towards the end of the conversation, much less end the conversation with them. Judging by the circumstances, the doctor can directly ask questions in order to find out: are there (were) suicidal thoughts, are there (were) thoughts about methods of suicide, are (were) the patient making any preparations for suicide. However, it would be more correct to preface direct questions with those that would make the patient feel that his condition is clear to the interlocutor, and, as it were, to “lead” the patient to the idea himself or, perhaps, with certain leading questions from the doctor, to talk about this side of his condition. Then directly posed questions simply won’t be needed. When the patient speaks himself, it means that he believes the doctor. In preliminary questions, you should return to what the patient initially told the doctor about his condition. Only now the doctor formulates his questions differently from the way he initially formulated them in order to identify disorders inherent in a general depressive state. The doctor takes into account the characteristics of the patient’s condition and the verbal expressions with which the patient describes his condition. The doctor’s questions acquire individual content that is most understandable to the patient. With the help of skillful questioning, the doctor not only obtains the necessary information, but often also alleviates the patient’s condition at the time of the conversation. Conscious depressive patients usually remember this circumstance well. At the same time, it should be firmly remembered that patients with depression are very often prone to dissimulation of their condition and, first of all, to dissimulation of thoughts about death and suicidal thoughts. Particularly confusing to psychiatrists is the fact that they often cannot detect the depressive triad, which is an indicator of the presence of depressive disorders. Instead of a “triad”, you very often see a talkative, lively, seemingly cheerful person who is pleased with himself. This is the surface, but deep down there is depression and hopelessness. When interviewing depressed patients, very often (in cases of subdepression) one should take into account the holistic picture of the condition, rather than chasing individual components of the triad. Anamnestic information, the patient’s statements, and the entire context of the conversation almost always allow us to give the necessary assessment of the patient’s condition. This is the rule for all psychiatry. It is especially important for depressed patients. After all, approximately 10% of people with depression commit suicide.

A special place among depressive conditions is occupied by a group of depressions, described in the last 25-30 years under a variety of names: vegetative depression, depression without depression, masked depression, somatized depression, etc. In all these cases we are talking about subdepressive states, combined with pronounced, and often dominant, vegetative-somatic disorders in the clinical picture. Their intensity in comparison with a slightly lowered mood, which at the same time seems to be obscured, makes it possible to designate this kind of depression as hidden. The frequency of such hidden depressions, which occur almost, if not exclusively, in outpatient practice, exceeds the number of overt depressions by 10-20 times (B. Jacobowsky, 1961; T.F. Papadopoulos and I.V. Shakhmatova-Pavlova, 1983). Initially, such patients are treated by doctors of various specialties, most often by internists and neurologists, and are admitted under the supervision of psychiatrists (if they are admitted at all), often after long periods of time after the onset of the disease.

The symptomatology of such hidden depressions is extremely diverse. The most common complaints are complaints about disorders of the cardiovascular system and digestive organs: short-term, prolonged, often in the form of paroxysms, pain in the heart area, accompanied in some cases by irradiation of pain, as with angina pectoris; various cardiac rhythm disturbances, up to paroxysms of atrial fibrillation, fluctuations in blood pressure; loss of appetite - up to anorexia, diarrhea, constipation, flatulence, pain along the gastrointestinal tract, etc. Pathological sensations, in particular pain, are very common: neuralgic paresthesia, migrating or localized pain (pain characteristic of lumbago, toothache, headaches). There are disorders resembling bronchial asthma and diencephalic paroxysms. Various sleep disorders are very common. Due to the fact that depressive disorders are difficult to identify, but the connection between somatic disorders and depression is undeniable, many call the vegetative-somatic disorders occurring in latent depression depressive equivalents (I. Lopez Ibor, 1968). The number of such equivalents has been increasing over the years. Comparing the psychopathology of latent depression with the onset of depression in general, one cannot help but notice the similarity between them - the severity of the somatic component. It is possible that latent depression represents the initial stage of the development of depression, in which the deepening of mental disorders does not occur for a long time, and somatic symptoms are distinct. This assumption is supported by cases of prolonged latent depression, in which, 3-5 years after the onset of the disease, a clear depressive component eventually appears, as well as those cases where the disease develops periodically and where, again, years later, another deterioration manifests itself in somatic, and obvious depressive disorders. The positive results of antidepressant therapy also indicate the mental cause of somatic disorders.

There are several signs to suspect “hidden depression”:

1) the patient is treated for a long time, persistently, and most importantly, to no avail by doctors of various specialties;

2) these doctors, despite the use of various research methods, do not find any specific somatic disease in the patient or are limited to making a vague diagnosis, for example, “vegetative-vascular dystonia”; True, a patient can be diagnosed with a real somatic disease, but often only clinically, without confirmation by objective research methods;

3) despite failures in treatment, patients stubbornly continue to visit doctors.

When examining such a patient, it is advisable for a psychiatrist to direct questioning to identify two psychopathological disorders - depression and delirium (they are persistently treated for delusional reasons). Questioning a patient with “hidden depression” is almost always difficult and in all cases takes time. Before visiting the psychiatrist, the patient visited a large number of specialists, in many cases was subjected to various methods of objective research, was treated for a long time, but did not feel any improvement in his condition. He was tired not only of his illness, but also of the doctors. Referral to a psychiatrist by the majority of such patients is regarded either as an annoying circumstance or simply a mistake, or as a desire to get rid of it: “everything can be attributed to nerves.” Such patients often come to see a psychiatrist dissatisfied, agitated, tense, wary, and irritated. A visit to a psychiatrist is often regarded by them as an empty formality. They consider themselves to be somatically ill; they talk only about their physical ill-being, its background and unsuccessful treatment. Often such patients very persistently express their own conjectures about the reasons for their poor health and unsuccessful treatment (you should always remember about delusions). The psychiatrist who makes a mistake is the one who, even if he correctly suspects existing mental disorders, immediately begins to ask questions aimed at identifying them. By the nature of the questions asked, the patient immediately understands who he is being mistaken for. The patient is not prepared for such questions. Even if the question is asked correctly and a certain symptom of depression exists, the patient may say that it does not exist, and this will only confuse the doctor. It is best to first let the patient talk. From the context of his spontaneous statements, it is very often possible to find out the signs of depressive disorders, only the patient will describe them in his own words. These are the ones the doctor must catch, because... It is then better to talk to the patient using his own expressions, which are then translated by the doctor into the language of psychiatric terms and formulations. There is another way to identify hidden depression: ask the patient to tell in detail how his day goes, starting with waking up and ending with it the next day. Typically, patients with “hidden depression” do this quite willingly. During the course of such a story, the doctor can ask clarifying questions or ask the patient to repeat what has already been said - when answering again, the patient often more accurately formulates the initial statements, including those related to the disease. It is better to ask repeated questions using the patient’s words. This makes it easier to win the favor of the patient - the doctor speaks as the patient thinks for himself.

MANIC SYNDROME(syn. mania) - a combination of elevated mood, acceleration of the pace of mental activity and physical activity

The intensity of these disorders, the so-called manic triad, varies over a very wide range. The mildest cases are called hypomania. It is not always easy to correctly assess the painful nature of this condition. For many people around them, they are simply active, although usually somewhat scattered in their actions, cheerful, sociable, resourceful, witty, enterprising and self-confident people. Thanks to their animated facial expressions, quick movements and lively speech, they seem younger than their age. The painful nature of all these manifestations becomes obvious when hypomania changes to depression or when the symptoms of the manic triad deepen.

In a distinctly manic state, a heightened and joyful mood is combined with unshakable optimism. All the patients’ experiences are colored only in pleasant tones. Patients are carefree and have no problems. Past troubles and misfortunes are forgotten, negative events of the present are not perceived, the future is depicted only in rosy colors - “a maniac never thinks about the sunset.” True, the cheerful and friendly mood of patients at times, especially under the influence of external reasons (patients’ reluctance to obey the instructions of staff, disputes with others, etc.), gives way to irritation and even anger, but these are usually just outbreaks that quickly disappear, especially if you talk to sick in a peaceful tone. Patients consider their own physical well-being to be excellent, and the feeling of excess energy is a constant phenomenon. The opportunities to realize numerous plans and desires seem unlimited, and they see no obstacles to their implementation. Self-esteem is always increased. It is easy to overestimate your capabilities - professional, physical, related to entrepreneurship, etc. Some patients can be dissuaded for some time from the exaggeration of their self-esteem. Others are unshakably confident that they are truly capable of making a discovery, implementing important social measures, occupying a high social position, etc. In these cases, we can talk about the occurrence of expansive delirium. This is most often observed in mature and elderly patients. Typically, delusional ideas are few in number, represent a statement of fact, and are only relatively rarely accompanied by any evidence.

Patients talk a lot, loudly, quickly, often without stopping. With prolonged speech stimulation, the voice becomes hoarse or hoarse. The content of the statements is inconsistent. They easily move from one topic to another, constantly deviating from the main subject of the conversation, and if they do get to the end, then with big zigzags. The always existing increased distractibility of patients to all sorts of external, even minor, stimuli also contributes to a new direction in the content of their statements. With increased speech excitation, a thought that does not have time to finish is already replaced by another, as a result of which statements become fragmentary (jump of ideas). The speech is interspersed with jokes, witticisms, puns, foreign words, and quotes. Strong words and expressions are often used. Speech is interrupted by inappropriate laughter, whistling, and singing. In a conversation, patients easily and quickly parry questions asked of them and immediately seize the initiative themselves.

The appearance of the patients is characteristic. The eyes are shiny, the face is hyperemic, and when talking, splashes of saliva often fly out of the mouth. Facial expressions are lively, movements are fast and impetuous, gestures and postures are emphatically expressive. Patients are often completely unable to sit still. During conversations with the doctor, they change their position, spin, jump up, and often begin to walk and even run around the office. They can eat while standing, hastily swallowing poorly chewed food. Appetite is usually significantly increased. Both in men and especially in women, sexual desire increases. The increase in symptoms of manic excitement usually occurs in the evening. Some patients experience insomnia at night, others sleep little but soundly.

Depending on the predominance of certain disorders in the picture of a manic state, separate forms of mania are distinguished: “cheerful” mania (increasedly optimistic mood with moderate speech and motor excitation); “angry” mania (a combination of high mood with dissatisfaction, pickiness, irritation); “confused” mania (occurrence of incoherent speech and disordered motor agitation against a background of elevated mood); “unproductive” mania (a combination of elevated mood and motor arousal with a lack of desire for activity, poverty of thinking, monotony and unproductive statements), “delusional” mania (a combination of elevated mood with various forms of figurative and, less often, interpretive delusions); “inhibited” mania (a combination of elevated mood, in some cases, speech excitation with motor retardation, reaching the intensity of stupor), mania with foolishness (a combination of elevated mood, speech and motor excitation with mannerisms, childishness, clowning, stupid or flat jokes). The manic rampage described in the past (furormaniacalis) - a state of pronounced psychomotor agitation with rage or anger, accompanied by destructive actions and aggression, is currently encountered as an exception.

Manic states are often accompanied by the same psychopathological disorders of more severe registers as depression. With mania, much more often than with depression, states of darkened consciousness arise, in particular, in the form of numbing, amentia-like and twilight states. Manic states can occur against the background of severe psychoorganic syndrome and dementia.

In a number of cases, combinations of manic affect with other psychopathological disorders received their own separate names (see Symptoms of mental illness).

Questioning patients with manic syndromes is usually not difficult. You should always remember that you should not be assertive in your conversation with them. When it comes to complex syndromes in which manic syndrome is only a component, the questioning must, often first of all, take into account the characteristics of other psychopathological disorders - delirium, catatonic symptoms, etc. In contrast to depression, it is impossible to dissimulate a manic state.

Affective syndromes - symptom complexes of mental disorders, determined by mood disorders. Affective syndromes are divided into two main groups - with a predominance of high (manic) and low (depressive) mood. Patients with depressive syndromes are many times more common than with manic syndromes, and special attention should be paid to them, since approximately 50% of people who attempt suicide suffer from depression. Depressive syndromes are characterized by three main symptoms, the so-called depressive triad: low mood, slow thinking and motor retardation. The most constant and important component of the triad, especially in mild depression - hypothymia, most often leading to suicide, is low mood. With hypothymia, low mood is usually manifested by complaints of weakness, lethargy, laziness, impotence, depression, sadness. Patients do not believe in their strength, exaggerate real difficulties and at the same time reproach themselves for cowardice, the inability to “pull themselves together.” Many of them simultaneously complain of a painful feeling of their mental alteration. They say that they have lost the opportunity to enjoy various personal or social events, perceive their surroundings less fully, and have lost interest in many things. This is melancholic depersonalization. Mild depressive states are often accompanied by tearfulness, irritability, grumpiness, and touchiness. Mental activity with them is slowed down, impoverished, the imaginative component of thinking is lost, the consciousness is dominated by involuntarily arising thoughts that are painful in their content, in which the past and present are presented only as failures and mistakes, and the future seems aimless. It is difficult, and sometimes even completely impossible, for patients to concentrate, think, or remember anything else that is not related to their current well-being. With hypothymia, patients are inactive, movements are slow. Consciousness of the disease, sometimes exaggerated, is always preserved in these patients. With the intensification of painful disorders, an affect of melancholy appears, often accompanied by pain in the chest or abdomen - the so-called pre-cardiac melancholy. Most often, patients describe their melancholy mood with the following words: “the soul hurts,” “the soul is crushed,” “there is a burning pain in the soul,” “the melancholy presses,” “aching melancholy,” “the soul is torn apart by melancholy.” Melancholic depersonalization also changes. Patients begin to complain of a feeling of internal devastation, complete indifference, the disappearance of all feelings, even in relation to loved ones - the so-called painful mental anesthesia. In this state, patients say that they have become petrified, numb, stupid, and ruthless. This is anesthetic depression. In other cases, patients talk about a feeling of change in the external world - “the light dimmed, the foliage faded, the sun began to shine less brightly, everything moved away and froze, time stopped” - the so-called melancholic derealization. Often depersonalization and derealization disorders coexist simultaneously. As depression deepens, self-esteem also changes. Self-reproaches give way to delirium. Patients begin to accuse themselves of various crimes, debauchery, selfishness, callousness, demand a “fair trial” and “deserved punishment” for themselves, say that they are unworthy of attention, that they are wasting space in the hospital - a depressive delirium of self-accusation and self-abasement. A type of depressive delirium is also delusions of ruin and impoverishment, especially frequent in elderly patients - “there are not enough funds to live, food is not spent economically, the economy has fallen into disrepair,” etc. Often, the basis of depressive delirium may be some a valid reason, but always insignificant, not corresponding to what the sick are afraid of or what the patients blame themselves for. In these cases, movement disorders can reach the intensity of depressive substupor and even stupor. The external appearance of such patients is characteristic - they are inactive, silent, inactive, sit for hours in a bent position or lie motionless. The facial expression is mournful and monotonous. If you ask them a question, they answer in monosyllables, often in a whisper, after pauses. An apathetic state must be distinguished from a depressive stupor. Apathetic (adpnamic, aspontaneous) syndrome is a lack of motivation to activity combined with powerlessness and indifference to both the environment and one’s own condition. With apathetic syndrome, there is no delirium, melancholy, or hallucinations, as can be the case with depressive stupor. Patients can lie or sit motionless and silent all day long, hardly changing their posture, not paying attention to those around them. Questions are usually answered: “yes, no” or with a one-word question. Often the patient is vaguely aware of the abnormality of his condition. Symptoms of depression are especially intense - in the lungs, and in severe cases - in the morning, while in the afternoon or evening there can usually be an objective and subjective improvement in well-being. This distinguishes them from asthenic conditions, in which health always worsens in the evening. Along with the listed variants of depressive syndromes, which are typical, there are a number of atypical depressive syndromes. Dysphoric depression (dysphoria) is characterized by a combination of low, melancholy or melancholy-anxious mood with varying degrees of irritability, often turning into anger with aggressive actions. In a state of dysphoria, patients cannot find a place for themselves, experience an irresistible need to move, become obsessive and annoying, picky, impatient, and dissatisfied with everything. Often, during dysphoria, patients try to commit suicide. Typically, mood changes associated with dysphoria occur acutely and may also disappear. Their duration usually ranges from several hours to several days - weeks. Occasionally, dysphoria continues for a number of months. With agitated depression, an anxious-sad mood is combined with speech and motor agitation. The presence of agitated depression is evidenced primarily by such statements from patients, which say that either themselves or their loved ones misfortune or disaster will soon befall. Anxiety can be pointless - the patient, remaining in the dark about the future, is always waiting for trouble; in other cases, the anxiety is specific - “they will shoot”, “they will kill”, “they will throw out into the cold”. Patients usually talk a lot. Their statements are extremely monotonous, their content reflects the prevailing mood and delusional ideas. Speech consists of short phrases, individual words, and is often accompanied by groans, moans, and lamentations. There is a constant tendency of patients to repeat with anxiety many times in a row without a break some word or short phrase - anxious verbigeration. Motor excitement (agitation) is manifested by restlessness, constant walking, and frequent changes of posture. Many patients say that they cannot find a place, that something “tempts” them to walk. Speech motor agitation increases when talking with patients. Sometimes agitation suddenly takes on the character of frantic excitement with self-torture and attempts to kill oneself - melancholic raptus. With mild agitation, an important sign indicating its existence is the patient's wringing of the fingers. Agitated depression can be accompanied by melancholic depersonalization, mental anesthesia, delusions of self-blame, self-abasement and ruin. In addition, she is characterized by other delusional pictures. Most often, delusions of accusation - the patient admits he is guilty, but at the same time believes that his guilt is exaggerated and that negative qualities and actions that are not characteristic of him are unfairly attributed to him. Typically, delusions of accusation are combined with affective, i.e., illusions that arise only in depressed mood, primarily verbal (auditory) - in the conversations of others, patients hear accusations against them. Hypochondriacal delirium also occurs. In a number of cases, especially in patients after 45-50 years, depressive delirium takes on the character of enormity and denial - the so-called Cotard delirium: the patient - “Judas, Cain, destroyed the whole world, because of him there was no harvest, everything dried up, the Earth cooled ", etc. In other cases, denial and enormity concern the patient’s body - “the intestines, brain, lungs are rotten, there is no blood, muscles, nerves,” but nevertheless the patient believes that he will not die and will suffer forever. Hypochondriacal depression. Patients complain of unpleasant and painful sensations in various parts of the body, expressing either fears or a firm conviction that they have a serious somatic disease - cancer, tuberculosis, syphilis. The mood is usually low - anxious, with irritability and dissatisfaction. All depressive states are always accompanied by distinct somatic changes, which can often occur long before the onset of affective disorders. This is primarily a decrease in appetite and taste up to their complete loss, weight loss, and deterioration of tissue turgor. Therefore, patients with depressive syndromes look older than their years. Night sleep disturbances are common. Women have constant irregularities in the menstrual cycle. Manic syndromes (mania) are characterized by increased mood, speech and motor agitation - the manic triad. With cheerful mania, patients experience a surge of physical strength and vigor, and are joyful and optimistic. The need for a change of impressions leads to the emergence of activities and entertainment that were previously absent. It’s easy to make acquaintances, often of a dubious nature, which can lead to drunkenness, casual relationships, and participation in criminal activities. Patients are talkative and resourceful in their answers. Their attention is sharp, but unstable and easily distracted. Both the important and the unimportant are noticed to the same extent. There is no ability to concentrate on one thing for a long time. The activities of patients are characterized by feverish haste, the need to deal with several things at once, none of which they can complete. The appearance of the patients is characteristic: they look younger than their age, their face is animated with a frequently changing expression, fast and impetuous movements, loud and accelerated speech, a slightly hoarse voice; business gait; treating others with a tone of superiority, ease and impatience. With angry mania, elevated mood is combined with severe irritability. Patients are picky, extremely impatient, annoying, over trifles during conversations they easily turn to shouting, scold cynically, become aggressive, and are prone to destructive actions. Euphoria is a state of elevated mood, combined with contentment, carelessness and serenity. A feeling of good physical health is characteristic. Passivity predominates. Speech stimulation is absent or weakly expressed. The level of judgment and critical attitude towards oneself and the environment is sharply reduced. Lower desires are often intensified, leading to sexual promiscuity, drunkenness, and gluttony. Mild degrees of manic states, in which patients can still perform professional and everyday duties quite well, are called hypomania. In manic states, despite increased appetite and even gluttony, there is a significant decline weight. The need for sleep is sharply reduced - patients sleep for 2-5 hours.A. With. observed in all mental illnesses. In some cases they are the only manifestations of the disease (circular psychosis, schizophrenia), in others - its initial manifestations (progressive paralysis, syphilis, brain tumors, vascular psychoses). The latter circumstance, as well as the very high frequency of suicides among patients with depressive syndromes, determines the tactics of behavior of medical workers. These patients should be subject to round-the-clock strict medical supervision" and, if possible, they should be referred to a psychiatrist as soon as possible. It must be remembered that not only rude, but simply careless treatment of manic patients always leads to increased agitation in them. On the contrary, attention sympathy for them allows, even for a short time, to achieve their relative calm, which is very important when transporting these patients.

Obsessiveness.

Obsessions are experiences in which a person, against his will, has any special thoughts, fears, doubts. At the same time, a person recognizes them as his own, they visit him again and again, it is impossible to get rid of them, despite a critical attitude towards them. Obsessive disorders can manifest themselves in the emergence of painful doubts, completely unjustified, and sometimes simply ridiculous thoughts, in an irresistible desire to count everything. A person with such disorders can check several times whether he has turned off the light in the apartment, whether he has closed the front door, and as soon as he moves away from the house, doubts take possession of him again.

This same group of disorders includes obsessive fears - fear of heights, enclosed spaces, open spaces, traveling in public transport and many others. Sometimes, in order to relieve anxiety, internal tension, and calm down a little, people experiencing obsessive fears and doubts perform certain obsessive actions or movements (rituals). For example, a person with an obsessive fear of pollution may spend hours in the bathroom, repeatedly wash his hands with soap, and if he is distracted by something, start the whole procedure again and again.

Affective syndromes.

These mental disorders are the most common. Affective syndromes are manifested by persistent changes in mood, most often decrease - depression, or promotion - mania . Affective syndromes often occur at the very beginning of mental illness. They may remain predominant throughout, but may become more complex and coexist for a long time with other, more severe mental disorders. As the disease progresses, depression and mania are often the last to disappear.

Speaking of depression We, first of all, have in mind its following manifestations.

Decreased mood, feeling of depression, depression, melancholy, in severe cases physically felt as heaviness or chest pain. This is an extremely painful condition for a person.

Decreased mental activity (thoughts become poorer, shorter, more vague). A person in this state does not answer questions immediately - after a pause, gives short, monosyllabic answers, speaks slowly, in a quiet voice. Quite often, patients with depression note that they find it difficult to understand the meaning of the question asked of them, the essence of what they read, and complain of memory loss. Such patients have difficulty making decisions and cannot switch to new activities.

Motor inhibition - patients experience weakness, lethargy, muscle relaxation, talk about fatigue, their movements are slow and constrained.

In addition to the above, characteristic manifestations of depression are:

feelings of guilt, ideas of self-blame, sinfulness;

a feeling of despair, hopelessness, impasse, which is very often accompanied by thoughts of death and suicide attempts;

daily fluctuations in condition, often with some relief of well-being in the evening;

sleep disorders; shallow, intermittent night sleep, with early awakenings, disturbing dreams, sleep does not bring rest).

Depression can also be accompanied by sweating, tachycardia, fluctuations in blood pressure, sensations of heat, cold, chilliness, loss of appetite, weight loss, constipation (sometimes symptoms such as heartburn, nausea, belching occur in the digestive system).

Depression is characterized by a high risk of suicide!

Read the text below carefully - this will help you to notice in time the appearance of suicidal thoughts and intentions in a person with depression.

If you have depression, the possibility of attempting suicide is indicated by:

statements of a sick person about his uselessness, guilt, sin;

a feeling of hopelessness, meaninglessness of life, reluctance to make plans for the future;

sudden calm after a long period of anxiety and melancholy;

accumulation of medications;

a sudden desire to meet old friends, ask forgiveness from loved ones, put your affairs in order, make a will.

The appearance of suicidal thoughts and intentions is an indication to immediately consult a doctor and decide on hospitalization in a psychiatric hospital!

Manias (manic states) are characterized by the following symptoms .

Increased mood (fun, carefree, rosy, unshakable optimism).

Acceleration of the pace of mental activity (the appearance of many thoughts, various plans and desires, ideas of overestimation of one’s own personality).

Motor excitement (excessive liveliness, mobility, talkativeness, feeling of excess energy, desire for activity).

Manic states, like depression, are characterized by sleep disturbances: usually people with these disorders sleep little, but a short sleep is enough for them to feel alert and rested. With a mild version of the manic state (so-called hypomania), a person experiences an increase in creative powers, an increase in intellectual productivity, vitality, and performance. He can work a lot and sleep little. He perceives all events with optimism.

If hypomia turns into mania, that is, the condition becomes more severe, the listed manifestations are accompanied by increased distractibility, extreme instability of attention and, as a result, loss of productivity. Often people in a state of mania look lightweight, braggarts, their speech is replete with jokes, witticisms, quotes, their facial expressions are animated, their faces are flushed. When talking, they often change their position, cannot sit still, and actively gesticulate.

Characteristic symptoms of mania are increased appetite and increased sexuality. The behavior of patients can be unrestrained, they can establish multiple sexual relationships, and commit thoughtless and sometimes ridiculous actions. A cheerful and joyful mood can be replaced by irritability and anger. As a rule, with mania, the understanding of the painfulness of one’s condition is lost.

Senestopathies.

Senestopathies (lat. sensus - feeling, sensation, pathos - illness, suffering) call the symptoms of mental disorders, manifested by extremely diverse unusual sensations in the body in the form of tingling, burning, twisting, tightening, transfusion, etc., not associated with any internal disease organ. Senestopathies are always unique, unlike anything else. The vague nature of these disorders causes serious difficulties when trying to characterize them. To describe such sensations, patients sometimes use their own definitions (“rustling under the ribs,” “squelching in the spleen,” “it seems like the head is coming off”). Senestopathy is often accompanied by thoughts about the presence of some kind of somatic disease, and then we are talking about hypochondriacal syndrome.

Affective syndromes have the form of negative emotional disorders, namely mania and depressive states. Affective syndrome of a depressive nature differs from others by the presence of incessant bad mood, sadness and melancholy.

These symptoms can be supplemented by bodily symptoms in the form of physical discomfort, which manifests itself in the form of heaviness in the chest and difficulty breathing - a feeling of insufficient inhalation. In addition to the above symptoms, inhibition of reactions and movements, suppressed interest in previously favorite things and a slowdown in the mental activity of the brain are detected.

Depressive states with affective syndrome they have a different nature and are divided into the following: depression of a psychogenic nature, endogenous depressive states,manic-depressive psychoses , symptomatic depression.

Anxiety and low self-esteem of a patient with a depressive state of affective syndrome are characterized by a gloomy perception of the surrounding reality. This condition is characterized by a change in the manifestation of activity during the day. The patient feels worst in the morning, since at this time the depressive state manifests itself most strongly, and by the end of the day the condition stabilizes a little. In this case, the patient experiences sleep disturbances, loss of appetite and weight loss.

Read in this article

Affective syndromes - types and manifestations

Agitated depressive state

An agitated depressive state manifests itself in the form of constant mental anxiety and impaired efficiency of motor activity. Patients cannot stand still and constantly make strange sounds. This depression is adynamic in nature, that is, there is inhibition of movement, speech and lack of initiative.

Hypochondriacal depression (hypochondria)

Hypochondriacal depression manifests itself in the form of excessive anxiety of the patient about the danger of his situation, for example, the danger of a completely harmless disease. Anxiety arises even if the illness from the disease does not cause much discomfort or the disease is habitual.

Asthenic depression

Asthenic depression is characterized by the presence of constant lethargy in the body, severe physical and mental fatigue, impaired concentration and increased irritability. Also, along with the above symptoms, melancholy, lethargy and depression of mental activity appear.

Hysterical depression

With depression of a hysterical nature, hysterical states appear, namely despair, accompanied by causeless sobs, convulsions, tremors, memory disorders, hallucinations. Patients with this type of depression are often prone tosuicidal behavior .

Manic affective syndromes

Affective syndromes of the manic variety are characterized by an uncharacteristically elevated mood, which, in turn, is accompanied by inexplicable optimism. With this syndrome, accelerated mental activity and excessive activity in body movements are observed.

Mania develops due to the presence of diseases of the central nervous system. Patients show unusual joy, feel happiness and a certain groundless “high” from their life, often overestimating their capabilities and strengths, which can lead, for example, tomegalomania . The high speed of updating thoughts and ideas is accompanied by severe distractibility. There is a high level of speech activity and a great desire to expand one’s activities, no matter the cost.

Patients with mania negatively accept any criticism and react to it aggressively. Patients often act thoughtlessly and senselessly. Against the background of general excitability, sleep disturbances, increased appetite, and sudden weight loss are possible.

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Manic-depressive psychosis - a severe mental illness that occurs with alternating changes in manic and depressive phases, between which there is a period of mental stability - the so-called “bright interval”.