The group of psychogenic depression also includes depressive reactions in patients with neurological and somatic diseases caused by a number of psychological, social, personal, biological factors, including the objective features of a somatic disease.
The frequency of psychogenias of this type in the general medical network is quite high. Among the psychological, as well as social influences that contribute to the occurrence of depressive reactions, the patient’s attitude to his own disease plays a primary role – the high subjective significance of somatic suffering. There are short-term and prolonged reactions to the disease.
Short-term reactions are more often associated with the psycho-traumatic effect of hospitalization (fear of unfamiliar surroundings, separation from loved ones) and begin with relatively mild manifestations of depressed mood, transient anxiety with concern for their health, combined with a tendency to dramatize the situation, a feeling of helplessness, their own helplessness in the face of somatic suffering. Short-term depressive reactions often do without treatment, and their reverse development occurs as the manifestations of the disease of the internal organs disappear and the ability to work is restored. Prolonged depressive reactions (their duration can exceed 6-12 months) are usually associated with the psycho-traumatic effect of a prolonged illness (often recurring subjectively severe symptoms, repeated hospitalizations with prolonged treatment, painful procedures, accompanied by side effects, disability, reduced quality of life) . The “soil” for the formation of protracted depressive reactions may be the personality characteristics of patients with an emphasis on the sphere of body consciousness, the predominance of features of anxious suspiciousness, and a tendency to hysterical reactions. According to scientists, among the factors contributing to the protracted course of such depressions, there may be associated mental diseases (schizophrenia, organic lesions of the central nervous system, etc.), as well as reactive states, the manifestation of which is not associated with a somatic disease.
Prolonged depression manifests itself more pronounced mood disorders. Their clinical picture most often corresponds to hypochondriac depression and includes various fears with obsessive thoughts about a somatic disease or memories of surgery. There is also an increased vulnerability with ideas of physical inferiority associated with damage to internal organs. Patients reproach themselves for causing helplessness to their family and medical personnel with their helplessness and are a burden for them.
Prolonged depression is more common in patients with severe, life-threatening or disability somatic diseases. Such depressions are detected in more than 1/3 of patients after myocardial infarction, those suffering from cancer (lung cancer, pancreatic cancer), systemic connective tissue diseases, as well as in patients with primary tuberculosis.
In patients with a chronic course of somatic disease, depressive neurotic states often turn into neurotic personality development, mainly of the hypochondriac and depressive types. Deformation of the personality structure due to its neurotic development persists in cases of somatic recovery. Psychological depressions in somatic patients are mainly characterized by anxiety-depressive type of experiencing the disease. This contributes to the formation of a specific, colored depressive inclusions of the “inner picture of the disease”, that is, a complex of ideas and emotional experiences associated with the sensation and awareness of painful changes, as well as with the understanding of the social consequences of the disease.