Patients with depressive syndrome suffer from a decrease in the ability to receive joy and pleasure from life, they lose interest in what is happening, energy and activity, and cannot concentrate on anything. Even small efforts cause them fatigue, their appetite decreases, and sleep is disturbed.

Patients with a depressive syndrome (depression) suffer from a decrease in the ability to receive joy and pleasure from life, they lose interest in what is happening, energy and activity, and cannot concentrate on anything. Even small efforts cause them fatigue, their appetite decreases, and sleep is disturbed. Patients are not self-confident, they have low self-esteem, up to thoughts about their own uselessness and futility.

Depressive syndrome is manifested by three main symptoms:

1. hypothymia, ranging from slight depression to the deepest longing with an understanding of the futility and worthlessness of its existence.
2. Slow thinking, its impoverishment and chaining to unpleasant experiences. Patients answer questions in monosyllables, taking a long pause.
3. lethargy in movements and speech up to a depressive stupor (complete immobility). Sometimes such lethargy is replaced by an explosion of anguish, during which the patient can suddenly jump up, start banging his head against the wall, scream howl, inflict various injuries on himself. In this case, it should be held until the attack weakens and returns to lethargy.

Reasons for the development of the disease

The exact causes of the syndrome have not yet been established, but there are three main hypotheses:

1. hereditary predisposition.
2. Interruptions in the activity of higher centers that govern emotions.
3. The provoking factor is stress.

Symptoms of pathology

Depression, especially its endogenous types, is characterized by diurnal fluctuations. Her symptoms tend to appear in the morning when patients complain of a feeling of complete hopelessness and despair, the deepest longing. It is at this time of day that people suffering from depression commit the greatest number of suicides. Also quite often there are opposite sensations - "emotional insensitivity". One case history contains a patient’s statement that his own children who come to him do not cause any feelings and this is perceived worse than longing, which the patient nevertheless perceives as a manifestation of humanity, and here he feels like just an insensitive piece of wood. This kind of depression is called anesthetic. Depression, as a rule, is accompanied by pronounced vegetative-somatic disorders:

1. Tachycardia.
2. Discomfort in the chest.
3. Fluctuations in blood pressure with a tendency to increase.
4. Loss of appetite.
5. Decrease in body weight.
6. Disorders of the endocrine glands.

Sometimes these manifestations become so strong that they can mask the depression itself. Pathology is subdivided, depending on which component prevails into several forms:

1. alarm form with expressed painful and heavy expectations of some specific misfortune, which cannot be avoided and the appearance of which is the fault of the patient himself. In this case, the patient experiences a monotonous excitation, both motor and speech.
2. Apathetic or adynamic form. In patients suffering from this form of depression, all impulses are weakened. They are indifferent to the surrounding reality, close people, and even to themselves. They do not complain about anything, except that they ask not to touch them.
3. Masked or Lavender Form(depression without depression) is manifested by a variety of sensory, motor and autonomic disorders, occurring in the form of depressive equivalents. Most often, patients complain of problems with the digestive organs and the cardiovascular system, accompanied by disorders of appetite and sleep.
4. Depressive equivalents. These are pathological conditions that occur periodically and are characterized by a complex of mostly vegetative symptoms that replace depressive attacks during .

It is necessary to differentiate the depressive syndrome that occurs with manic-depressive psychosis, atherosclerosis of the vessels supplying the brain and other serious mental pathologies. This is of great importance, since treatment in such cases should be aimed not only at stopping depression, but also at combating the underlying disease.

Video: Depressive disorders

For the 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 relevant. In most cases, it is not possible to determine the cause of a mental disorder. Based on this, the emphasis is on determining the leading signs, which are then combined into a syndrome typical of the disease.

For example, deep depression is characterized by the appearance of suicidal thoughts. 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 a contradiction, or schism. This means that the external emotional state of a person does not coincide with his internal mood. For example, when the patient is happy, he cries bitterly, and when he is in pain, he smiles.

In patients with epilepsy, the main syndrome is considered paroxysmal - this is a sudden appearance and the same sharp extinction of the symptoms of the disease (attack).

Even the international classifier 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 - the presence of a variety of hallucinations related either to hearing, or to vision, or to 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 to themselves. With visual hallucinosis, the patient can "see" something that is not really there - it can be inanimate objects, or people or animals. Often this phenomenon can be observed in blind patients.
• The paranoia syndrome is a primary delusional state that reflects the surrounding reality. It can be an initial sign of schizophrenia, or develop as an independent disease.
• Hallucinatory-paranoid syndrome is a diverse combination and the presence of hallucinations and a delusional state that have a common pathogenesis of development. A variation of this syndrome is the mental automatism of Kandinsky-Clerambault. The patient insists that his thinking or ability to move does not belong to him, that someone from outside automatically controls him. Another type of hallucinatory-paranoid syndrome is the Chikatilo syndrome, which is the development in a person of a mechanism that begins to guide his behavior. The increase in the syndrome occurs over a long period of time. The discomfort that has arisen in the patient gives impetus to the commission of sadistic crimes on the basis of sexual weakness or dissatisfaction.
• The syndrome of pathological jealousy is one of the forms of obsessions and delusions. This condition is subdivided into several more syndromes: the "existing third" syndrome (with really 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 zealous fantasies and signs of paranoia).

Syndromes associated with impaired intellectual development.

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

A syndrome associated with a state of affect.

• Manic syndrome is characterized by such a triad of signs as a sharp increase in mood, an accelerated flow of ideas, motor-speech excitement. As a result, there is a reassessment of oneself as a person, there is a megalomania, emotional instability.
• A depressive state, on the contrary, is characterized by a reduced mood, a slow flow of ideas, and motor-speech retardation. There are such effects as self-abasement, loss of aspirations and desires, "dark" thoughts and a depressed state.
• Anxiety depressive syndrome is a combination of depressive and manic states that alternate with each other. Motor stupor may occur against the background of an increase in mood, or motor 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 by increased fatigue, excitability and mood instability, which is especially noticeable against the background of autonomic disorders and sleep disorders. Usually, the signs of asthenic syndrome subside in the morning, manifesting themselves with renewed vigor in the second half of the day. Often, asthenia is difficult to distinguish from a depressive state, so experts distinguish a combined syndrome, calling it astheno-depressive.
• The organic syndrome is a combination of three symptoms, such as deterioration in the process of memorization, a decrease in intelligence, and the inability to control affects. This syndrome has another name - the Walter-Buhel triad. At the first stage, the condition reveals itself as general weakness and asthenia, instability in behavior and decreased performance. The patient's intellect suddenly begins to decline, the circle of interests narrows, 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 epileptic seizures or psychoses.

Syndrome associated with impaired motor and volitional functions.

• The catatonic syndrome has such typical symptoms as catatonic stupor and catatonic excitation. Such states manifest themselves in stages, one after another. This psychiatric syndrome is caused by a pathological weakness of neurons, when completely harmless stimuli cause an excessive reaction in the body. During stupor, the patient is lethargic, shows no interest in the world around him and in himself. Most patients simply lie with their heads against the wall for many days and even years. Characteristic sign of "air cushion" the patient lies, and at the same time his head is raised above the pillow. The sucking and grasping reflexes, which are inherent only in infants, resume. Often at night, the manifestations of the catatonic syndrome weaken.
• Catatonic excitation is manifested by both motor and emotional excited state. The patient becomes aggressive and negative. 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 stubbornly remain silent, or speak uncontrollably and senselessly.
• A lucid catatonic state occurs in full consciousness.
• Oneiric catatonic state manifests itself with depression of consciousness.

neurotic syndrome

• Neurasthenic syndrome (the same asthenic syndrome) is expressed in weakness, impatience, exhausted attention and sleep disorders. The condition may be accompanied by pain in the head, 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 takes a large number of unnecessary tests and studies.
• The hysterical syndrome is characterized by excessive self-suggestion, selfishness, imagination and emotional instability. Such a syndrome is typical in hysterical neuroses and psychopathy.
• The psychopathic syndrome is a disharmony of the emotional and volitional state. It can proceed according to two scenarios - excitability and increased inhibition. The first option implies excessive irritability, negative mood, desire for conflicts, impatience, predisposition to alcoholism and drug addiction. The second option is characterized by weakness, lethargy of the reaction, physical inactivity, decreased self-esteem, skepticism.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

masked depression. For masked depression (laurel, depression without depression) is characterized by the predominance of various motor, sensory or autonomic disorders of the type of depressive equivalents. The clinical manifestations of this depression are extremely diverse. Often there are various complaints of disorders of the cardiovascular system and digestive organs. There are attacks of pain in the heart, stomach, intestines, radiating to other parts of the body. These disorders are often accompanied by sleep and appetite disturbances. Depressive disorders themselves are not clear enough and are masked by somatic complaints. There is a point of view that depressive equivalents are the initial stage in the development of depression. This position is confirmed by observations of subsequent typical depressive attacks in patients with previously masked depression.

With masked depression:

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

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

Psychopathological signs:

Sadness, melancholy, joylessness, loss of feeling of pleasure.

Feeling of loss of senses (psychic anesthesia, devastation or petrification). Heavy burden. Vital fatigue, depression, despair, hopelessness, pessimism, disappointment, feelings of guilt, fear, worthlessness, suicidal thoughts.

Hypochondria

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

Thinking

Thinking "in a circle", philosophizing, obsessive philosophizing, indecision, mental emptiness, poverty, inability to think, decreased level of thinking, inability to make a decision and carry out an intention.

Time goes slowly or stops, but it can also rush past.

Depressive mood causes experience, leads to delusional fears, beliefs:

bodily disease, destruction, death (hypochondriac delirium, delirium of death): "I am rotten, I am drying up, I have already completely disintegrated inside."

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

Perception

Everything becomes gray, pale, dull, 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 areas.

hallucinations

In severe melancholy, there are optical, in many cases with the character of pseudohallucinations. Patients see shadow images of death, hell, skeleton.

Motor skills

On the one hand, motor retardation and slowing down, stupor up to stupor and. However, patients in a state of agitation are in constant anxiety, running back and forth, scratching themselves and lamenting stereotypically. Adynamic and agitated depression.

Somatic symptoms

Correspond to vital decline: lack of revival, 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, feeling of a lump in the throat, squeezing the chest, pain in the heart area, shortness of breath, shortness of breath, distension of the abdomen, fullness, a feeling of overstretching of the internal organs.

Meets

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

Depression in schizoaffective mixed psychoses

Organic depressions in cerebral structural changes

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

neurotic depression

depression with prolonged affective stress.

Psychoreactive depression as a direct reaction to difficult life experiences.

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

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

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

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

Clinical picture

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Etiology and pathogenesis

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

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

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

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

Diagnosis

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

Differential Diagnosis

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

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

Treatment

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

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

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

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

Forecast

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

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

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

V. M. Shamanina.