When considering the structure of affective syndromes (from lat. affectus-emotional excitement, passion) it is accepted to be guided by three main parameters:
- Pole affect-depressive, manic or mixed;
- The composition, structure of the syndrome-typical or atypical, simple or complex, harmonious or disharmonious;
- Depth, the strength of the manifestations of psychotic or non-psychotic level.
With typical syndromes, everything is more or less simple, they are characterized by triads. This
Depressive triad:
1) low mood;
2) slow-paced thinking;
3) motor retardation and hypobulia (“Can I? Do I want to? I want it?”).
Manic triad:
1) high mood;
2) accelerated pace of thinking;
3) motor excitation and hyperbulia (“Oh, how I can! Oh, how I want to! Everything, and more!”).
Be that as it may, mood is the main, leading symptom. Yes, there can be ideas of nypoleondabest in the manic syndrome and their own planktonogenic and kubistichesky with depression, desires, respectively igogo or lol, as well as intent or attempts to leave this world in depressive affect. But these will be additional, or optional, syndromes. That is, they may or may not be present.
The standard of a typical manic or depressive syndrome may well be those in endogenous psychosis [26] – say, TIR (well, well, let there be a BAR [27]). And, since we are talking about endogeneity, it is worth mentioning the characteristic signs for it: first, the daily fluctuations (“Morning is not good!”), when subjectively a person feels better in the afternoon than in the morning, and secondly:
1) increased heart rate;
2) dilation of the pupils;
3) tendency to constipation.
This is due to the failure of the autonomic nervous system with a predominance of tone of its sympathetic part. Menstrual irregularities, changes in body weight — this is in pursuit, as well as seasonality (well, at least just the frequency) and autochthonous (from Greek. autochthon — local, born here) — that is to say the state came by itself, but not all bastards provoked him.
For atypical affective syndrome is characterized by the fact that the foreground is not the main, and facultative signs (anxiety, fear, obsessive or obsessive phenomena, hallucinations or derealization with depersonalization, etc.).
For a mixed affective syndrome, it is characteristic to attach to the main signs of one affect some one of the opposite triad: for example, agitated depression (when inhibition would be necessary) or manic stupor (when one should expect excitement).
The affective syndromes of non-psychotic level include subaffective syndromes-hypomania and subdepression.
When it comes to complex affective syndromes, they mean their combination with syndromes from other, non-affective groups: manic-delusional, depressive-delusional, depressive-hallucinatory, depressive-paranoid, depressive – or manic-paraphrenic and other terrible expressions that can permanently enter the listener into a stupor.
Let’s look at each of the groups of affective syndromes — depressive, manic and mixed.
Why is it so bad — and all for me?!
Cry of the soul
So, the symptoms of depression. I will immediately make a reservation, so as not to lead the reader into the temptation to find something like this without sufficient reason. Depressive syndrome is not just a bad mood because of a badly spent night, an overly expressive seller in the store, an abundance of moral freaks around and one single crow-sniper, sighting bombed on the head of the only sane person in the radius of its duty barrage. Depressive syndrome is a really painful, painful and disabling disorder of mental activity. It can not be eliminated by simply using dense anti-aircraft fire, firing on a feathered bandit or releasing steam on the one who pushed you into the subway, through genocide (well, or at least slaughter) with a eugenic purpose.
Depressive syndromes can be divided into typical, represented by classic depressive and classic subdepressive syndromes, and atypical. Atypical, in turn, are represented by atypical subdepressive syndromes, simple, complex and masked atypical depressions. Now briefly on points.
Classic depressive syndrome.
It’s a depressive triad:
1) low mood;
2) slow-paced thinking;
3) motor retardation and hypobulia (“Can I? Do I want to? I want it?”). These are diurnal fluctuations of the state characteristic of the endogenous process (i.e., the process that arose inside, out of connection with external causes): very bad in the morning and a little easier in the evening. This is Protopopov’s triad:
1) increased heart rate;
2) dilation of the pupils;
3) tendency to constipation
or the predominance of the tone of the sympathetic Department of the autonomic nervous system.
It’s also insomnia. Thoughts in the spirit of “I-no one, worm, creature trembling, nothing in life has not achieved and unworthy of her, and in all their troubles to blame only me” (perhaps in some ways these thoughts are fair, but it is very destructive). This despair, this longing, which is so strong that it feels like a real pain, tearing, tearing the chest from the inside, claws scratching its way out (it is also called vital longing), a longing so unbearable that it is sometimes easier for a person to commit suicide than to endure it. This is a symptom of Vergaut — when the skin fold of the upper eyelid and the eyebrow at the border of the middle and inner thirds do not form, as usual, a smooth arc, and make an angle — a kind of mournful house, from which the expression of the patient’s face becomes even sadder. This is a complete lack of visible prospects. And-Yes, it is always a danger of suicide.
Classic subdepressive syndrome.
When the mood is reduced less dramatically. Melancholy is present, but not vital, not painfully tearing apart, but more like sadness, depression, pessimism (not militant, but already raised its paws).
Inhibition in the motor and mental sphere takes place, but more in the form of lethargy, a decrease in the desire to strain the mind, memory and body — not because you quickly run out of steam, but because the forces were not, and are not expected. Desires there is, but (hypobulia, remember?) some timid, sluggish, is initially adjusted for the General fatigue of all the precious to yourself.
Self-esteem is naturally reduced. Decision-making, among other things, is hampered by constant doubts about their correctness (for confidence, you need strength and mood).
Now to the atypical syndromes.
Atypical subdepressive syndromes. This:
Astheno-subdepressive syndrome. In its composition, in addition to the features characteristic of the classic subdepressive syndrome, the features of the asthenic syndrome will clearly emerge: weakness, rapid physical and mental exhaustion, fatigue, emotional lability (easily explodes, easily irritated, easily cries, but relatively quickly calms down) and hyperesthesia (the patient is extremely sensitive to either sharp sounds, or bright colors, or sharp smells, or jumps from the touch).
Adynamic subdepression. When her mood is low, but is dominated by a sense of physical helplessness, inability to make a wrong move, total indifference (“What will that bondage — all the same…”), lethargy, drowsiness, modusoperandi and zheleobraznogo.
Anesthetic subdepression. Here, in addition to the reduced mood and the General pessimistic orientation, all motives to do something, to undertake disappear, and also there is a so-called narrowing of affective resonance: first of all it is noticeable by the disappearance of feelings of sympathy and antipathy, proximity and kinship, the ability to empathize — there are simply no emotions and feelings, there is only one dull product of digestive activity, which painfully experiences their loss.
About masked depression, I will tell you more in the section of private psychopathology.
Simple atypical depression
From classical depression, they differ in that in the first place they are present and dominated by one or two additional, facultative symptoms, for which they are called, and not the classical depressive triad, individual symptoms of which are either absent or erased and little expressed. According to which of the facultative symptoms prevail, and is called simple atypical depression. Do not forget that the smoothness and mild severity of depressive symptoms do not mean that atypical depression is harmless: the level of psychotic, and do not forget it. Like masked, it can always suddenly change its course, worsen and even lead to suicide. But back to the varieties.
Adynamic depression. The symptoms are similar to those of the eponymous subdepression, but the lethargy, impotence and lack of motivation are more global and comprehensive; the forces are not just there — they seem to have never been and are not expected in principle; and the ability to hold occupied horizontal surfaces, the patient may well argue with the polyps of the Great barrier reef. Not forget also about signs of endogeneity (on the morning worse, on the evening better, plus triad Protopopova, plus greasy hair and skin faces).
Anaclitic depression (depressio anaclitica; from Greek. anaklitos-leaning, leaning). It can be found in children aged 6 to 12 months, who for some reason had to leave their mother, and their living conditions are far from normal. Such children are inhibited, immersed in themselves, lag behind in development, nothing pleases them, they do not laugh, they do not eat well.
Anhedonic depression. What in life are you used to enjoy? Introduced? And now imagine that there are worthy representatives of the opposite sex, and fine drinks, and the opportunity to go shopping, and not squinting, but in an adult way, but … Sex seems to be a set of meaningless gymnastic exercises, the liquid in the glass just fogs the brain, but does not have the same, the former, taste, smell and play, and shopping just lost Not to mention the balloons that fit to return back to the store — not happy!
Anaesthetic depression. As well as anesthetic subdepression, proceeds with painful realization of that feelings are not present — to the native child, to parents, to the spouse or the spouse. There should be, but in their place is a painful hole. Plus, again, signs of endogeneity.
Asthenic depression, or asthenic-depressive syndrome. Similar to asthenic-subdepressivee, but besides being mood disorders harder and deeper, and the fatigue and exhaustion manifest themselves at any even minimal activity, asthenic symptoms (when the morning more or less, but the later the worse, because the whole tired) superimposed on the endogenous, when it is bad in the morning and in the evening relax a little bit. As a result, it was bad all day.
Vital depression (from lat. vita-life). To be more precise, the basis of the name was the syndrome of vital, or atrial, anguish — the same, tearing, scratching the chest, tearing the heart — with feelings of physical pain in the chest, from which nothing helps.
Nagging depression. You can not even decipher, the main symptom-grumbling, grumbling, dissatisfaction with everything-from the government to the personal genotype.
Dysthymic depression. It, as a rule, falls short of the criteria of depression itself, because its main symptom is a reduced mood. But! It lasts months and years, with brief (day, week) timeouts to a more or less acceptable state. At the same time, there seems to be no external reasons for such a mood. Or, somewhere in the past, there was some trauma or loss, but so much time has passed that all the deadlines for reactive depression are long gone.
Dysphoric depression. Under it dismal mood wears explosive connotation depressed-embittered, nepriyaznennogo, unhappy with all and the entire, – here is you, to example, “so and went would on brazen satisfied mug.”
Ironic depression. It is a depression with a mournful smile on its lips, with a bitter irony to itself and, what makes this depression quite dangerous — with a willingness to pass away from life smiling like this. The risk of suicide with it is quite high.
There are also tearful depression, with a predominance of tearfulness and weakness, and anxiety depression, with a predominance of anxiety on the General dreary background.
Complex atypical depression
The structure is a combination of depressive symptoms and syndromes from other psychiatric groups (paranoid, paraphrenia).
The most common:
Depressive-paranoid syndrome, when depression is combined with delirium (if you want to kill, poison, shoot three times in a particularly perverted form-what fun is there).
Depressive-hallucinatory-paranoid syndrome, when, among other things, there are hallucinations, only reinforcing the conviction of the patient that everything is bad (you can hear voices and hooves of wild hunting, you can smell the gas, which has already begun to penetrate into the room, you can hear an infernal voice that says offensive, but generally fair mischief).
Depressive-paraphrenic syndrome, when depression is present, delirium, too, but the main feature is the nature of delirium: it is fantastic, with a phenomenal scope, its scale is amazing — it is cosmic, apocalyptic and epochal events with the patient in the lead role. As a rule, the culprit or the victim. In any case, suffer him forever, many and for deal.
In the words of one manic-depressive patient, “the disease would have been absolutely unbearable had it not been for these beautiful manic phases.” In fact, one of the main problems of the treatment of manic syndrome is that the patient feels great-both physically and mentally, and sincerely wonders: what can be treated here, why is it all suddenly attached to me, and well, scat, nasty!
As in the case of depressive, manic syndromes can also be divided into several groups: classic, atypical and complex.
Classic manic syndrome. It is, above all, a manic triad:
- High mood. In fact, it is not just elevated, it is not good or even excellent — it is radiant. This is happiness that you want to give to others. It is rapture, sometimes and sometimes turning into ecstasy. It is the joy of every second of being. This feeling from the category of ” here poperlo!»;
2) Accelerated pace of thinking. The associative process is accelerated, decisions and conclusions are made with dizzying speed and ease – in a psychotic state, most often to the detriment of their depth, objectivity, productivity and compliance with the realities of the moment. Everything is subordinated to counter the belief that EVERYTHING is FINE and ALL the best — and spit to open a new company in growing sturgeon in wastewater treatment plants sold apartment — in ten years we will bathe in black caviar and money (already, by the way, bought for the occasion).
3) Motor excitation and hyperbole. This is when it is difficult to sit still, when the energy just permeates the whole body, when it seems as if the legs do not touch the ground, as if one push — and you will fly. Besides, there are so many ideas and plans, and they all require immediate execution… by the Way, about ideas and plans. There really are a lot of them. The brain gives birth to more and more with feverish speed, from which sometimes there is a “leap of ideas”: no sooner had to put into words one, as it is replaced by another, and in turn already third-what kind of implementation, when generate something really do not have time! Therefore, quite often hyperbulia remains unproductive or several grandiose projects hang at the stage of the project (if you’re lucky) or at the stage of preparatory work (if you’re less lucky). In relation to the opposite sex — the same song. Seems, if ready love if not all, then the vast majority. And given the burning gaze, extraordinary ease in communication and beating over the edge energy (including through the RIGHT EDGE) – looking for adventure on his awl pricked basis usually finds them.
By the way, there is a phenomenon that explains how a manic companion easily finds a common language with everyone and many people like it — syntonality. This is an amazing ability to penetrate the mood and aspirations of the interlocutor, to be on the same note with him and as if to reflect in a mirror the slightest subtlety of his mood and behavior. Well, how can such a vis-a-vis not charm? True, the greatest degree of severity and subtlety of syntonicity is in the hypomanic state — in manic, the patient sometimes begins to just go ahead, like an armored train with drunken anarchist drivers, but nevertheless.
Don’t forget about the triad of Protopopov:
1) increased heart rate;
2) dilation of the pupils;
3) tendency to constipation.
It is also present here as an indicator of endogeneity (if we are talking about the manic phase of the disease). In addition, as with most psychoses, sleep is disturbed. The shade of this insomnia is interesting. If with depressive or paranoid syndromes, such a sleep disorder is transferred hard and painfully, then with manic any patient will tell you: “What are you! What a dream! I’m fine, just my body does not need so much time to rest! An hour, two or three at the most, and I am fresh and alert again.” And indeed fresh and disgustingly cheerful…
Classic hypomanic syndrome. It’s pretty much the same, except that there’s no such leap of ideas, and the bulk of the plans aren’t as intimidating. Just steadily elevated mood, thinking accelerated — but not so much as to become unproductive. Yes, it takes less time to sleep, Yes, the attitude to yourself, your condition and your problems a little easier, but even a professional can sometimes not notice the difference with a healthy person, especially if the patient desperately does not want to be treated: “WHY??? It’s so good!”And in fact, if it were not for the risk that everything will develop into a psychotic level of manic syndrome — it would be a pity to adjust something.
Atypical manic syndromes.
Fun, or unproductive, or “pure” (as Leonhard called it) mania. Her mood is elevated, with a kind of euphoric tinge. The patient behaves as if he had learned the Tao: everything, the highest wisdom is found, the person is happy, therefore, you can no longer do anything — and so everything is fine. That’s not doing, just enjoying being.
Angry mania. Imagine a slightly intoxicated cheerful ensign with a unit of brakes entrusted to him-recruits who do not just brake, but also try to show the honor. Yet, damn it, will lead to compliance with the Charter and the General concepts of the internal service, more than one MOP on the ridge broken off. And perishing’s throats disrupt here and at all easier simple. Unproductive activities and inconsistent thinking — this is so, in the form of a bonus.
Expansive mania. In addition to high mood and accelerated thinking with ideas of greatness, there is an irresistible thirst for all plans to immediately implement, which causes a lot of trouble to others, and especially to households, since the money for the return of the fullness of the Aral sea by beer lovers and by drinking a couple of echelons with a foam drink is withdrawn from a single family budget.
Resonant mania. With it, the unquenchable thirst for activity is absent. But surrounding from this not particularly easier, because words can be zadolbat not less, than Affairs. If not more. And the patient will talk a lot, regardless of your willingness to listen to him. Reasoning will be as lengthy as it is fruitless, wisdom-exclusively crafty. Plugging the fountain of eloquence is possible only mechanically.
Complex manic syndromes.
Manic-paranoid. The combination of mania with delirium greatness, or relations (me hate for what I such — – forth helpfully merits), prosecution (my blueprint ballistic rubber missiles-poprygunchika want steal intelligence services already six States, on which she, supposedly, will punch).
Manic-hallucinatory-paranoid. The same plus verbal true or pseudo-hallucinations (special services dirty swear, counting the alleged damage, let bad-smelling gases).
Manic-paraphrenic. Here brad acquires fantastic traits and truly galactic scope: if perishing rich, then “Forbes” refuses print the size of the fortune, to not upset rest included in list, if is important something not less than Emperor Galaxies. Well, let it be the lover of the Empress. If children born out of wedlock — something million, no less. Yes, at a glance.
Mixed affective syndromes are represented by agitated depression and manic stupor. Why mixed? Because in their structure, in addition to the main, there is a symptom of the opposite sign of the syndrome: excitement and motor disinhibition in depressive and, conversely, motor and mental retardation in manic.
Agitated depression. When her mood drastically reduced, the ideas of self-accusation, his own insignificance, worthlessness and other things are present, BUT. Instead of, as it should be in classical depression, everything was decorous, sedate, with maskoobraznostyu face, meager movements and thoughts in an hour on a teaspoon, here everything is different. Instead of inhibition-anxiety, anxiety and bustle, with wandering around the room and sighs ” Oh, how it is!”, “Oh, what am I!”, “Oh, what will happen, what will happen!”. And after all, it is likely that it will. At the peak of this bustling cheburkina it may even occur raptus melancholic (from the Greek. melas-dark, black, chole-bile and from lat. raptus-gripping, a sharp movement) – when patient as if explodes from within its melancholy, pain and despair. He sobs, he groans, he rushes, tears his clothes and hair, beats himself or literally killed against the wall. The risk of suicide at such a time is extremely high. Such a condition was first described in psychiatric literature by Yu. V. Cannabich in 1931.
Manic stupor. Mood elevated so that is enough for one small subdepressive nation. A person is not just good: he is the best. So good, that simply not to hand words. Buddha under his ficus religiosa in the moment of enlightenment and close so good was not. All the other manic citizens gush ideas, jump thoughts (Yes, all the crazy squadron) and make a lot of some extra movements — well, purely kindergarten, pants on the straps! A person is already good, he had already gained, learned and did eat. What’s the hurry? Allowed to envy.
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