According to K. Schneider (1932), obligate symptoms and facultative manifestations can be distinguished in the depressive state, and neuro-psychopathic-like manifestations, overvalued and delusional formations should be referred to the latter. A.B. Smulevich et al. (1970) suggests that additional symptoms are a marginal manifestation of depression, are characterized by marked lability and dynamic signs, and introduce a certain disharmony in the psychopathological structure of the depressive syndrome.
It should be borne in mind that reduced mood can be an integral part of more complex syndromes: depressive paranoid, depressive hypochondriac, hysterical, depersonalization and derealization, psychasthenic depression, senesthopathic depression.
Decreased mood can be an integral part of more complex mental disorders, accompanied by fixation on unusual pain sensations with the appearance of obsessive states and hysterical behavior.
The complex depressive syndromes include depressive-delusional and depressive-paranoid syndrome. The latter includes pronounced depressive affect, delusional ideas of guilt, special significance, dramatization, condemnation, persecution and influence, delusions of damage and everyday relations, delusions of persecution and poisoning, nihilistic delusions (delusions of denial), delusions of immensity (Kotar’s syndrome) (Tiganov A . S., 1974), as well as mental automatism. Depression with symptoms of dysmorphophobia includes overvalued and delusional ideas of physical inferiority. It can be combined with hallucinations, pseudo-hallucinations in the framework of Kandinsky-Klerambo syndrome, catatonic disorders, one-ayroid stupefaction.
Complicated mental disorders also include psychotic forms of depression, which occur in 15% of cases. With a combination of depression and delusions, the latter can be of different content: delusions of guilt (sinfulness and crimes), less often hypochondriacal, delusions of physical inferiority, staging, condemnation, special significance, damage, persecution, poisoning, impact, vastness of denial (Kotar’s rant). Perhaps the appearance of auditory hallucinations of accusatory nature, less hallucinations are visual, including scenes of death and suffering.
Course of depression
Most often, depression develops slowly and imperceptibly. Not only for the patient, but also for his inner circle. At the first stage it can be manifested as irritability, a feeling of general discomfort. The feelings experienced by the patient in this period are difficult for him to put into words. Characteristics of patients often coincide with the initial manifestations of depression, therefore, many forerunners of depression are attributed to people due to the characteristics of their personality. Due to the desire of a person to find the source of their suffering, patients in a psychologically understandable way try to explain the reason for the development of the depressed state and depression. Later, a depressed person begins to realize that he is sick, but cannot understand what. As a rule, during this period depression is already firmly holding the patient and causing unbearable suffering. It is possible that at such a time a person seeks professional help from a doctor.
The duration of the onset of depression is an important diagnostic criterion. As a rule, a depressive disorder lasts at least two weeks, and a major depressive episode lasts at least 2 years. Without treatment, most patients experience a depressive episode within 6–9 months, however, 25% of patients still have residual symptoms of depression.
Some forms of recurrent depressive disorder can be attributed to short-term impairment of the depressive spectrum; postpartum depression that develops in women in the range from one week to several months; a disorder that occurs before menstruation in women in 5% of cases (depression and irritability for one to two weeks before the arrival of menstrual bleeding).
According to some researchers, clinically significant depressive disorders take a chronic course in 1/3 of cases, and the remaining patients in 70% have repeated episodes. The transition of the “major depressive episode” to the chronic form is observed in 10% of men and 20% of women. Bipolar disorders acquire a chronic course in only 1% of the population. Vegetative disorders, sleep disturbance, hypochondriacal fixation, irritability, gloominess, and interpersonal problems are characteristic of an incomplete exit from unipolar depression.
Depression has a high risk of recurrence, exacerbation, and a tendency to a chronic course. Epidemiological studies show that in 3-5% of the population their duration exceeds two years, in 12.5% more than 5 years, and patients with chronic depressions observed by a psychiatrist range from 26 to 30%. Depression often recurs in individuals who have undergone the first depressive episode up to 20 years.
According to scientists, every 5th patient has a depression that lasts until about 2 years. Before the use of antidepressants, a depressive episode usually lasts about a year. With modern treatment, a depressive episode averages about 4-6 months. However, as the disease progresses, the exacerbations become more frequent, the duration of the gap between them after 5-6 episodes is 6-9 months, followed by a tendency to more rare relapses, and leads to an average of 9 phases.
Depression usually develops slowly over several weeks. Earlier distinguished “acute melancholy” with the duration of the disease from several weeks to a year or more; “Chronic melancholia” that lasts for several years (usually the symptoms are more or less mild) and “intermittent melancholia”.