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Neurobiologists from the Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences have developed a non-invasive method for analyzing the level of cortisol in the body. A new method for determining the stress hormone in hair will help in the treatment and prevention of depression. Scientists have submitted their work in the journal Metabolic Brain Disease . The research was supported by a grant from the Russian Science Foundation.     

Chronic stress is responsible for a variety of mental disorders, including depressive disorders. The pace of modern life creates additional stress factors that accompany urbanization, the continuous increase in the volume of current information, and the complication of social and personal life. The accumulation of negative emotions leads to the fact that the prevalence of depression is steadily increasing, and, according to the forecast of the World Health Organization, by 2030 depression will move to the first place among diseases.

The body’s stress reactivity, that is, its response to stressful stimuli, largely determines the likelihood of developing depression. Therefore, the assessment of stress reactivity allows us to assess the propensity of a person to develop post-stress depression.

“In accordance with our working hypothesis, the pathogenesis of depressive disorders is closely related to the patient’s inability to adequately respond to stress. In other words, impaired stress reactivity is a central biological component of this group of diseases, and its study allows not only understanding the patterns of depression development, but also assessing the patient’s condition and the effectiveness of his treatment, ”says Natalia Gulyaeva, head of the RSF grant.

The stress response is formed by the so-called hypothalamus-pituitary-adrenal axis. The hypothalamus produces a neurohormone , corticotropin- releasing factor (CRF), which stimulates the formation of the hormone adrenocorticotropin (ACTH) in the pituitary gland . This hormone enters the bloodstream and causes the adrenal cortex to secrete stress hormones corticosteroids, mainly cortisol. Cortisol, which travels through the blood to all cells in the body, alters its metabolism, providing the substances that are necessary to adequately respond to stress.

Correction of impaired stress reactivity is a promising approach for effective treatment and prevention of depression. The main molecular and cellular mechanisms underlying stress reactivity and its disturbances are the functioning of the hypothalamic-pituitary-adrenal neuroendocrine axis, and in the brain – the balance of neurotransmitters and neurotrophic factors, as well as the cytokine system. Disruption of these interconnected systems, leading to numerous structural and functional changes in the brain, underlies the pathogenesis of depression. It is these systems and processes that are potential targets for the prevention and treatment of depressive disorders.

However, the validity of a single determination of cortisol in human biological fluids, primarily in blood, is not high due to significant fluctuations in the level of this hormone during the day. Now biologists have developed and tested in practice a new method of non-invasive (without penetration into the body) assessment of the level of cortisol in the human body.

“Determination of cortisol in the hair of depressed patients and healthy people allowed us to compare the functioning of their main stress-implementing link during the month before the examination. Hair cortisol levels were significantly lower in women with depressive disorder than in healthy women of the corresponding age, with hair cortisol levels being lower as the severity of depression increased. This indicates suppression of the hypothalamic-pituitary-adrenal axis in female patients with depression, which is the basis of their impaired stress reactivity, ”Gulyaeva said.

Currently, on the basis of the SPC of Psychoneurology named after Z.P. Soloviev of the Moscow Healthcare Department, which took an active part in the project, clinical trials are continuing using the developed method. This approach provides scientists and clinicians with an effective, non-invasive means of assessing disease progression and the effectiveness of treatment for depression.  

Scientists have been able to turn on neurons that make mice behave aggressively

Unlike rats, mice appear to us as peaceful creatures that feed on seeds, love cheese and can gnaw on soap in our country house. But what many see as the unshakable foundations of the world order can be changed. “Bearded” joke “Don’t wake the beast in me. – And we are not afraid of hamsters! takes on a new sound. Scientists from Yale University have demonstrated that a rodent, whose jaws are used to eat grains, can be turned into a formidable consumer of the second order, killing prey with one bite, if you turn on his “predatory instinct.” The meaning of the research paper published in the journal Cell  , of course, not in creating an army of bloodthirsty mice or shaking the foundations of the universe by swapping the places of predators and prey. In fact, through this experiment, a network of neurons was identified that is responsible for chasing prey.

Werewolf mice

If you look for videos where a mouse is eating someone, you can probably stumble upon the opposite situation: the mice themselves are eaten by tarantulas, millipedes, and even chickens. Now imagine ordinary mice that walk around the cage and do not give themselves away. But as soon as you turn on the laser, they all turn into “zombies”, which, like in the TV series “The Walking Dead”, begin to chase and bite everything in their path, even sticks and bottle caps.

“We turned on the laser, and they began to jump on objects, grab them with their paws and bite vigorously, as if they were trying to grab and kill prey,” – this is how the head of the research group Ivan de Arujo describes the mouse metamorphoses , an assistant professor of psychiatry at the Yale University School of Medicine from the laboratory named after John Pierce.  

What is the mechanism that made laboratory mice forget about their usual behavioral patterns and start attacking everything? Like werewolves from horror stories under the beam of the full moon, these rodents begin to show predatory habits under the influence of light. But do not rush to break the light bulb in the basement, because ordinary mice will not turn into ferocious and ruthless killers just like that.

The only known exception – the giant descendants of mice, accidentally brought by ships from Gough Island (Tristan da Cunha Archipelago, Atlantic Ocean), which feed on the chicks of the endemic songbird, the Gough Rovettian Bunting , and large sea albatrosses and petrels – only confirms the rule. The rodents that bred in the absence of natural enemies were forced to find a new source of food, and what else can you profit from on the island, where huge numbers of seabirds nest? But even these mice do not kill chicks (whose parents, by the way, can weigh as much as 300 times more predators), but simply bite off pieces of them, eating them alive (although, of course, it sounds and looks no less creepy, and the damage to the population of majestic rodents cause a lot of birds).   

Optogenetics : “bulbs in the head”

Optogenetics , a new method of controlling impulses inside a living organism with the help of light , helped to find brain regions that include the hunting instincts of animals . The possibilities of this approach are impressive: electrochemical impulses are the communication between neurons, so by controlling them, you can interfere with the work of the brain, erasing and changing memories and controlling emotions.

Optogenetics can also set muscles in motion (as it works, for example, in the cyborg stingray, which Indicator.Ru wrote about in his review) and help restore vision, because the proteins on the action of which the method is based are special opsins (in this case, they became kanorhodopsin 2, which in nature helps Reingard’s Chlamydomonas to float into the light ), are related to those that are in our cones and sticks of eyes. The carriers of special opsins (more precisely, the genes encoding them) into the cell are vectors – harmless viruses that embed the desired piece of DNA into the DNA of the cell. Being in the membrane, they change their shape, reacting to light of a certain wavelength, and pass positively charged ions inside the cell, which changes the ratio of charges inside and outside. As a result, a potential difference is formed and an electrochemical signal arises, which activates the chains and networks of nerve cells. 

By selectively manipulating different types of neurons, scientists have found a group that is responsible for stalking prey, and another one responsible for killing victims. The prey was not only non-living objects such as sticks, bottle caps, moving toy beetles, but also living insects (crickets).

Scientists also tried to selectively break the connections between neurons of each type and found that without the work of the ” biting ” mechanism, mice pursue prey, but cannot kill it. The bite force of their jaws in this case is reduced by 50%, and the newly minted would-be hunters are not able to commit the very deadly bite with which real predators kill prey almost instantly.

Where predator instinct dozed

Perhaps, invasive mice on Gough Island cannot overcome the same problem , which is why they practically eat albatross chicks alive. However, the chicks do not run away and cannot offer strong resistance, which, for example, is quite possible to expect from a wildebeest or a deer, whose powerful horns and hooves left no chance for a weak or sluggish predator to eat. Thus, they stimulate natural selection, which spurred wolves, lions and other hunters to learn how to kill quickly, preferably with one bite, because the second attempt may not be presented.

But in mice from the John Pierce Laboratory, if they are shined with a laser, these systems are activated, like in real predators. The systems are located in the amygdala – two groups of nuclei, or clusters of neurons, in the temporal lobes of the brain. These areas are closely related to the formation of emotions, and not only negative ones like fear and aggression, but also pleasure, and are included in the limbic system, which is responsible for the body’s adaptation to environmental conditions. Malfunctioning or damage to the tonsils is a possible cause of increased anxiety, depression, PTSD, and even autism. It is noteworthy that the amygdala is quite different in men and women, and in people of homosexual orientation, the structure of these areas is more similar to that of people of the opposite sex. Men’s amygdala is larger, and under stressful stimuli (including watching horror movies), the left is activated, triggering actions in response to emotions, while in women, the right. It’s funny that the connection of the amygdala with hunting instincts reminds of the old as the world stereotypes about the man-hunter and hunter.

Scientists are now trying to understand what information from the senses enters the amygdala in order to determine what triggers the mechanisms of predator behavior and how two groups of neurons are coordinated, one of which is responsible for the bite, and the other for the pursuit. “We have gained control over their anatomical incarnation, so we hope to be able to control them even more precisely in the future,” says de Arajo .

The Hunger Games

It is interesting that the animals did not bite their relatives, although correlations between the activity of the amygdala and the level of aggressiveness are known. “The system does not just increase aggression,” the authors of the work explain. “It seems to be related to the animal’s interest in getting food.” But hunger turned out to be associated with hunting instincts and forced the mice to actively pursue prey.

In nature, the behavior of predators often takes on complex and complex forms that are characteristic of many jaw- toots ( infratotype Gnathostomata , including the superclasses of fish and tetrapods), including humans. “This is the main evolutionary player in the formation of the brain,” notes de Arajo . “There must be a rudimentary subcortical pathway that connects the signals from the senses with jaw movement and biting .” 

The study grew out of scientists trying to understand which neural mechanisms are responsible for feeding animals. Laboratory staff watched how the mice lived in cages and how they ate. This led them to the idea of ​​studying the areas of the brain associated with hunting and feeding. There are many zones on this list, but one is responsible only for hunting, and not just food in general. This turned out to be the very central nucleus of the amygdala, which can also control the muscles of the jaws and neck involved in hunting. According to the authors of the study, this area is ideal for “switching on” the system of movements characteristic of hunting in maxillary vertebrates.

Scientists from the Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences analyzed the behavior of rat pups and proved that pro-inflammatory stress in childhood leads to the development of anxiety-depressive behavior in adulthood. Research on this phenomenon was supported by a grant from the Russian Science Foundation (RSF); its results were published in the journal Behavioral Brain Research .    

Pro-inflammatory stress is a stressful effect of a different nature, causing inflammation, in particular, in the brain tissue ( neuroinflammation ). At the same time, the cells of brain microglia , which have the properties of macrophages (cells of the immune system that capture and eliminate foreign or toxic particles), and astrocytes , also glial cells, secrete special chemicals, cytokines, which are mediators of inflammation. In the first stage, inflammation is an adaptive and beneficial process, but sometimes it goes too far. In such cases, excessive secretion of cytokines begins and processes develop that contribute to the degeneration and death of cells, in particular neurons.

“The starting point was quite simple: psychiatrists had long noticed that almost the majority of people with depression experienced some kind of serious stress trauma, such as violence, at an early age. In addition, it is known that problems in infancy or even prenatal age – fetal hypoxia or infection – lead to the development of a variety of diseases, including depression, ”said co-author of the article, Doctor of Biological Sciences, Professor Natalia Gulyaeva, head of the Laboratory of Functional Biochemistry of Nervous systems and deputy director of the Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences, head of the grant of the Russian Science Foundation.

The goal of the scientists was to find the mechanisms responsible for the development of the disease, so that, by targeting these mechanisms, subsequently stop the process of the disease or even prevent it.

During the experiment, scientists simulated early pro-inflammatory stress by injecting newborn (3-5 day old) rat pups in a small dose of bacterial lipopolysaccharide – a fragment of the bacterial wall that caused inflammatory processes in the body, in particular neuroinflammation . Then we monitored how the behavior of growing animals changes in comparison with control animals that were not exposed to pro-inflammatory stress in adolescence (for rats – one month) and before reaching puberty – three months. In particular, the scientists watched how the rat pups develop symptoms of depression and anxiety, investigated the synaptic plasticity of the brain, which determines the body’s ability to learn and memory.

As a result, scientists have found that rat pups gradually develop symptoms characteristic of psychoemotional disorders. In adolescence, signs of anxiety appeared and depressive-like behavior began to appear , which was already pronounced in adult animals. The synaptic plasticity of the brains of animals was severely impaired by pro – inflammatory stress already in adolescence. Moreover, the level of corticosterone , the stress hormone, has been increased, which means that these animals have a permanent internal stress factor. In a stressful situation, both in humans and in rats, a large amount of this stress hormone is secreted from the adrenal glands (in humans, the hormone cortisol is the analogue of corticosterone ), and this has an adaptive value, mobilizing metabolic processes to overcome stress. However, if the level of corticosterone (or cortisol in a person) is steadily increased, the additional release of the hormone no longer occurs, and this significantly reduces the body’s resistance to stress. So the excess of corticosterone does a double whammy – depletes metabolic sources and weakens the ability to resist stress.

The researchers hope that the results of their work will be introduced into the clinic both for preventive measures when exposed to extreme factors on the child’s body, and for the development of new approaches to treating depression based on the identified new molecular-cell mechanisms.

Italian scientists have discovered a neural connection between the prefrontal cortex and the brain stem that blocks instinctive behavior in mice. More information about the study can be found in the journal Nature Neuroscience.  

Instincts such as fear or sexual desire are essential for human survival. But in modern life, being in society, people are forced to control their natural instincts, blocking them when necessary.

Previous research has shown that the region of the brain responsible for human instincts is the brain stem. It was also believed that the “processing” of natural instincts (regulation of social behavior) occurs in the prefrontal cortex. Now scientists at the European Molecular Biology Laboratory in Italy have literally discovered this connection between the prefrontal cortex and a group of midbrain neurons (periaquatic gray matter).

In the course of their work, the researchers found that in a mouse that was repeatedly infringed by another mouse, the connection between the brain stem and the prefrontal cortex weakened, which in a certain way affected the animal’s behavior: the mouse began to show its fear to a greater extent. Then the scientists blocked the connection between these areas of the brain in a mouse that was not attacked by other mice. It turned out that blocking this neural connection changed the behavior of the “brave” mouse, and she began to show her fear.

Scientists believe that human social behavior, like in mice, is also controlled by this neural connection. According to the researchers, the results of their work will help in the treatment of schizophrenia, depression and other mental disorders associated with the work of the prefrontal cortex of the brain.

Russian scientists have presented new arguments in favor of the hypothesis that people with depression are more active in neural networks that are responsible for thinking about themselves and their close environment. The study was supported by a grant from the Russian Science Foundation, and its findings were published in the Journal of Affective Disorders .    

Depression is one of the most serious and common mental disorders. Despite this, science knows little about the physiological causes of depression, since the condition of patients is very heterogeneous, and disorders affect many mental processes. There is a hypothesis that in depression, a certain part of the brain is extremely active, the so-called network of the passive mode of the brain, which is associated with thoughts about oneself and about loved ones (in a healthy state it is most active when a person is not busy with anything). Scientists from the Research Institute of Physiology and Fundamental Medicine of the Russian Academy of Sciences proposed diagnostics to test this hypothesis and thus provided new evidence.

The activity of the passive mode of the brain in depression means that a person is fixated on his own problems, and sees his situation as hopeless and presents his image in the eyes of others in the most negative colors. At the same time, the connections that are responsible for performing tasks related to the outside world and information processing are weakening. The hypothesis that this region of the brain is associated with depression has previously been confirmed using functional magnetic resonance imaging, measuring the saturation of blood with oxygen in specific areas of the brain. This method does not allow making unambiguous conclusions, since the work of the cardiovascular system significantly affects the saturation of blood with oxygen.

Scientists decided to test the same hypothesis using a second method – electroencephalography. In this case, using the connected electrodes, the electromagnetic activity of different areas of the brain is examined. Scientists recruited two groups of patients: healthy and suffering from clinical depression. The results obtained in each group of patients were then compared with the results of functional magnetic resonance imaging. As a result, the researchers confirmed the increased activity of the network of the passive mode of the brain in patients with depression. Both methods localized the effect of “dominance” in the anterior regions of the left hemisphere, which was previously shown to be associated with the genesis of depression.

The authors of the study hope that the proven hypothesis will soon be applied in clinical practice. The results of the study, according to scientists, will help to better understand how to work with patients with depression. For example, with the help of methods of cognitive-behavioral therapy, they need to be more focused on the outside world.

Scientists analyzed a wide database of genetic data and found 80 genes that influence a patient’s predisposition to depression. They described the results of this work in an article published in the journal Nature Communications . 

Depression is a complex condition, the predisposition to which depends on genetic factors. The three main signs of this disorder are anhedonia (loss of the ability to experience joy), impaired thinking (negative perception of reality, an unjustifiably pessimistic view of the world) and motor retardation.

Depression affects one in five people in the UK every year and 322 million people worldwide suffer from it. Often this condition can be caused by a difficult situation in life – the loss of a loved one or other mental trauma. However, scientists still do not know why some people are very susceptible to depression, while others are more resistant to it. To get closer to answering this question, geneticists at the University of Edinburgh used data from the UK Biobank resource , which contains information about the genetics and health of about half a million people. In the study, the researchers analyzed the sequencing of the genomes of 322,580 people to find areas that may be associated with a predisposition to depression.

As a result, about eight dozen genes were under suspicion. Some of them are associated with the work of synapses – the junctions of nerve cells that allow them to communicate with each other and the cells of the body, transmitting chemical and electrical signals. Others regulate the work of the short processes of neurons – dendrites. 17 of the genes found were particularly strongly associated with depressive disorders. For 14 of them, the relationship with depression was first established.

The results were corroborated by data from 23andMe, a paid genome-reading company. According to scientists, their work will help understand the genetic mechanisms of depression in order to better fight it.

Australian scientists through a survey found that the restrictions associated with the coronavirus pandemic and their consequences had a negative impact on the mental health of the population. Because of this, people show symptoms of depression and anxiety. The research is published in the journal Frontiers in Psychiatry .  

“We already know from past studies of the pandemic that people who are most affected, such as those who are sick and caring for them, have serious side effects. However, the impact of COVID-19 on the general population, even those who are not ill , can also be significant. Our data shows that the side effects of COVID-19 affect the general population, regardless of the severity of the illness. The concern is that countries with tight restrictions that avoid the worst-case spread of the coronavirus may be overlooking the indirect effects of the pandemic, ”said lead author Ami Dowell .

Scientists at Australian National University surveyed about 1,300 Australian adults in March 2020. This was the time of the first coronavirus restrictions, when international borders, bars, restaurants were just closed in the country and crowds were banned. To ensure representativeness, the researchers surveyed the same number of men and women from all age groups over 18 years old, living in all states of Australia. To prevent bias, the authors included their survey in market research without mentioning either coronavirus or mental health; As a result, the subjects did not know about the purpose of the survey. According to the researchers, among those interviewed, there were only 36 patients with COVID-19 or closely communicating with the sick.

The results showed that direct infection with the coronavirus does not harm mental health. However, the side effects of the pandemic, such as financial hardship or interruptions in work and social activity, were found to be closely associated with symptoms of depression and anxiety, as well as lower psychological well-being. At the same time, working from home had no negative consequences. Young women were the most psychologically resistant to the side effects of the pandemic.

“These data underline that the methods used by states to combat COVID-19 affect the psychological health of the population, which itself did not get sick. It is important that governments and policymakers recognize that minimizing social and financial shocks should also be a central goal of public health policy, ” Dowell said .

An international team of scientists have discovered possible molecular mechanisms for the brain switching from anxiety to depression. In the long term, this discovery may lead to the creation of new, more effective drugs for the treatment of human mental disorders. The work was published in the journal Progress in Neuro-Psychopharmacology and Biological Psychiatry .  

A group of scientists from Russia, China, the Netherlands and Brazil tested the hypothesis of the existence in the brain of a mechanism responsible for conjugating disparate symptoms into a single disease. Thus, the symptoms of depression – decreased appetite or depressed mood – can occur in many people, but only a few specific symptoms combine to form a disease. As an experimental model in the study of anxiety states, mice are often used under conditions of chronic social stress. The two males are planted in a cage, where they begin to fight, after which they are separated by a transparent partition with holes through which they can feel each other, but cannot contact. They are left for the whole day, and then the manipulations are repeated for many days in a row – as a result, “winners” and “losers” appear, the state of which is of interest for the study of anxiety and depression. According to the model, after about 10 days, the “vanquished” develop anxiety, and after 20 days, depression.

Scientists wondered how one pathology passes into another, and suggested that unique genes may be responsible for this. Such switch genes cannot be detected by classical methods, because they are not responsible for any symptom, but only for switching one pathology to another. To experimentally prove the hypothesis, the scientists performed genome-wide screening of mice brain gene activity in two key areas: the prefrontal cortex , which is responsible for long-term planning and social behavior, and the hippocampus, which is responsible for memory.

“Our discovery is this: We found out what happens on day 15 in a model of transition from experimental anxiety to depression-like state in mice. At this point, molecular mechanisms begin to activate in the brain that are not associated with neurotransmitters (as in anxiety) or inflammation (as in depression). These mechanisms are associated with the cellular skeleton and astrocytes , the side glial cells in the brain that are increasingly associated with mental illness. Thus, we have shown that when in mice one pathology of the brain turns into another, unique cellular mechanisms are activated, in fact acting as a “switch”, which can launch the vector of pathogenesis either in one direction (anxiety) or in another direction (depression). , – said the head of the study, leading researcher at UrFU and professor at St. Petersburg State University Alan Kaluev .

In about 70% of people with chronic anxiety, the disorder can develop into depression over time. At the same time, traditional antidepressant therapy helps 30–40% of people. The number of diagnosed cases is growing every year, and fundamentally new drugs for depression do not appear. Therefore, the mechanisms discovered by scientists can become a target for the creation of fundamentally new classes of psychotropic drugs.

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.

The main manifestation of the diseases of this group is obsessive (obsessive) thoughts, which are stereotypically repeated. These ideas are very hard to be tolerated by the subject due to his aggressiveness (the patient, for example, is frightened that he can suddenly beat his beloved dog, but at the same time knows that he does not want to cause suffering not only to his faithful friend, but to any living being in general) or his absurdity (the patient is unable to replace a prematurely soiled shirt, as he only does so on Mondays and Thursdays).

There may also be insane images (bloodied traffic victims) or attractions (such as picking your nose or twirling your hair around your finger in front of other people). Let us emphasize that neither images, nor drives, nor ideas are accompanied by a feeling of imposing them from the outside by some magical power, confidence that the patient himself is the object of control by someone else (such a symptom is characteristic of obsessive thoughts in the structure of the schizophrenic process).

Other typical manifestations of the disorder are compulsive (i.e., with a struggle of motives) actions (rituals), which are no less burdensome for existence than obsessive thoughts. They are not associated with satisfaction from the performance of internal useful tasks (for example, the need to wash hands several times a day without a real need, or to iron first shirts, then linen, and then pants, or skip a vehicle and wait for the next one if its number starts to an odd digit, etc.). Rituals aimed at preventing unlikely events that can harm the patient himself or his environment (including from the patient’s side). In general, ritual thinking is a rudimentary component of the human mentality; it was widely used at the stage of the formation of a person as a thinking, social being, when the underdevelopment of algorithmic approaches to processing information about the environment and ignorance of the causes of many phenomena were compensated by the activity of such a rudimentary psychological function as faith. Religious beliefs or anniversaries of special occasions are nothing more than manifestations of ritual thinking. Honoring the heroes of the day is a ritual that everyone obediently adheres to, not realizing that in this way people demonstrate a desire to protect the life of a person who has already reached a certain age from possible further misfortunes and fatal accidents. Therefore, it is sometimes difficult to determine whether a particular ritual in a patient is a manifestation of a mental disorder or is it a part of that collective unconscious (according to K. Jung), which he carries within himself as part of a certain ethnosocial and cultural layer. In addition to rituals, slowness and indecision are also considered compulsive actions.

Researchers have noted a positive correlation between obsessive states and depression, which led to attempts to use antidepressants ( cipralex , paxil , fevarin , remeron, or the previous generation antidepressant – anafranil ) in the treatment of obsessive states . Sometimes, in this way, it is possible to achieve success and relieve the patient from the suffering associated with obsessions . This disorder is more common in individuals with anankastic features, does not depend on gender, and begins at a young or adolescent age. Its course is chronic. Compulsive ritual actions respond better to behavioral therapy than obsessive thoughts, but, unfortunately, both manifestations in the same patient tend to coexist.

Given the great importance of obsessive- compulsive disorder for the general practitioner, here are its criteria:

1. Obsessive- compulsive symptoms should be regarded as one’s own thoughts or impulses. 

2. There is at least one thought or action with which the patient struggles unsuccessfully (if he has even completely reconciled with others). 

3. The thought of performing an obsessive action should not in itself be pleasant for the patient. However, there is some decrease in anxiety or tension after performing the ritual. 

4. Obsessive thoughts, images or actions are repeated, breaking the desire of their “carrier” to get rid of the unpleasant “accompaniment”. 

5. Finally, there must be a violation of the social functioning of the individual, and the obsessive- compulsive disorders themselves act as a source of distress. 

We will not dwell on neurasthenia separately. Note that today the view of neurasthenia is significantly different from that that dominated among psychiatrists of the previous generation: most consider neurasthenia not as a separate psychogenic disease, but as one of the manifestations at the level of asthenic syndrome of low-symptom (latent) organic brain damage. The neuroses of childhood are characterized by the predominance of fears, somatovegetative (enuresis, vomiting) and movement disorders (tics, logoneurosis , hysterical paralysis). The younger the child’s age, the more monotonous the neurotic picture.