According to scientists, according to the binary typological model of depression, its psychopathological manifestations can be divided into positive and negative group of symptoms. Depending on the prevalence of a particular symptom, emit typical and atypical depression. The typical form is usually manifested by melancholy with gratuitous pessimism, despondency and depression. Pathological changes in mood that are not reducible to polar phase disorders — depressive and manic — can coexist simultaneously. The clinical picture of such conditions is characterized by the replacement of one or more elements of mania with signs of depression and vice versa. For example, arousal for depression or limitation of motor activity in a manic state.
Pathological changes in mood that are not reducible to polar phase disorders — depressive and manic — can coexist simultaneously. The clinical picture of such conditions is characterized by the replacement of one or more elements of mania with signs of depression and vice versa. For example, arousal for depression or limitation of motor activity in a manic state. It is noted in the literature that mixed states are observed in cases where the temperament as the basis of psychopathological disorder in polarity does not correspond to the current affective phase (for example, with the manifestation of depression against the background of hyperthymic temperament, the formation of excited, agitated depression is possible). Aggressiveness and hostility in depression are interrelated with anxiety and premorbid personality traits (suspicion, rigidity, irritability, hysteria, demonstrativeness).
Blurred forms are more often considered as part of atypical depressions. We are talking about syndromes that do not reach full psychopathic completeness, in which the main manifestations characteristic of depression (hypothymia proper, psychomotor disorders, ideas of guilt, etc.) are poorly expressed, some of them are completely absent (“subsyndromic depression”) (Junior R. et al., 2000). In other cases, the actual affective disorders recede into the background and are often not recognized, because the leading position in the clinical picture is occupied by syndromes that go beyond the limits of psychopathological disorders of affective registers.
According to A. B. Smulevich (2002), there are various options for atypical depression. In group A, depressions are formed by modifying the psychopathological manifestations of affective disorders (apathetic, asthenic, anesthetic, depersonalizing, adynamic, depressed with the exclusion of somatic sensations). In group B1, depressions are formed by accentuating one of the obligate components of affective syndrome (anxious, hypochondriacal, “self-ejaculating”); in group B2, depressions are formed due to the addition of psychopathological manifestations of non-affective registers (depression with obsession, delirium, hysterical depression) (Broytigam V. et al., 1999). An example of a mixed state are complaints of depression, intolerable heaviness in the chest, tension in the head, lack of appetite. These complaints are expressed with an unusual expression: a loud voice, with lively facial expressions and gestures. Instead of braking thoughts, they are flooded (depression “with a surge of ideas”), talkativeness, movement with anxiety, agitation. The prevalent affect is dysphoria with flashes of irritability, less often anger Frequent claims to others, conflict. With the dominance of the ideas of guilt and their own failure in this category of patients suicidal attempts are possible.
Symptoms of “mixed depressive state” may include: dysphoria with anger and agitation, agitation with psychomotor anxiety, excessive fatigue, recurrent anxiety with panic attacks, subjectively sexual agitation, persistent insomnia, hysterical expression, obsessive suicidal thoughts and impulses, persistent insomnia, hysterical expression, obsessive suicidal thoughts and impulsive inspiration, persistent insomnia, hysterical expression, obsessive suicidal thoughts and impulsive inspiration, persistent insomnia, hysterical expression, obsessive suicidal thoughts and impulsive inspiration, persistent insomnia, hysterical expression, obsessive suicidal thoughts and impulsive motivation.