Depression classification

Unlike past notions of depression as a triad of symptoms characterized by low mood, slow thinking, and retardation of movements, the diagnostic criteria for modern classification systems (ICD-10 and DSM-IV) include a fairly large range of symptoms related to psychiatry, neurology, therapy and psychology.

At present, it is not recommended to contrast reactive or psychogenic depression with its endogenous forms, since the term “endogenous depression”, despite its long history, is rather contradictory. Usually, this phrase refers to depressive states that develop on a constitutional basis, for which organic etiology or a relationship with severe psychological stress cannot be determined. Sometimes the term “endogenous depression” is used in a descriptive sense — to define a depressive syndrome characterized by low mood, lack of susceptibility to external stimuli, tendency to cyclical state fluctuations during the day, inhibition, sleep disturbance (usually with early awakenings), and lack of energy. In some cases, endogenous depression has the so-called. vital manifestations. For physical depression, almost physical, precisely localized physical suffering is characteristic (more often in the chest area). At present, due to insufficient accuracy, the psychoanalytic term “depressive neurosis” (characterologic depression) is not used. This concept has many meanings that do not correlate with the main provisions of psychoanalysis. The diagnosis of “depressive neurosis” (F34.1) was made in the absence of signs of endogenous depression, a causal relationship with a stressful event or situation, as well as manifestations of personality disorder. As you can see, it is difficult to find a set of clinical manifestations that meet these criteria.

According to the international classification of diseases (ICD-10), various types of depression are distinguished. The most common depressive episode (major depression) is less common – bipolar depression.

The core of the classification of disorders of the depressive spectrum is the concept of a depressive episode (F32) – a disorder (painful condition), which manifests itself as signs of depression.

A depressive episode (a single episode of a depressive reaction, psychogenic depression, reactive depression), depending on the number of symptoms and their severity, can be mild, moderate or severe. Mild depression is quite difficult to distinguish from sadness, especially if the mood fluctuates during the day. In case of depression of moderate severity, the presence of several symptoms no longer allows a person to show the usual activity for him. Severe episode (clinically severe depression), in turn, is subdivided on the basis of the presence or absence of symptoms of psychosis, congruent or not congruent to mood. When depression with signs of psychosis, occurring in 15% of patients, there are delusions and hallucinations.

A depressive state may be part of affective bipolar disorder (F31) (previously, manic-depressive psychosis), characterized by two or more episodes of mood and activity disorders. In some cases, these disorders are manifested by elevation of mood, a special feeling of joy, self-confidence, and sometimes – vigor, irritability (apparently, depending on the characteristics of a person’s personality, the appearance of a particular form of depression – manic) is possible; may be accompanied by inadequate behavior, cause irresponsible actions (waste of money, conclusion of unnecessary contracts, purchase of goods on credit, promiscuous sex, etc.), in others – a decrease in mood and activity, reminiscent of typical options for depression.

Rare forms of bipolar disorder are considered to be accelerated circular disorder (according to the American DSM-IV classification – four or more mood phase changes during the year), mania with manifestations of dysphoria (“gloomy mania”) and a mixed state (frozen combination of depression and mania). It should be noted that accelerated circular disorder may be a consequence of chronically flowing hypothyroidism. Some researchers refer to bipolar disorder and cyclotymy.

Perhaps more often than bipolar, recurrent depressive disorder (F33) occurs – repeated depressive episodes (depressive reaction, psychogenic depression, reactive depression, seasonal depressive disorder). Severe forms of recurrent depressive disorder correspond to such previously used terms as the depressive type of manic-depressive psychosis (melancholia).

When classifying depression, they also secrete chronic mood disorders or persistent mood disorders: dysthymia and cyclotymy.

Dysthymia (F34.1) is characterized by chronic depression of mood for several years, the severity or duration of episodes of which are not sufficient for the diagnosis of recurrent disorder.

Cyclothymia, usually occurring between the ages of 15 and 25, is a more prolonged, “mild” form of bipolar depression, in which mood changes constantly from mild mania to mild depression and vice versa. With cyclothymia, seizures are short (several days) and irregular.

Other mood fluctuations (mixed affective episode) and adaptation disorders (short-term depressive reaction, prolonged depressive reaction, mixed anxiety and depressive reaction) also belong to disorders of the depressive spectrum; depressive behavior disorder (F92.0), starting in childhood or adolescence. Many conditions that could previously have been classified within the framework of neurotic depression, when using the ICD-10 classification criteria, are placed under the heading of neurotic disorders.

According to domestic researchers, this trend narrows the possibility of studying the depression of the neurotic register. Domestic taxonomy of depressive spectrum disorders was traditionally based on the classification of diseases (nosological classification). In this case, differentiation was carried out within the framework of the classical etiological and clinical dichotomy, which determines the endogenous (internal) or exogenous (external) character of affective disorders. The endogenous form is usually attributed to depression in schizophrenia, circular (bipolar), intermittent, (recurrent, monopolar) and involutional depression. The psychogenic form included neurotic, reactive, and asthenic (exhaustion, exhaustive) depression. The intermediate place between endogenous and psychogenic depression was occupied by the so-called. endoreactive dysthymia – prolonged depressive states, at the first stages of which the main role was played by psycho-traumatic factors, at the subsequent stages – internal (endogenous). Somatogenic depressions caused by exogenous-organic factors and including organic (vascular, senile, post-traumatic, epileptic, etc.) and symptomatic depressions (infectious, toxic, caused by internal diseases, etc.) were also distinguished.

Scientists have identified a large number of different types of depression: anesthetic depression or “participation poverty depression” with signs of mental anesthesia, painful insensitivity; depression with delusions of charge; anxious depression with motor agitation and accelerated speech; adynamic or inhibited depression; depression with symptoms of dysphoria or “grim, sullen depression”; tearful depression with increased fatigue and hysterical symptoms; ironic depression (“smiling depression” is characterized by irony, sarcasm about one’s position, expressing deep disappointment and loss of the basic values ​​of life); apathetic depression; depression with derealization and depersonalization (a feeling of deep inner self-change, experiencing the illusion of the external world); psychasthenic depression, which includes various obsessive states; Hypochondriac depression with complaints of various pains and constant malaise. In accordance with the clinical features of the depressive syndrome, the author later singled out a simple (melancholic, anxious, apathetic) and complex (depressed with delusions) version of depression.

Depressive states are often found in various mental disorders (comorbid, parallel, combined depression): in neurotic conditions (especially protracted), stress-related disorders (reactive, psychogenic depression), in manic-depressive psychosis, schizophrenia, involutional psychosis, epilepsy , symptomatic and intoxication psychosis, as well as organic brain diseases (including depressive states caused by vascular disorders), depression alcoholism and drug addiction.

Most patients with a depressive disorder have at least one more mental illness. Therefore, the question of the nosological independence of depression is quite controversial, its more accurate description at the syndrome level, which meets the requirements of the modern classification of mental disorders.

local_offerevent_note February 20, 2019

account_box admin

Leave a Reply

Your email address will not be published. Required fields are marked *