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Depressive syndromes

Depressive syndromes are characterized by three main symptoms, the so-called depressive triad: low mood, slower thinking and motor retardation. The most constant and important component of the triad, especially in mild depressions - hypothia, which often lead to suicide, is lowered mood. Therefore, it is important to start treatment for depression as soon as possible to eliminate the risk of suicidal attempts.

In hypothymia, low mood is usually manifested by complaints of weakness, lethargy, laziness, weakness, 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 myself together." Many of them at the same time complain about the perception of their mental alteration. They say that they have lost the opportunity to enjoy various personal or social events, they perceive their surroundings less fully, they have lost much interest. This is the melancholic depersonalization . Mild depressive states are often accompanied by tearfulness, irritability, grumbling, touchiness. The mental activity in them is slowed down, depleted, the figurative component of thinking is lost, involuntarily arising in its consciousness are preoccupied with the content of thought, in which the past and the present seem only as failures and mistakes, and the future seems purposeless. It is difficult, and sometimes even impossible, for patients to concentrate, to think, to remember something else that is not related to their true state of health.

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In hypothymia, patients are inactive, movements are slow. The consciousness of the disease, sometimes exaggerated, is always preserved in these patients.

With the increase in painful disorders, there is an anguish affect, and often accompanied by painful sensations in the chest or abdomen , the so-called atrial melancholy. Most often, patients describe their melancholy mood with such words: “the soul hurts”, “the soul was squeezed”, “burning pain in the soul”, “anguish presses”, “aching melancholy”, “the soul from anguish tears to pieces”. The melancholic depersonalization is also modified. Patients begin to complain about the feeling of internal devastation, complete indifference, the disappearance of all feelings, even towards relatives, the so-called agonizing psychic anesthesia. In this state, the patients say that they are petrified, stiff, made stupid, ruthless. This is anesthetic depression .

In other cases, patients talk about the sensation of the variability of the external world - “the light has faded, the foliage has faded, the sun began to shine less brightly, everything has moved away and stopped, time has stopped” - the so-called melancholic derealization . Often, depersonalization and derealization disorders coexist simultaneously. With the deepening of depression, self-esteem is also modified. Self reprisals are replaced by delirium . Patients begin to accuse themselves of various crimes, debauchery, selfishness, callousness, demand “fair trial” and “deserved punishment” over themselves, they say that they are not worthy of attention, in vain occupy a place in the hospital - depressive nonsense of self-accusation and self-deprecation. A kind of depressive nonsense is also nonsense of ruin and impoverishment, especially frequent in elderly patients - “there is not enough money for living, food is not used sparingly, the economy has declined” and so on. Often some kind of depressive nonsense can be the basis a valid reason, but always insignificant, not corresponding to what the patients are afraid of or blame themselves for. In these cases, movement disorders can reach the intensity of a depressive sub-stop and even stupor. The appearance of such patients is characteristic - they are inactive, silent, inactive, they sit for hours in a bent posture or lie motionless. The expression is sad and monotonous. If they turn to them with a question, they answer in monosyllables, often in a whisper, after pauses. It is necessary to distinguish an apathetic condition from a depressive stupor. The apathetic (adynamic, aspontanny) syndrome is the absence of impulses for activity in combination with impotence and indifference both to the surrounding and to one's own state. With apathetic syndrome there is no delirium, anguish, hallucinations , as it can be with a depressive stupor. Patients can lie still and sit silently for days at a time, almost without changing their posture, not paying attention to those around them. Questions are usually answered: "yes, no" or a monosyllabic question. Often the patient is vaguely aware of the abnormality of his condition.

Depression symptoms are especially intense in the lungs and, in severe cases, in the morning hours, while in the afternoon or in the evening there can usually be an objective and subjective improvement in health. This distinguishes them from asthenic conditions , in which state of health always deteriorates in the evening.

Along with the listed options 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 variously expressed irritability, often turning into anger with aggressive actions. In a state of dysphoria, patients do not find a place for themselves, they have an insurmountable need for movement, they become obsessive and annoying, picky, impatient, and dissatisfied with everything. Often during dysphoria, patients try to commit suicide. Typically, mood changes in dysphoria occur acutely and may also disappear. Their duration usually ranges from several hours to several days - a week. Occasionally, dysphoria continues for months.

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With agitated depression, anxiously depressing mood is combined with speech and motor stimulation.

The presence of agitated depression is indicated primarily by such statements of patients, which state that either themselves or their loved ones will soon suffer a misfortune or a catastrophe. Anxiety can be pointless - the patient, remaining in ignorance of the future, all the time waiting for trouble; in other cases, the alarm is specific - “shot”, “killed”, “thrown into the cold”. Patients usually talk a lot. Their statements are extremely monotonous, their content reflects the prevailing mood and delusions. Speech consists of short phrases, individual words, often accompanied by groaning, groans, lamentations. The constant tendency of patients to repeat with anxiety many times in a row without interruption is any word or short phrase - disturbing verbigration. Motor excitation (agitation) is manifested by restlessness, constant walking, and frequent change of posture. Many patients say that they cannot find a place, that something “tempts” them to walk. Speech motor arousal increases with talking with patients. Sometimes the agitation suddenly takes on the character of a frenzy of excitement with self-torture and attempts to kill oneself — a melancholic raptus. With mild agitation, an important sign indicating its existence is wrinkling of sore fingers.

Agitated depression may be accompanied by melancholic depersonalization, mental anesthesia, delusions of self-accusation, self-abasement and ruin. In addition, it is characterized by other delusional paintings. Most often, delusions of accusation - the patient pleads guilty, but at the same time considers that his guilt is exaggerated and that he is unfairly attributed to negative qualities and actions that are not characteristic of him. Usually, delusions of accusation are combined with affective, i.e., arising only with depressed mood, illusions, primarily verbal (auditory) - in conversations around people hear patients hear accusations. Hypochondrial nonsense is also found. In some cases, especially in patients after 45-50 years, the depressive nonsense takes on the character of immensity and denial - the so-called Korat's nonsense: the patient - “Judas, Cain, destroyed the whole world, because of him there was no harvest, everything was dry, the Earth was cold "Etc. In other cases, the denial and immensity relate to the patient's body—" the intestine, brain , lungs, no blood, muscles, nerves rotted, but nevertheless the patient believes that he will not die and will suffer forever.

Hypochondriac depression . Patients complain of unpleasant and painful sensations in various parts of the body, they either express concern, or firm conviction, that they have a serious somatic disease - cancer, tuberculosis, syphilis. The mood is usually lowered - anxious, with irritability and discontent.

All depressive states are always accompanied by distinct somatic changes that 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, deterioration of tissue turgor . Therefore, patients with depressive syndromes look older than their age. Common sleep disorders are common. In women, menstrual irregularities are constant.