Depressive states: course, clinic

There are several options for a depressive state, which differ in clinical manifestations, as well as in severity. The clinical manifestations and course of depression are influenced by nosological affiliation, the age of patients, their personality traits and many other factors.

Anxious-agitated depression differs from inhibitory (typical) dramatic behavior. The mood is reduced, but not depression prevails, but anxiety, unmotivated fear. Instead of lethargy, motor excitement appears. Patients run around the ward, do not find a place for themselves, pulling their hair out, banging their heads against the wall, moaning loudly, crying, obsessively turning to others with various requests. This form of depression often occurs with psychosis of the involutionary period. 

Hypochondriacal depression (depressive-hypochondriac syndrome) is characterized by the fact that patients have many somatic discomfort in various parts of the body. Such sensations do not have a clear localization; it can be a squeezing, dull or boring pain. The complaints of patients are peculiar, vague and do not fit into the framework of specific somatic diseases. The clinical picture of hypochondriac depression is characterized by hypochondriacal fears; in patients, thoughts prevail that they have some kind of severe somatic illness. The strength of the depressive, dreary mood may be less pronounced than with typical depression. If the clinic is dominated by senestopathies, this form is sometimes called senestopathic. 

Depressive-paranoid syndromes , in addition to the symptoms characteristic of depression, contain delusional ideas, and sometimes hallucinatory experiences. Delirium in patients with these syndromes always has a negative meaning: ideas of persecution, poisoning, robbery, self-accusation, etc. If the patient talks about the destruction or absence of his internal organs, he is talking about depression with nihilistic delusions, the extreme variant of which is Cotard’s syndrome – a combination of anxiously agitated depression with fantastic delusions of large-scale denial. Patients claim that their intestines have “stuck together”, their lungs have “died”, there are no other organs, they may even consider themselves dead. Denial can spread to the surrounding world – there is no one in the world, the planet has cooled down and is empty.

Latent (vegetative or somatized) depression is a form of depression in which somatic, autonomic symptoms come to the fore, and emotional disorders fade into the background. Somatic complaints – pain in the abdomen, heart area, head. Sometimes functional disorders of internal organs are observed: tachycardia, gastrointestinal disorders, dysmenorrhea, etc. Such patients are most often under the supervision of a surgeon or therapist, they may be diagnosed with neurocirculatory dystonia, diencephalic crises, conversion disorders. However, upon careful questioning and examination, it is possible to reveal characteristic depressive symptoms (“minor” mood, slowing down of thinking, decreased initiative, loss of interests, etc.). 

Subdepression is a mild form of depression in which patients do not always complain of boredom, but rather talk more about boredom. What needs to be done seems difficult, overwhelming, uninteresting to them. This is especially true for work that is associated with the stress of thinking or requires decision-making. Working capacity decreases, this causes a feeling of guilt in patients. Sleep disorders occur, patients wake up early with thoughts and anxiety about the day that begins. Somatic symptoms, as with other forms of depression, include decreased appetite, weight loss, patients look haggard, aged. They may have a feeling of coldness, chills. Sometimes there is a feeling of internal “trembling”, which patients explain as special, not similar to the usual trembling. Sometimes patients have irritability, excessive impressionability, tearfulness. This form of depression is also called hypothetical. 

By etiology, one can distinguish:

  • somatogenic (resulting from somatic diseases),
  • endogenous (with affective disorders, schizophrenia, involutional psychoses)
  • and psychogenic (for stress-related disorders) depression.

It should also be emphasized that the problem of suicide in depressed patients is relevant for patients of all age groups. More than two thirds of patients with these conditions think about suicide, up to 40% resort to suicide attempts, and up to 15% commit suicide. This fact confirms the need for timely diagnosis and treatment of depressive conditions.

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