Depression in the structure of neurotic disorders

Cyclothymia – unsharply expressed mood swings. For decades, this disease was “absorbed” by neurasthenia and hysteria. Comprehensive development of the doctrine of cyclothymia belongs.

Cyclothymia is characterized by short cycles over several days, with inhibited depression being replaced by increased activity, elevated mood and irritability, and a reduced need for sleep. Bipolar tendencies with cyclothymia can manifest as ease of mood changes after taking antidepressants.

Depression is relatively common in neurotic disorders, especially those that include anxiety manifestations (general, common or generalized anxiety disorder), obsessive compulsive disorder, and post-traumatic stress disorder syndrome.

It should be noted that the term “anxiety” is collective, serving to denote a complex group of disorders that differ at the clinical and psychological levels, as well as in the effectiveness of various means and methods of therapy.

The relationship between depression and anxiety is rather complicated, and it is often difficult to isolate the primary, dominant disorder. Although its selection significantly affects the tactics of treatment.

According to some researchers, anxiety is an integral part of depression; in the opinion of others, it is an independent disorder, often combined with depression. Some authors view anxiety as a component of anxiety and depressive disorder.

Along with numerous assertions about the specificity of the symptoms of neurotic depressions, there are data that clarify these ideas, investigating the sensitivity of depression to electroconvulsive therapy, showed that a number of symptoms demonstrate a correlation with insufficient therapeutic effect, and this fact was observed in both endogenous and reactive depression.

Signals of anxiety traditionally include: intense waiting, feeling threatened, repeated anxious thoughts, irritability, difficulty concentrating, sleep disturbance, dodging behavior, signs of increased motor activity and autonomic dysfunction. Mechanisms of anxiety response of the individual are untenable, being a key element in the formation of neurotic disorders. With a high degree of anxiety, a certain inertia of psycho-physiological functions arises, caused by a decrease in their mobility due to the rigid structure of connections. This, in turn, impedes the implementation of the most effective and efficient ways to respond. It is about rigidity associated with disturbing mechanisms of perception and limiting the possibility of adaptation of a sick person.

Anxiety disorders are observed in 77% of patients with depression caused by neuroendocrine disorders, and in 26% there are paroxysmal states of the panic attack type – attacks with vegetative disturbances and the presence of stressful sensations of the surrounding world. An alarming series of symptoms in the presence of paroxysmal conditions usually includes a pronounced feeling of fear at the height of the attack and waiting for a second attack. Most often this is a specific, isolated fear, “anxiety on the heart,” with awakening in the middle of the night, and motor restlessness. In 43% of cases, in the absence of paroxysmal states, various manifestations of general anxiety disorder are identified: constant internal stress, anxious fears for the fate of loved ones, deepening hypochondriacal symptoms, unmotivated fear or anxiety, arising in response to information about a misfortune that has no direct relationship to the patient.

Many researchers have suggested viewing anxiety as one of the most universal and basic ways of responding. At present, it is believed that, as a primary response level, anxiety is almost the same as a non-specific stress response in its psycho-physiological and neurochemical reactions. There is an assumption that the appearance of an alarm indicates the inclusion of personal registers of various levels. Anxiety is often combined with severe fatigue, loss of interests.

No less important is the role of anxiety in the formation of complex mental disorders. However, the laws that appear in this case become more complex, because anxiety here acquires a certain color, and any true or imaginary threat from the outside is accompanied by its manifestations.

Anxiety disorder (including panic attacks and phobias) in more than 40% of cases is accompanied by depression. If symptoms of a pronounced depressive episode occur, even with marked signs of anxiety disorder, a diagnosis of depression is made. Especially often depression joins agoraphobia – an obsessive fear of open space and social phobia – an obsessive fear of large crowds of people.

For obsessive-compulsive disorder, characterized by the appearance of obsessive-compulsive states: thoughts, ideas, experiences, actions, and depression are characterized by a certain commonality of symptoms: guilt, low self-esteem, self-doubt, sleep disturbance, a number of asteno-vegetative disorders. According to most psychiatrists, to successfully cope with these conditions, it is necessary to have a therapeutic effect on both diseases at the same time.

In conclusion, it should be noted that the criteria for the differential diagnosis of depressive spectrum disorders (endogenous, psychogenic and symptomatic depressions) are not sufficiently developed and require special (clinical, psychopathological, clinical, psychological, clinical and biological) studies.

Despite relativity and a weak definition of the concepts “endogenous” and “psychogenic”, from the point of view of prognosis and tactics of treatment, it has always been significant to separate endogenous and psychogenic depression. However, attempts at such a hard separation were often unsuccessful. The complexity of this separation was also demonstrated by intermediate forms, for example, endoreactive dysthymia.

local_offerevent_note February 26, 2019

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