Affective syndromes

Affective syndromes include polar emotional disorders - depression and mania.

Depressive syndrome is characterized by a morbidly low mood, anguish, which sometimes is accompanied by a physically painful feeling of pressure or heaviness in the chest area, intellectual and motor braking (difficulty in the flow of thoughts, loss of interest in professional activities, slowing down to full immobility-depressive stupor). The nature of depression is different; Depending on the nosological affiliation, psychogenic depression (reactive, neurotic), endogenous depression in manic-depressive psychosis and schizophrenia, and, finally, symptomatic depressions that occur in somatic and other diseases are distinguished.

Pessimistic perception of the world during depression is accompanied by anxiety, guilt, ideas of low value, acquiring in severe cases the nature of delusions of self-blame or sinfulness, suicidal ideas and tendencies. The most typical signs of depression include a change in the intensity of symptoms throughout the day - the greatest increase in manifestations in the morning and the improvement in the state by the evening. There are also violations of sleep (shallow, short night sleep, drowsiness during the day), menstrual cycle, decreased appetite, accompanied by weight loss.

There are different variants of the depressive syndrome: agitated, adynamic, hypochondriacal, asthenic, hysterical depression, depression with delirium, with depersonalization phenomena, etc. In agitated depression, anxiety and motor anxiety predominate: patients rush, groan, find no place. In the case of adynamic depression, the foreground is inhibition, immobility, lack of motivation. The picture of hypochondriacal depression is determined by anxious fears or even conviction of having a serious illness. At the same time, numerous hypochondriacal complaints, as well as various painful sensations, are usually not associated with any changes in internal organs. Asthenic depression occurs with a predominance of lethargy, physical and mental fatigue, disorders of concentration, hyperesthesia. At the same time, affective disorders, melancholy, intellectual and motor inhibition in these cases are few. With hysterical depression, hysterically colored affective disorders prevail, exaggerated despair with sobs, convulsions, conversion (astasia-abasia, tremor, aphonia) and dissociative (amnesia, hysterical hallucinations) symptomatology. There are often demonstrative suicide attempts that arise as a type of "suicidal blackmail."

Manic syndrome is characterized by a morbidly elevated mood, combined with unreasonable optimism, accelerated thinking and excessive activity. Manias most often arise within the framework of endogenous psychoses (manic-depressive psychosis, schizophrenia), organic diseases of the central nervous system, and also with some intoxications; Psychogenic provoked mania are observed. Patients are characterized by experiences of joy, happiness, reassessment of their own abilities, sometimes reaching the level of ideas of greatness. The ease of formation of associations, hypernemia (exacerbation of memories with the influx of memories) are combined with increased distractibility, superficial judgments. Tendency is noted, aspiration for constant expansion of the sphere of activity and contacts. In this case, often show increased irritability, conflict (angry mania). Patients commit rash acts, senselessly spend money. Sleep, as a rule, is disturbed (shortening of sleep hours with early awakening), appetite is increased; Sexuality often increases; The menstrual cycle is broken. Unclear mania (hypomania) is often combined with a variety of somatic symptoms, alges, neurotic manifestations.