Lecture
Depression is one of the most common forms of reactive states. Its characteristic feature, perhaps more than for any other form of psychogenic reaction, is the absence of any perceptible boundary between normal and pathological.
Mild depression is the most widespread form of normal human experience: in most normal people, any significant loss causes a depressed, sorrowful mood, general lethargy and slowing, loss of sleep and appetite, tears, and so on.
In pathological cases, it is primarily a matter of a quantitative increase in these same phenomena. Depressive syndromes include states featuring an obligatory symptom – a decline in mood ranging from mild sadness or sorrow to profound despondency – and facultative symptoms – a decline in mental activity, motor disturbances, and various somatic disorders (disturbance of cardiac rhythm, weight loss, constipation, decreased appetite, etc.).
The depressive triad
Emotional symptoms
A sad, sorrowful mood (the world becomes joyless and colorless), fear, irritability, hopelessness, a sense of inadequacy, a feeling of numbness, inner emptiness, apathy or inner restlessness, indecisiveness, guilt.
Cognitive symptoms:
Slowed thinking (pensiveness), impaired concentration, thoughts of death, bleak views of the future, a sense of the meaninglessness of life, lowered self-esteem, a negative self-image, anticipation of catastrophes, ideas of sinfulness, an orientation toward failure, a feeling of worthlessness.
Beck (1976) summarized these disturbances as the «cognitive triad»: a negative image of oneself, the world, and the future.
Psychomotor retardation: hypomimia or amimia, restricted mobility, stupor.
Psychomotor agitation: constant restlessness, a feeling of being hounded, a (fussy) urge for activity.
Vital disturbances: fatigue, weakness, lack of energy, lethargy, exhaustion, a sensation of pressure or pain in the region of the heart or stomach, loss of appetite, weight loss, headaches, digestive disturbances, decreased libido.
Sleep disturbances: difficulty falling asleep, interrupted sleep, early awakening.
Diurnal mood fluctuations
Autonomic disturbances: increased vagotonia, dry mouth, difficulty breathing, dizziness, constipation, cardiac rhythm disturbances.
Depression can be spoken of as a syndrome only when there is a more or less constant combination of symptoms in the emotional, cognitive, and somatic spheres; as a result of these symptoms the patient's image and quality of life are impaired, and the depressive syndrome takes a protracted course
The term «neurotic depression» was introduced by E. Kraepelin in 1895.
This symptom complex is also described as
non-psychotic,
non-endogenous,
reactive (situational),
personality-based depression
The predominant mood is characterized by feelings of grief or fear.
Decline in vital tone – absence of desires and interests.
A sense of one's own inferiority.
Self-reproach.
Thoughts of suicide; suicides.
Hypochondriacal complaints.
Disturbance of sleep and appetite.
Strong dependence on proof of love and attachment.
Lack of independence and a demanding stance.
A tendency to «cling» to someone.
Reduced tolerance for frustration in the face of failure.
Overt or somatized fears.
Characteristic of depressive patients
Underestimation of one's own chances and abilities combined with passivity and restraint, indecisiveness
Allows others to make excessive demands on them, submissiveness.
Feels uncomfortable in group situations.
Cannot make demands on their own.
Lack of initiative.
Avoids situations of self-assertion.
Avoids discussions by withdrawing into themselves.
Lack of self-confidence and a positive sense of self-worth.
Remains dependent and even seeks dependency, fear of independence.
Seeks closeness with another person, clings to them. The partner represents an «adult» figure, a mother figure.
Seeks security
Fears being abandoned – fear of losing the object, fear of losing the object's love, fear of separation.
A characteristic feature of the modern clinical picture of neuroses – the dominance of emotional disturbances, especially in protracted forms of neurosis.
Neurotic depression can become a stage of neurotic development.
The syndrome always arises psychogenically and its manifestations reflect the psychotraumatic situation. Main components: a lowered mood background that does not reach the degree of anguish. Lowered mood is usually combined with pronounced emotional lability, often asthenia, mild anxiety, decreased appetite, and insomnia.
A pessimistic attitude that is not generalized, but limited to the zone of the conflict situation.
There is a pronounced component of struggle against the illness, a striving to change the psychotraumatic situation.
No mental or motor retardation, ideas of self-blame, or suicidal tendencies.
Symptoms are less persistent, somatic disturbances are less pronounced, more dynamic, and respond more easily to treatment than in endogenous depression.
Expressiveness of patients' facial expressions; the facial expression is depressive only when the psychotrauma is mentioned.
The decrease in self-esteem is less pronounced.
The depressive affect appears in the form of anxious-depressive, asthenic-depressive, phobic-depressive, and hypochondriacal-depressive syndromes.
«Psychological understandability of experiences», the reflection of psychotraumatic pathogenic factors in experiences and statements.
Characteristic features:
1) preservation of the main personality traits,
2) psychogenic, psychologically understandable onset and course,
3) nosognosia;
4) ambivalent attitude toward suicidal thoughts;
5) the presence, in the dynamics of the clinical picture's development, of phobias, obsessive disorders, and sometimes pronounced hysterical disorders.
Psychotic depression is an acute form of depression in which episodes of psychosis occur. Psychosis refers to hallucinations, disorientation, or any other type of inability to perceive reality. Psychotic depression occurs in every fourth patient hospitalized with a diagnosis of acute depression.
In addition to such symptoms of clinical depression as feelings of helplessness, worthlessness, and hopelessness, psychotic depression also adds psychosis.
Symptoms of psychotic depression include: Nervous agitation, Increased anxiety, Constipation, Hypochondria, suspiciousness, Insomnia, Mental impairment, Physical immobility, Psychosis
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