Typical depression is characterized by classic manifestations (depressive triad): low mood (hypotymia), motor and ideational retardation. Depressive states (especially mild ones - cyclothymic) are characterized by mood swings during the day with improvement general condition, a decrease in the intensity of depression in evening time, low severity of ideational and motor retardation.

With the same mild depression, one can note in patients a feeling of unmotivated hostility towards loved ones, relatives, friends, constant internal dissatisfaction and irritation. The more severe the depression, the less pronounced the mood swings are during the day.

Depression is also characterized by sleep disorders - insomnia, shallow sleep with frequent awakenings or lack of feeling of sleep.

Depression is also characterized by a number of somatic disorders: patients look older, their nails become brittle, hair loss accelerates, the pulse slows down, constipation occurs and becomes frequent, menstrual cycle and amenorrhea often appears, appetite disappears (food is “like grass”), as a result of which patients eat forcefully and their body weight decreases.

In Russian psychiatry, it is customary to distinguish between simple and complex depression, within which almost all psychopathological variants of the depressive syndrome encountered in clinical practice are considered.

Simple depressions include melancholic, anxious, adynamic, apathetic and dysphoric depression.

Melancholic (sad) depression is characterized by depressed mood, intellectual and motor retardation. In patients, along with a depressed mood, an oppressive, hopeless melancholy appears, accompanied by an unpleasant sensation in the epigastric region, heaviness or pain in the heart. Patients perceive everything around them in a gloomy light, impressions that gave pleasure in the past seem to them to have no meaning, have lost relevance, and they view the past as a chain of mistakes. Past grievances, misfortunes, and wrong actions come to mind and are overestimated. Patients see the present and future as gloomy and hopeless. Patients spend whole days in a monotonous position - sitting with their heads bowed low, or lying in bed; their movements are extremely slow, their facial expression is mournful, and there is no desire for activity. Suicidal thoughts and tendencies indicate the extreme severity of depression. Ideational inhibition is manifested by slow, quiet speech, difficulties in processing new information, often with complaints about a sharp decline memory, inability to concentrate.

Anxious depression can be either agitated or inhibited.

C- With anxiety-agitated depression, the picture of the condition is dominated by motor excitation in the form

agitation with accelerated speech, nihilistic delirium occurs, and often Cotard's syndrome occurs. o In inhibited depression, the psychopathological picture is largely determined by anxiety. In the depressive triad, motor retardation is expressed, the pace of thinking does not change, and ideational inhibition is manifested by the anxious and melancholy content of thinking. Anxiety is felt physically by patients, feelings of melancholy, ideas of self-blame and inferiority, suicidal thoughts and the somatic signs of depression described above appear.

Anesthetic depression is characterized by the predominance in the picture of the disease of symptoms of mental anesthesia - the loss of emotional reactions to the environment. Such depressions can be purely anesthetic, melancholy-anesthetic and anxious-anesthetic.

❖ In purely anesthetic depressions, anesthetic disorders are the most significant sign syndrome, while other symptoms of depression may be erased, absent or mildly expressed.

❖ Melancholy-anesthetic depression is characterized by a feeling of vital melancholy, localized in the heart area, daily mood swings, ideas of self-blame and self-deprecation, suicidal thoughts and intentions, somatic signs of depression, as well as adynamia in the form of a feeling of physical or (less often) so-called moral weakness. Patients regard the feeling of loss of feelings as evidence of their real emotional alteration and base the plot of ideas of self-accusation on it.

Adynamic depression The clinical picture of these depressions includes increased weakness, lethargy, impotence, the inability or difficulty of performing physical or mental work while maintaining motivations, desires, and desire for activity. There are ideational, motor and combined variants of these depressions.

❖ In the ideational version, manifestations of adynamia prevail over depression itself. The mood is low, patients express ideas of inferiority, but the main plot of their experiences consists of adynamic disorders. Adynamia is expressed in complaints about lack of moral strength, mental exhaustion, mental impotence, poor intelligence. In the depressive triad, ideational inhibition dominates over motor inhibition.

“The motor version of adynamic depression is characterized by a predominant feeling of weakness, lethargy, muscle relaxation and impotence. The affective radical is represented by depression with a feeling of inner restlessness and tension.

F- The combined variant of depression is characterized by signs of both ideational and motor adynamia.

Apathetic depression. In the clinical picture of apathetic depression, the impossibility or difficulty of performing mental or physical activity as a result of the lack of desire and desire for any type of activity, a decrease in the strength of impulses and all types of mental activity. There are apatomelancholic and apatoadynamic depressions.

❖ Apatomelancholic depression is manifested by bad mood, feelings of melancholy, ideas of self-blame, suicidal thoughts, but the patients themselves rate apathy as one of the most severe disorders. An inverse relationship is noted between the severity of apathy and melancholy.

F Apatoadynamic depression is characterized by a combination of apathy and adynamia. Actually, melancholy is atypical for these depressions, and anxiety in the form of vague internal restlessness and tension is extremely rare.

Dysphoric depression is a condition characterized by the occurrence of dysphoria against a background of decreased mood - irritability, anger, aggressiveness and destructive tendencies. In this case, objects and situations that did not attract the patient’s attention shortly before may suddenly become a source of irritation. The behavior of patients during the period of dysphoric depression varies: in some, aggression and threats to others, destructive tendencies and obscene language predominate; for others, a desire for solitude associated with hyperesthesia and hatred of the whole world; still others have a desire for vigorous activity that is unfocused and often absurd in nature.

The clinical picture of simple depression may include hallucinatory, delusional and catatonic manifestations, when, along with depression, melancholy and anxiety, verbal hallucinations of a threatening or imperative nature, ideas of influence, persecution, guilt, damage, ruin, and impending punishment appear. At the height of depression, acute sensory delirium with staging and episodes of oneiric clouding of consciousness can develop.

Quite often, depressive states take on the character of melancholic paraphrenia with corresponding delusional experiences from “mundane” interpretations to mystical constructions.

IN existing classifications, in addition to those described above, tearful and ironic depression often appears (with the latter, a smile wanders on the face of patients, they sneer at their condition and helplessness), stuporous depression, etc. The characteristics reflected in the names of these depressions are insignificant - they only emphasize certain features depressive state, which can be observed in the clinical picture of depression of various structures.

The presented typology of simple depressions, naturally, does not exhaust all their diversity and in this regard is largely relative. This is primarily due to the fact that, along with the classic clinical pictures of the described depressions, there are conditions that are often difficult to attribute to a certain type depressions due to their significant variability and polymorphism of the main manifestations.

Complex depressions include senesto-hypochondrigesian depression and depression with delusions, hallucinations and catatonic disorders. They are distinguished by significant polymorphism and depth of positive disorders, as well as variability due to the presence in the clinical picture of the disease of manifestations that are outside the framework of disorders obligatory for depression.

Senestoipochondriacal depressions are very complex. In these cases, affective disorders themselves recede into the background and complaints of extremely unpleasant, painful sensations in various parts of the body, sometimes of extremely pretentious, bizarre content, become the leading ones. Patients are focused on feelings of somatic ill-being and express alarming concerns about their health.

In the structure of depressive states with delusions and hallucinations, catatonic disorders occupy a large place - from individual manifestations in the form of increased muscle tone or negativism to pronounced pictures of substupor and stupor.

The ratios themselves affective disorders and disorders that go beyond the boundaries of obligate symptoms of depression, researchers consider differently: some believe that ineffective circle disorders arise independently of affective disorders, others consider affective disorders to be secondary compared to more severe psychopathological manifestations.

Along with simple and complex depressions, protracted (protracted) and chronic depressions are described in the literature.

Protracted, or prolonged, depression can have a monomorphic structure, if the condition does not change its psychopathological picture for a long time, and a polymorphic structure, if the picture of depression changes during the course of the disease.

❖ The clinical picture of monomorphic depression is characterized by relative simplicity, low variability, insignificant dynamics of individual manifestations, and uniformity of the picture throughout the entire course of the disease. Such depressions are usually characterized by anxious adynamic, anesthetic, dysphoric or senestohypochondriacal disorders. In these cases, lethargy, adynamic, anesthetic and anxiety states without a certain sequence and pattern replace each other.

o In patients with a variable (polymorphic) clinical picture and deep psychopathological disorders during an attack, simple hypothymic disorders can transform into complex states (with delusions, hallucinations, catatonia), and it is impossible to identify any pattern in the change in the described disorders.

Chronic depression differs from prolonged depression not only in its protracted nature, but also in the signs of chronicity, manifested by uniformity and monotony of the psychological picture of depression. In these cases, hypomanic “windows” may appear, as well as symptoms of the neurotic register in the form of senestopathic, obsessive-phobic and vegetophobic paroxysmal states. General Features Chronic depression can be represented as follows:

❖ the predominance of melancholic, depersonalization and hypochondriacal disorders;

❖ disharmony of the depressive triad, characterized by a combination of low mood and motor inhibition with monotonous verbosity;

❖ dissociation between the intensity and variety of complaints of an affective nature and the outwardly calm, monotonous appearance and behavior of patients;

o- hypochondriacal coloring of ideas of self-accusation;

❖ the obsessive nature of suicidal thoughts with an attitude towards them as alien.

Most of a person's problems and diseases are related to his physical health. But there are also those that relate to the psychological component. Among them is depression, one of the most common diagnoses in psychotherapy. AND we're talking about not about the usual decrease in psycho-emotional tone or spoiled mood. Here we look at depression as serious illness psyche.

What it is

Depression (from the Latin depressio - “depression”) is generally considered to be: mental disorder, which in most cases occurs after various traumatic events in a person’s life, but can develop without obvious reasons. Attacks tend to recur.

The disease includes a triad of phenomena characterized by a slowdown human activity at different levels:

• physical,
• mental,
• emotional.

Classification

Approaches to trying to distinguish types of depression according to various signs so many. Let's get acquainted with the main ones.

Causes

The impetus for a depressive state can be a whole set of factors, including:

• external influences on the psyche (from acute psychological trauma to a chronic state of constant stress);
• genetic predisposition;
• various endocrine changes (adolescence, postpartum and menopause);
• congenital or acquired organic defects of the central nervous system;
• somatic (physical) diseases.

In turn, heavy psychological trauma may be caused by:

• tragedy in personal life (from illness or death loved one before divorce and childlessness);
• problems with your own health (from serious illness to disability);
• disasters at work (from creative or production failures and conflicts to job loss or retirement);
• experienced physical or psychological violence;
• economic turmoil (from a transition to a level of security lower than usual to financial collapse);
• migration (from changing an apartment to another in the same city to moving to another country).

It is believed that it is necessary to seek professional help if:

1. A person has a depressed mood for more than 2 weeks, with no tendency to improve.
2. All the previously helpful ways to relax and lift your spirits (communication with friends, nature, music, etc.) no longer work.
3. Thoughts about suicide appeared.
4. Family and work social ties are actively collapsing.
5. The circle of interests gradually narrows, the taste for life is lost, and the desire to “withdraw into oneself” appears more and more often.

We will also try to understand the versatility of the symptoms of severe depression. This type may appear as:

• serious impairment of physical well-being. This may be a malfunction of the digestive system, painful sensations in the muscles, heart and head, constant drowsiness or insomnia against the background of severe general weakness,
• loss of natural desires: complete lack of appetite, sexual needs, loss of maternal feelings,
• sudden mood changes,
• constant self-flagellation, heightened feelings of guilt, anxiety or danger, uselessness,
• lack of work activity, refusal to go to work at all,
• slowness of thinking, it becomes very difficult to think and make decisions,
• the appearance of indifference to loved ones and previously loved people, the patient understands this and suffers even more,
• thoughts about suicide
• inhibition of reactions,
• and even, especially difficult cases, hallucinations, etc.

At the same time, the symptoms in adolescents, women and men also have distinctive features.

• gloominess, moodiness, outbursts of hostile aggression directed at parents, classmates, friends;
• a sharp decline in academic performance due to weakened attention function, increased fatigue, loss of interest in learning;
• narrowing of the circle of friends, constant conflicts with parents, frequent changes of friends and acquaintances;
• acute non-acceptance of even the minimum amount of criticism, complaints of misunderstanding, dislike for him, etc.;
• absences from classes, all kinds of tardiness and careless attitude towards one’s personal responsibilities at home and in school;
• bodily pains unrelated to organic pathology (headaches, in the abdomen and in the heart area), fear of death.

Symptoms of depression in women

Their peculiarity lies in their seasonality, tendency to chronicity, connection with reproductive cycle. This

• pronounced vegetative manifestations (from nausea and suffocation to rapid heartbeat and chills);
• violations eating behavior(an attempt to “eat away” one’s problems and disgusting mood, as well as anorexia).

Features characteristic of men

• attempts to indulge in alcohol and smoking,
• severe fatigue and irritability,
• loss of interest in work or hobbies,

If a person gets depressed, the advice of others will not help him. You can't do it without the work of a professional.

Usually, it is not the patients themselves who turn to a psychologist about depression, but their concerned relatives, since the patient himself simply does not see the point in treatment and is too immersed in his experiences. You can even contact a regular therapist who can make a preliminary diagnosis of depression. Clarification can only be made by a psychiatrist.

At the first appointment, information is collected about complaints, history of the current illness, state of health at the time of appointment, the patient’s life history, family, and connections with society. This is how the type of depression is determined and the issue of the need for consultations with other specialists is resolved.

For example, only a psychiatrist in a hospital setting deals with the treatment of severe endogenous depression, while organic and symptomatic species Therapists supervise together with the psychologist.

For early diagnosis, professionals also use special questionnaires (Beck, Zung), scales that not only detect the presence of depression in a patient, but also assess its severity, and are also able to further monitor the progress of the treatment process.

Hormonal studies and studies of the bioelectrical activity of the brain (electroencephalogram) may also be carried out.

In medical practice, diagnostic criteria are used to accurately diagnose depression. So, the patient must be exposed to at least 5 of the following symptoms every day for 2 weeks or more:

1. Depressed mood, manifested in the form of irritability and tearfulness.
2. Decline in interests in any field of activity, inability to have fun, apathy.
3. Unintentional changes in appetite and weight gain or loss.
4. Insomnia or, conversely, constant drowsiness.
5. Retardation or, conversely, a manifestation of excessive psychomotor agitation.
6. Loss of strength, instant fatigue.
7. Feelings of worthlessness and guilt.
8. Decreased concentration and performance, especially in intellectual areas.
9. Presence of suicidal thoughts and plans.

However, these symptoms cannot be associated with alcohol abuse, physical illness or loss.

Treatment

There are 4 treatment methods in total, which complement each other:

Drug therapy

Involves the use of drugs that can relieve acute condition depression:

• antidepressants,
• tranquilizers,
• neuroleptics,
• mood stabilizers (mood stabilizers),

This treatment is selected by the doctor on an individual basis; It is dangerous to use these medications on your own: they all affect the brain and, if the dosage is incorrect, can cause irreparable harm to a person.

Antidepressants are most often used in the treatment of depression as medicines, capable of enhancing the patient’s emotional background and restoring his joy of life. They can only be prescribed by a specialist who will monitor the person’s condition during treatment.

Specifics of antidepressants:

• their healing effect begins to appear only after quite a long period time after starting treatment (at least 1-2 weeks);
• most of their side effects are active in the first days and weeks of use, and then disappear or significantly decrease;
• upon admission to therapeutic doses they do not cause physical or mental dependence, but they are canceled gradually, not abruptly (since there is a risk of the patient developing “withdrawal syndrome”);
• It is necessary to take medications for a long time, even after the condition has normalized, for a sustainable effect.

Psychotherapy

Offers a very wide range of different techniques, applied sequentially, in adequate combination with each other. For severe depression drug treatment complements psychotherapy; in mild cases, only psychotherapeutic methods can be used. Apply the following types psychotherapy:

• psychodynamic,
• cognitive-behavioral,
• trance, etc.

The course of treatment consists of consultations with the attending psychotherapist and, as a rule, lasts more than one month.

Physiotherapy

Has auxiliary meaning. Various procedures are used, such as:

• light therapy,
• color therapy,
• aromatherapy,
• music therapy,
• art therapy,
• therapeutic sleep,
• massage,
• mesodiencephalic modulation, etc.

Shock techniques

It happens that the end of long-term and deep depression, resistant to conventional therapy, can be facilitated by the use of techniques that create a high physical and psychological “blow” for a person, in other words, shock. However, they are quite dangerous - therefore they are used only in psychiatric hospitals after the approval of a council of doctors and only with the written informed consent of the patient. You can “shock”:

1. Therapeutic fasting (with complete fasting for 1-2 weeks, survival becomes the main goal for the body, all systems are mobilized and apathy disappears);
2. Sleep deprivation (the patient is asked not to sleep for about 36-40 hours, while the nervous system, thought processes are “rebooted”, mood improves);
3. Drug shock insulin therapy;
4. Electroconvulsive therapy, etc.

Prognosis and prevention

Perhaps the only advantage of depression is that it can be successfully treated. 90% of people who turn to doctors for help make a full recovery. Only a qualified psychologist and psychiatrist can provide comprehensive information on the prevention of depression that can help a specific person. The general recommendations are:

• Healthy sleep (for an adult - at least 8 hours a day, for children and adolescents - 9-13 hours).
• Proper nutrition (regular and balanced).
• Maintaining a daily routine.
• Spending time with family and friends (walking together, visiting cinemas, theaters and other places for entertainment).
• Great physical activity.
• Avoiding stressful situations.
• Time for yourself, to receive positive emotions.

Remember that depression is the same disease as gastritis or high blood pressure, and it can also be cured. Don’t blame yourself for the lack of “willpower”, for the inability to pull yourself together. Contact a specialist without delay or waste of time - the best way out from the situation.

The video shows a psychotherapist explaining the difference between a bad mood and a real illness:

DEPRESSIVE SYNDROMES(lat. depressio depression, depression; syndrome; synonym: depression, melancholy) - mental disorders, the main symptom of which is a depressed, depressed, melancholy mood, combined with a number of ideational (thought disorders), motor, and somato-vegetative disorders. D.s., like manic (see Manic syndromes), belong to the group of affective syndromes - conditions characterized by various painful changes in mood.

D. s. is one of the most common pathol. disorders that occur in almost all mental illnesses, the features of K-rykh are reflected in the manifestations of depression. The generally accepted classification of D. s. No.

D. s. tend to repeatedly re-development, therefore, significantly disrupt the social adaptation of some patients, change their rhythm of life and, in some cases, contribute to early disability; this applies both to patients with pronounced forms of the disease, and to a large group of patients with erased wedge manifestations of the disease. In addition, D. s. pose a risk of suicide, create opportunities for the development of drug addiction (see).

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

Clinical picture

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

The most common, typical forms of D. s. refer to the so-called simple depression with a characteristic triad of symptoms in the form of depressed, melancholy mood, psychomotor and intellectual inhibition. In mild cases or initial stage development of D. s. patients often experience a feeling of physical fatigue, 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 about “laziness,” lack of will, and the fact that they cannot “pull themselves together.” Low mood can have a variety of shades - from a feeling of boredom, sadness, easy fatigue, depression to a feeling of depression with anxiety or gloomy moodiness. Pessimism appears in assessing oneself, one’s abilities, and social value. Joyful events do not find a response. Patients strive for solitude and feel different from before. Already at the beginning of D.'s development. Persistent disturbances of sleep, appetite, and gout are noted. disorders, headaches, unpleasant painful sensations in the body. This is the so-called cyclothymic type of depression, characterized by a shallow degree of disorder.

As the severity of depression deepens, psychomotor and intellectual retardation increases; melancholy becomes the leading background of the mood. IN in serious condition patients look depressed, their facial expressions are mournful, inhibited (hypomimia) or completely frozen (amimia). Sad eyes upper eyelids semi-lowered with a characteristic Veragut fold (the eyelid is curved upward in its inner third). The voice is quiet, dull, monotonous, poorly modulated; speech is terse, answers are monosyllabic. Thinking is inhibited, with a poverty of associations, with a pessimistic focus on the past, present, and future. Characteristic thoughts about one's inferiority, worthlessness, ideas of guilt or sin (D.s. with ideas of self-accusation and self-abasement). When psychomotor retardation predominates, the patients’ movements are slow, their gaze is dull, lifeless, directed into space, there are no tears (“dry” depression); in severe cases, there is complete immobility, numbness (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, and a desire for self-mutilation. Often during such periods, patients commit suicide. A feature of melancholy 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 melancholy).

As in the initial stage, during the full development of D. s. Somatovegetative disorders remain pronounced in the form of sleep disturbances, appetite, and constipation; patients lose weight, skin turgor decreases, extremities are cold, cyanotic, blood pressure decreases or increases, endocrine functions are upset, sexual instinct decreases, women often stop having periods. Characteristic is the presence of a daily rhythm in the fluctuation of the condition, often with improvement in the evening. In very severe forms of D. s. daily fluctuations in condition may be absent.

In addition to the most typical forms described above, there are a number of other varieties of D. with. associated with modification of the main depressive disorders. They distinguish smiling depression, which is characterized by a smile in the presence of bitter irony at oneself in combination 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, depression with a predominance of tears is observed - “tearful” depression, “grumpy” depression, with constant complaints - “aching” depression. In cases of adynamic depression, a decrease in motivation with the presence of elements of apathy and a sense of physical activity comes to the fore. 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, “gloomy” depression develops with a feeling of hostility, an angry attitude towards everything around, often with a dysphoric tinge or with a painful feeling of internal dissatisfaction with oneself, with irritability and gloominess.

D. s. are also distinguished. with obsessions (see Obsessive states). With mild psychomotor retardation, D. s. with a “feeling of numbness,” a loss of affective resonance, consisting of a reduced ability to respond to a situation and external phenomena. Patients become as if emotionally “stone”, “wooden”, incapable of empathy. Nothing pleases them, nothing worries them (neither their family nor their children). This condition is usually accompanied by complaints from patients about the loss of emotions and feelings (anaesthesia psychica dolorosa) - D. p. with depressive depersonalization, or anesthetic depression. In some cases, depersonalization disorders can be more profound - with a feeling of significant changes in one’s spiritual “I”, the entire personality make-up (DS with depersonalization); some patients complain of an altered perception of the outside world: the world seems to lose color, all surrounding objects become gray, faded, dull, everything is perceived as through a “cloudy cap” or “through a partition”, sometimes surrounding objects become as if unreal, lifeless, like as if drawn (D.s. with derealization). Depersonalization and derealization disorders are usually combined (see Depersonalization, Derealization).

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

Severe depression is characterized by the development of depressive-paranoid syndrome (see Paranoid syndrome), characterized by acute, pronounced affect of anxiety, fear, ideas of guilt, condemnation, delusions of staging, false recognitions, ideas of special significance. Enormity syndrome may develop (see Cotard syndrome) with ideas of eternal torment and immortality or hypochondriacal delirium of fantastic content (Cotard's nihilistic delirium, melancholic paraphrenia). At the height of the disease, the development of oneiric disorder of consciousness is possible (see Oneiric syndrome).

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

H. Sattes (1955), N. Petrilowitsch (1956), K. Leonhard (1957), W. Janzaric (1957) described D. s. 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 feeling of burning, itching, tickling, the passage of cold or heat with a narrow and persistent localization to senestopathies with a wide, constantly changing localization.

Along with the above-described forms of D. s. a number of authors identify a large group of so-called. hidden (erased, hidden, masked, latent) depression. According to Jacobovsky (V. Jacobowsky, 1961), latent depression is much more common than expressed depression, and is observed mainly in outpatient practice.

Latent depression refers to depressive states that manifest themselves primarily as somatovegetative disorders, whereas typically depressive symptoms are erased, almost completely overlapped by vegetative ones. We can speak about whether these conditions belong to depressive ones only on the basis of the frequency of these disorders, the presence of daily fluctuations, positive therapeutic effect from the use of antidepressants or a history of affective phases or hereditary burden affective psychoses.

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

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

The duration of larval depressions varies. There is a tendency towards 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 larvae forms makes it possible to apply the most adequate therapeutic tactics to them. Close in wedge picture to latent depression are “depression without depression”, described by Priori (R. Priori, 1962), and vegetative depression by Lemke (R. Lemke,

1949). Among “depression without depression” the following forms are distinguished: pure vital, psychoaesthetic, complex hypochondriacal, algic, neuro-vegetative. Lemke's vegetative depression is characterized by periodic insomnia, periodic asthenia, periodic headaches, pain or senestopathies (see) in various parts of the body, periodic hypochondriacal states, phobias.

All the varieties of D. s. described above. are found in various mental illnesses, without differing in strict specificity. We can only talk about the preference of certain types of D. s. For certain type psychosis. Thus, neuroses, psychopathy, cyclothymia, and some types of somatogenic psychoses are characterized by shallow D.s., occurring either in the form of simple cyclothyme-like depression, depression with tearfulness, asthenia, or with a predominance of somatovegetative disorders, obsessions, phobias, or mildly expressed depersonalizations. derealization disorders.

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

In schizophrenia (see) the range of varieties of D. s. the widest range - from the mildest to the most severe and complex forms; as a rule, atypical forms are found when adynamia comes to the fore with a general decrease in all impulses or a feeling of hostility and a gloomy, angry mood prevails. In other cases, depression with catatonic disorders comes to the fore. Complex D. is often noted. with delusions of persecution, poisoning, influence, hallucinations, mental automatism syndrome. To a large extent, the characteristics of depression depend on the nature and degree of personality changes, on the characteristics of the entire clinical picture of the schizophrenic process, and the depth of its disorders.

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

Reactive (psychogenic) depression occurs as a result of mental trauma. Unlike D. with., with MDP here the main content of depression is filled with a psychoreactive situation, with the elimination of the cut the depression usually goes away; there are no ideas of primary guilt; Ideas of persecution and hysterical disorders are possible. In a protracted reactive situation, D. s. may be protracted with a tendency to its vitalization, to a weakening of reactive experiences. It is necessary to distinguish reactive depression from psychogenically provoked depression 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 the attack with the subsequent predominance of symptoms of the underlying disease.

More and more attention is being paid to depression, which occupies an intermediate position between the so-called. endogenous, main forms found in MDP and schizophrenia, and reactive depression. This includes Weitbrecht's endoreactive dysthymia, Kielholz's wasting depression, background depression and Schneider's soil depression. Although this entire group of depressions is characterized by common features, caused by a combination of endogenous and reactive features, distinguish separate wedges and forms.

Weitbrecht's endoreactive dysthymia is characterized by the interweaving of endogenous and reactive aspects, the predominance in the clinic of senestopathies with astheno-hypochondriacal disorders, gloomy, irritable-dissatisfied or tearful-dysphoric mood, often with a vital character, but with the absence of primary ideas of guilt. A slight reflection of psychoreactive moments in the clinic distinguishes endoreactive dysthymia from reactive depression; Unlike MDP, with endoreactive dysthymia there is no manic and truly depressive phase, and there is a weak hereditary burden of affective psychoses in the family. In premorbid individuals, sensitive, emotionally labile, irritable, and somewhat gloomy individuals predominate.

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

Depressions of the background and soil of Schneider, as well as Weitbrecht's dysthymia, are characterized by the occurrence of affective phases in connection with provoking somatoreactive factors, but without their reflection in the clinic of D. s. Unlike D. s., with MDP there is no vital component, as well as no psychomotor retardation or agitation, as well as depressive delusions.

With symptomatic depression caused by various somatogenic or cerebral-organic factors, the clinic is different - from shallow asthenodepressive states to severe depression, either with a predominance of fear and anxiety, for example, with cardiac psychoses, or with a predominance of lethargy, lethargy or adynamia with apathy in prolonged somatogenic , endocrine diseases or organic diseases of the brain, then gloomy, “dysphoric” depression in certain types of cerebral-organic pathology.

Etiology and pathogenesis

In the etiopathogenesis of D. s. great importance is attached to the pathology of the thalamohypothalamic region of the brain involving the cerebral cortex and endocrine system. Delay (J. Delay, 1953) observed changes in affect during pneumoencephalography. Ya. A. Ratner (1931), V. P. Osipov (1933), R. Ya. Golant (1945), as well as 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. increasing the tone of the sympathetic part c. n. With. I.P. Pavlov believed that the basis of depression is a decrease in brain activity due to the development of extreme inhibition with extreme depletion of the subcortex and suppression of all instincts.

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

Japanese authors Suwa, Yamashita (N. Suwa, J. Jamashita, 1972) associate the 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) is of great importance in the pathogenesis of D. s. causes disorder in the activity of the reticular formation.

In the mechanism of affective disorders important role Disturbances in the metabolism of monoamines (catecholamines and indolamines) are also considered. It is believed that for D. s. characterized by functional failure of the brain.

Diagnosis

Diagnosis D. s. placed on the basis of identification characteristic features in the form of decreased mood, psychomotor and intellectual retardation. The last two signs are less stable and show significant variability depending on the nozol, the form within which depression develops, as well as on premorbid characteristics, the age of the patient, the nature and degree of personality changes.

Differential diagnosis

In some cases D. s. may be similar to dysphoria, asthenic state, apathetic or catatonic syndromes. Unlike dysphoria (see), with D. s. there is no such pronounced angry intense affect with a tendency to affective outbursts and destructive actions; with D. s. with a dysphoric tinge, there is a more pronounced decrease in mood with sadness, the presence of a circadian rhythm in the intensity of disorders, improvement or complete recovery from this state after therapy with antidepressants. In asthenic conditions (see Asthenic syndrome), increased fatigue in combination with hyperesthesia comes to the fore, irritable weakness, with 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.

Unlike 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 has a hard time experiencing indifference. With D. s. with abulic disorders, in contrast to apathetic states in schizophrenia (see), these disorders are not so pronounced. Developing within the framework of dynamic processes, they are not of a permanent, irreversible nature, but are subject to daily fluctuations and cyclicity in development; with depressive stupor, in contrast to lucid (pure) catatonia (see Catatonic syndrome), patients have severe experiences of a depressive nature, there is severe psychomotor retardation, and catatonic stupor is characterized by a significant increase in muscle tone.

Treatment

Antidepressant therapy is gradually replacing other treatment methods. The choice of antidepressant largely depends on the form of D. s. There are three groups of antidepressant drugs: 1) mainly with a psychostimulating effect - nialamide (nuredal, niamid); 2) with wide range actions with a predominance of thymoleptic effect - imizin (imipramine, melipramine, tofranil), etc.; 3) mainly with a sedative-thymoleptic or sedative effect - amitriptyline (tryptisol), chlorprothixene, melleril (sonapax), levomepromazine (tizercin, nozinan), etc.

For depression with a predominance of psychomotor retardation without a pronounced affect of melancholy, as well as for adynamic depression with a decrease in volitional and mental activity, drugs with a stimulating effect are indicated (drugs of the first group); for depression with a predominant feeling of melancholy, vital components, and motor and intellectual retardation, drugs of the second (sometimes first) group are indicated; for anxious depression, depression with irritability, tearfulness and grumpiness without severe psychomotor retardation, therapy with drugs with a sedative-thymoleptic or sedative tranquilizing effect is indicated (drugs of the third group). For anxious patients, prescribe antidepressants with psychostimulating effect dangerous - they cause not only increased anxiety, the emergence of depressive agitation with suicidal tendencies, but also an exacerbation of psychosis in general, an intensification or appearance of delusions and hallucinations. With complex D. s. (depressive-paranoid, depression with delusions, hallucinations, Kandinsky syndrome) a combination of antidepressants with antipsychotics is necessary. Almost all antidepressants have side effect(tremor, dry mouth, tachycardia, dizziness, urination problems, orthostatic hypotension, sometimes hypertensive crises, transition from depression to mania, exacerbation of schizophrenic symptoms, etc.). When increasing intraocular pressure It is dangerous to prescribe amitriptyline.

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

Both in clinical and outpatient settings, all higher value therapy with lithium salts is acquired, which have the ability not only to affect affective disorders during the depression phase, but also to prevent or delay the appearance of a new attack and reduce its intensity.

Forecast

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

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 psychoses, the possibility of repetition of 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 general clinical features of depression late age, Zhurn, neuropath, and psychiat., vol. 70, v. 9, p. 1356, 1970, bibliogr.; Sternberg E. Ya. and Shumsky N. G. About some forms of depression in old age, in the same place, vol. 59, century. 11, p. 1291, 1959; Das depressive syndrome, hrsg. v. H. Hip-pius 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 Ver-sagenzustande 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 the book: 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 with h t H. J. Depressive und manische endogene Psychosen, in the book: Psychiatrie d. Gegenwart, hrsg. v. H. W. Gruhle u. a., Bd 2, S. 73, B., 1960, Bibliogr.; aka, Affective Psychosen, Schweiz. Arch. Neurol. Psychiat., Bd 73, S. 379, 1954.

V. M. Shamanina.

— mental illness, manifested not only by mental but also physical symptoms. In everyday life, depression is called melancholy and lack of desire to act actively. But it's not the same thing. Depression is serious and demanding special treatment pathology. Its consequences may be irreparable.

Manic-depressive syndrome

Depression has its own specific course in different individuals. When making a diagnosis of depressive syndrome, a doctor must determine its type. With manic-depressive syndrome, two phases alternate (as the name implies). The intervals between them are called periods of enlightenment. manic phase characterized by the following manifestations:

• acceleration of thought
• excessive use of gestures
• psychomotor stimulation
• energy that may not be inherent to this person during periods of enlightenment
• good mood, even indicatively good

This phase is characterized by frequent laughter of the patient, he is without apparent reason in high spirits, enters into communication with others, talking a lot. In this phase, he can suddenly become confident in his own exclusivity and genius. In many cases, patients imagine themselves as talented actors or poets.

After this phase, mania begins with the opposite clinic:

• melancholy and
• depression for no reason
• slow thought
• movements are constrained, insignificant

Manias last less time than phases of depressive syndrome. This can be either 2-3 days or 3-4 months. Often, with this type of depression, a person is aware of the state he is in, but cannot cope with the pathological symptoms himself.

Astheno-depressive syndrome

This is a mental disorder, the main manifestations of which are:

• slow flow of thought
• slow speech
• slow movements, gestures
• increasing anxiety
• rapid onset fatigue
• weakness in the body

The reasons can be of two groups:

• internal
• external

The first of these groups includes patholia in emotional sphere and stress of various natures. External reasons diseases appear:

• pathologies of the heart and blood vessels
• infection
• received injuries
• surgery that was difficult
• oncology (tumors)

In patients at puberty and at a young age, this depressive syndrome can be very negative. The following symptoms are added:

• protests for no reason
• increased irritability
• manifestations of anger in speech and behavior
• rudeness towards others, even the closest people
• constant tantrums

When an illness lasts a long time and does not go away, then a person may feel guilty about what is happening to him (and that he cannot recover through his own efforts). Then he begins to assess his condition extremely gloomily, gets angry at the world and evaluates it negatively.

Astheno-depressive syndrome has a direct impact on a person’s physical well-being:

• decreased libido
• violation of the cycle of critical days
• sleep disorder
• decreased or lack of appetite
• digestive diseases, etc.

It is worth knowing that with this type of depressive syndrome, a person feels better when he is well rested, or when he eliminates somatic symptoms diseases. Treatment is selected depending on how severe the pathology is in a particular case. Sometimes just a session with a psychotherapist is enough. But when severe course This type of depression requires a course of psychotherapy in combination with sedatives and antidepressants.

Anxiety-depressive syndrome

As in previous cases, the features of this type of depression can be understood from the name itself. This is characterized by a combination of anxiety and panic fears. These manifestations are characteristic mainly of adolescents, so it is not surprising that anxiety-depressive syndrome is most often diagnosed in people in puberty. The reasons are the inferiority complex, vulnerability and excessive emotionality characteristic of this stage of personality development.

Manifestations of this type consist of painful various fears that develop into phobias. Often teenagers with this syndrome are very afraid of punishment, both for actions done and for actions not committed. They are afraid of punishment for their lack of intelligence, talent, skills, etc.

A person can no longer objectively evaluate the world, his personality with all its characteristics and roles, and the situations happening to him. He sees everything in the darkest tones and perceives it with a great deal of hostility. The formation of persecution mania is quite likely. Patients in such cases think that someone (most people or everyone) conspired to frame, deceive, hurt, etc.

With persecution mania, a person may begin to think that there are enemy agents around, monitoring the patient’s actions. A person becomes suspicious (even towards the closest people), and is characterized by excessive suspiciousness. The patient’s energy is spent on confronting the world and those elements that he himself invented. He begins to go into hiding and take other actions to “protect himself from the agents.” To recover from anxiety-depressive syndrome (and persecutory mania), you need to consult an experienced psychotherapist or psychiatrist. He can also appoint sedatives, if he sees a need for them for a particular patient.

Depressive Personalities

Depressive individuals are characterized by:

• pessimism (very rarely - skepticism)
• suppressed actions
• slow action
• restraint
• quietness
• small expectations from life in your favor
• lack of desire to talk about oneself
• hiding your life

Depressive individuals may hide their character traits with poise. Separately, they consider gloomy and depressive individuals who, in addition to a depressed state and a negative outlook on the world, exhibit the following characteristics:

• sarcasm
• grumpiness with or without reason
• grumpiness

A depressed person is not the same as a person with depressive psychosis. Depressive reactions are also not synonymous this concept. The same disorders from the point of view of symptoms are depressive character neuroses and depressive personality structure. The difference between depressive neurosis is the presence of various mood disorders, a clear characteristic symptoms it cannot be described.

The personality becomes depressed due to the predisposition and characteristics of the relationship between the child and parents. A strong attachment to the mother is required (with ambivalence), which leads to the fact that the child cannot act independently and solve his problems. The child is afraid of losing affection. He has problems with self-determination. The formation of a depressed personality is influenced by the deterioration of relationships with herself and her father, conflicts with other close people, and terrible life situations.

Treatment involves:

• crowding out
• formation of independence
• elaboration of the topic of negative transference

Depressive-paranoid syndromes

Levels of depression (classical development):

• cyclomatic
• hypothymic
• melancholic
• depressive-paranoid

When depression stops in its development at any of the above stages, the following type of depression is formed:

• cyclothymic
• subsyndromal
• melancholic
• delusional

In the cyclomatic stage the patient becomes unsure of himself, has a low assessment of his appearance/professional qualities/personal qualities, etc. He doesn't enjoy life. Interests are lost, the person becomes passive. At this stage there are no:

• psychomotor retardation
• anxiety
• affect of melancholy
• ideas of self-accusation
• thoughts of committing suicide

What is typical for this stage:

• asthenic phenomena
• sleep problems
• decreased sexual desire

Next,hypothymic stage, is special in that a melancholy affect appears, moderately expressed. The patient complains that he is hopeless; the person becomes dull and sad. He says that there is a stone on his soul, that he means nothing to this world, that life has no purpose, and that he has wasted his time for many years. He sees everything as difficulties. The patient begins to think about how exactly he can commit suicide, and whether it is worth doing it. Close people and a psychotherapist at this stage can convince a person that in reality everything is not as it seems to him.

The patient's condition at this stage is better in the evenings. He is capable of labor activity and team interactions. But these actions require the patient to activate his willpower. Their thought process slows down. The patient may complain that his memory Lately got worse. The patient's movements may be slow for some time, and then a period of fussiness begins.

The hypothymic stage is characterized by the typical appearance of patients:

• pained expression
• person deprived of life
• drooping corners of the mouth
• dullness of sight
• uneven back
• shuffling gait
• monotonous and raspy voice
• periodic sweat on the forehead
• the man looks older than his age

Autonomic symptoms appear: loss of appetite (as in the previous stage), constipation, lack of sleep at night. The disorder at this stage acquires a depersonalization, apathetic, anxious or melancholy character.

Melancholic stage of depression characterized by painful suffering of the patient, his mental pain borders on physical pain. The stage is characterized by obvious psychomotor retardation. A person can no longer conduct a dialogue with someone; answers to questions become meek and monosyllabic. The person does not want to go anywhere, does nothing, just lies for most of the day. Depression becomes monotonous. Features of appearance characteristic of this stage:

• dry mucous membranes
• frozen face
• a voice devoid of emotion and many intonations
• hunched back
• minimal number of movements, almost complete absence of gestures

A person is thinking about suicide and trying to realize his plans for such an outcome. The patient may develop melancholic raptus. The man begins to rush back and forth around the room, wrings his hands, and tries to commit suicide. Overvalued ideas of low value are replaced by crazy ideas self-deprecation.

A person negatively evaluates his actions and actions in the past. He believes that he did not fulfill his family and professional responsibilities. And it is no longer possible to convince them of the opposite. The patient lacks the ability to think critically; he cannot look at things and his personality objectively.

Delusional stage of depression has 3 stages. The first is characterized by delusions of self-blame, the second by delusions of sinfulness, the third by delusions of denial and enormity (at the same time catatonic symptoms develop. The ideas of self-blame are that a person blames himself for everything that happens in the world, with his relatives and children.

Gradually paranoid clinic develops, based on the following fears:

• get sick and die
• commit a crime and be punished for it
• impoverish

When a person begins to blame himself even more, he begins to have false recognitions, ideas of the special significance of what is happening. A little later, some catatonic manifestations, verbal hallucinations, and illusory hallucinosis appear.

A person in a hospital at this stage of the development of the disease begins to believe in many cases that he has been placed in prison. He mistakes the orderlies for guards. It seems to him that everyone around him is secretly watching him and whispering. No matter what people around him talk about, he thinks they are discussing his future punishment/revenge. He may consider as his crime even small mistakes in the past, which in fact are not violations of the law or even any rules established in society.

The paraphrenic stage, which follows the one described above, is characterized by the patient blaming himself for all the sins and crimes that exist in the world. They think that very soon there will be a war all over the world and the end of the world is near. Patients believe that their torment will be eternal when they are left alone after the war. The formation of delusions of possession is likely (the person believes that he has been reincarnated as the devil, symbolizing world evil).

In some cases, at this stage of depression, the so-called Cotard’s nihilistic delirium is formed. At the same time, the person feels that they smell of rotting flesh, that everything inside them has begun to disintegrate, or that their body does not exist. Catatonic symptoms are likely to follow.

The depressive-paranoid syndromes described above (which are part of the disease of depression) are formed according to a certain indicated image. They are different from delusional psychoses which may be a consequence/manifestation of depression.

Depressive syndromes(lat. depressio depression, oppression; synonym: depression, melancholy) - psychopathological conditions characterized by a combination of depressed mood, decreased mental and motor activity (the so-called depressive triad) with somatic, primarily vegetative, disorders. They are common psychopathological disorders, second only to asthenia in frequency (see. Asthenic syndrome ). Approximately 10% of those suffering from D. s. commits suicide.

In some cases, stuporous symptoms occur—distinct movement disorders reaching the intensity of substupor and, occasionally, stupor. Characteristic appearance such patients: they are inactive, silent, inactive, and do not change positions for a long time. The facial expression is mournful. Eyes are dry and inflamed. If patients are asked a question (often repeated several times), they answer in monosyllables, after a pause, in a quiet, barely audible voice.

Symptoms of depression (in mild cases and less often in severe cases) are especially intense in the morning; in the afternoon or evening, the condition of patients, both objectively and subjectively, can improve significantly (recovery by five o'clock in the afternoon, as French psychiatrists put it).

There is a large number of depressions in which there is primarily a lack of motor, and less often, speech inhibition. They are called mixed depression - a depressed or melancholy mood is accompanied by speech and motor excitement (agitation). At the same time, depressive affect also changes; usually it is complicated by anxiety, less often by fear (anxious-agitated or agitated depression with fear). In this state, patients are haunted by painful premonitions of impending misfortune or catastrophe. In some cases, anxiety is pointless, in others it is specific (arrest, trial, death of loved ones, etc.). The patients are extremely tense. They cannot sit or lie down, they are constantly “tempted” to move. Anxious agitation with motor agitation very often manifests itself in the incessant appeals of patients to the staff with the same requests. Speech excitement, as a rule, is manifested by groans, groans, and monotonous repetition of the same words or phrases: “scary, scary; I ruined my husband; destroy me”, etc. (the so-called alarming verbigeration). Anxious agitation can give way to melancholic raptus - a short-term, often “silent” frantic excitement with the desire to kill or mutilate oneself. Anxiety-agitated depression may be accompanied by depressive delusions of various contents. They most often cause Cotard's syndrome - fantastic nonsense enormity and denial.

Denial can extend to universal human qualities - moral, intellectual, physical (for example, there is no conscience, knowledge, stomach, lungs, heart); to the phenomena of the external world (everything is dead, the planet has cooled down, there are no stars, no Universe, etc.). Nihilistic or hypochondriacal-nihilistic delirium is possible. With delusions of self-blame, patients identify themselves with negative historical or mythical characters (for example, Hitler, Cain, Judas). Incredible forms of retribution for what was done are listed, including immortality with eternal torment. Cotard's syndrome in its most pronounced form appears in adulthood and old age. Some of its components, for example, the idea of ​​universal destruction, can arise at a young age.

Depression is also complicated by the addition of various psychopathological disorders: obsessions, overvalued ideas, delusions, hallucinations, mental automatisms, catatonic symptoms. Depression can be combined with shallow manifestations of psychoorganic syndrome (so-called organic depression).

A special version of D. s. are latent depression (synonym: vegetative, without depression, masked, somatized, etc.). In these cases, subdepression is combined with pronounced, and often dominant, vegetative-somatic disorders in the clinical picture. Hidden depression, which occurs almost exclusively in outpatient practice, exceeds ordinary depression in frequency by 10-20 times (according to T.F. Papadopoulos and I.V. Pavlova). Initially, such patients are treated by doctors of various specialties, and if they go to a psychiatrist, it is usually a year or several years after the onset of the disease. The symptoms of latent depression are varied. Most often, they occur with disorders of the cardiovascular system (short-term, long-term, often in the form of paroxysms, pain in the heart area, radiating, as happens with angina, various disorders rhythm of cardiac activity up to seizures atrial fibrillation, fluctuations in blood pressure) and digestive organs (decreased appetite up to anorexia, diarrhea, flatulence, pain along the way gastrointestinal tract, attacks of nausea and vomiting). Unpleasant pain in various parts of the body is often observed: paresthesia, migrating or localized pain (for example, characteristic of lumbago, toothache, headache). There are disorders resembling bronchial asthma and diencephalic paroxysms, and very often various sleep disorders. Autonomic-somatic disorders observed in latent depression are called depressive equivalents. Their number is increasing. Comparison of the symptoms of latent depression with the onset of a wide variety of D. s. reveals certain similarities between them. And ordinary D. s. often begin with somatic disorders. With hidden x long time(3-5 years or more) there is no deepening of affective disorders. Hidden depression, like depressive syndromes, is characterized by periodicity and even seasonality of occurrence. The mental conditionality of somatic pathology with hidden diseases is also evidenced by their successful treatment antidepressants.

Depressive syndromes occur in all mental illnesses. In some cases they are their only manifestation (for example, schizophrenia,

manic-depressive a), in others - one of its manifestations (epilepsy, traumatic and vascular lesions of the brain, brain tumors, etc.).

The diagnosis is made based on clinical picture. In elderly people it is often carried out differential diagnosis With psychoorganic syndrome.

Mild forms of depression are treated on an outpatient basis, severe and severe forms are treated in a psychiatric hospital. Antidepressants and tranquilizers are prescribed. With the complication of D. s. neuroleptics are added to delusional, hallucinatory and other deeper psychopathological disorders. For anxiety-agitated diseases, especially those accompanied by deterioration of the somatic condition, as well as for diseases with a long-term adynamic component, it is indicated electroconvulsive therapy. For the treatment and prevention of some D. s. lithium salts are used (see Affective insanity ). Due to the possibility of treatment, severe D. s., for example, with Cotard's delirium, are extremely rare; Mostly they occur in undeveloped forms. "Shift" D. s. towards subdepression is an indication for mandatory use, especially in outpatient treatment, psychotherapy, the form of which is determined by the structure of the d. and the personality of the sick person.

The prognosis depends on the development of D. s., which can be paroxysmal or phasic, i.e. The disease occurs with remissions and intermissions. The duration of attacks or phases ranges from several days to 1 year or more. An attack or phase can be single throughout life or repeated, for example annually. With multiple attacks or phases of D. s. often occur at the same time of year. Such seasonality, other things being equal, is favorable factor, because allows you to begin treatment before the onset of painful disorders and thereby smooth out the intensity of the manifestation of depressive syndrome. In old age D. s. often have a chronic course. Therefore, in these patients, the issue of prognosis should be addressed with caution. D. syndromes that can lead to death, for example, malignant presenile melancholia, have practically disappeared (see. Presenile s ). The main danger of D. s. lies in the possibility of suicide attempts by patients. More often they tend to commit suicide at the beginning of development and with a pronounced reduction in depressive disorders. Therefore, it is not recommended to discharge such patients prematurely; it is better to “overstay” them in the hospital. In a hospital setting, suicide attempts are typical for patients with agitation, anxiety and fear.

Bibliography: Anufriev A.K. Hidden endogenous depression. Message 2. Clinical systematics, Journal. neuropath. and psychiat., vol. 78, no. 8, p. 1202, 1978, bibliogr.; Vovin R.Ya. and Aksenova I.O. Protracted depressive states, L., 1982, bibliogr.; Depression (psychopathology, pathogenesis), ed. O.P. Vertogradova, s. 9, M., 1980; Nuller Yu.L. Depression and depersonalization, L., 1981, bibliogr.; Nuller Yu.L. and Mikhalenko I.N. Affective s, L., 1988, bibliogr.