Psychiatry - H.T. Sotsnyk 2003

General Psychopathology and Symptomatology of Mental Illness
Syndromes Predominated by Emotional Disorders

Affective (emotional) syndromes are psychopathological conditions characterized by persistent mood changes.

Depressive syndrome is a combination of depressed mood, diminished mental and motor activity, accompanied by somatic and, first of all, autonomic disorders.

In mild cases of depression or at its early onset, somatic symptoms are constant: hyperhidrosis, tachycardia, Blood pressure fluctuations, hot flashes, chills, decreased appetite, and constipation. Night Sleep becomes superficial, interrupted, accompanied by anxious dreams and early awakening. A loss of the sensation of sleep may occur. The upcoming day causes anxiety. In the morning, patients experience lethargy and fatigue, requiring a deliberate effort of will to get out of bed. They feel vague apprehensions or specific, heavy premonitions. Tasks that need to be done seem complex, difficult, and exceeding their personal capabilities. Thinking and concentrating on a single issue become strenuous. Patients experience absent-mindedness and forgetfulness. Self-confidence diminishes, minor matters cause hesitation, and decisions are made only after prolonged rumination.

As the depressed mood deepens, patients begin to complain of acute mental anguish. Simultaneously, many experience heavy sensations in the chest, the upper abdomen, and less frequently in the HEAD, described as feelings of tightness, constriction, and heaviness. With a further intensification of depression, Complaints arise of a "wrenching anguish," of the "soul being crushed, broken, burning, and tearing apart." Many patients speak of experiencing pain, but of a non-physical, ineffable nature. A distinct depressive affect is accompanied by a profound sense of indifference, which in severe cases takes the form of a painful internal emptiness and a loss of all emotions—anaesthesia psychica dolorosa. Such cases are referred to as anaesthetic depression. There may be a sense of alteration in the surrounding environment—it loses its color and clarity, appearing frozen, distant, and perceived "as if through a veil." Complaints about the slow passage of time, or the feeling that time has stopped or even vanished completely, are quite common.

With further progression of depression, various delusional ideas emerge, most commonly delusions of self-depreciation and self-blame. Hypochondriacal delusions are also quite frequent. In some cases, these manifest as delusions of physical illness, where the depressed patient is absolutely convinced of having a specific, incurable disease—hypochondriacal delusional depression. In others, There is a delusional conviction of the destruction of Internal Organs—depression with nihilistic delusions. Nihilistic delusions may combine with megalomanic delusions of negation, known as Cotard's syndrome. Frequently, particularly in middle and old age, depressions are accompanied by delusions of persecution, poisoning, or ruin—paranoid depression.

In elderly patients with depression, ideomotor retardation is sometimes replaced by persistent speech-motor excitation. In such cases, the depressive affect is complicated by anxiety and, less commonly, fear; hence, such depressions are termed agitated. In agitated depression, patients are haunted by heavy premonitions of an impending misfortune or a catastrophe, The Nature of which is only vaguely surmised. Patients are extremely tense and restless. They pace continuously, compulsively turning to the staff and others with various requests or remarks, sometimes standing by the ward door for hours, shifting from FOOT to foot, and grabbing at the clothing of medical personnel and visitors. Speech agitation in agitated depression often manifests as groaning, moaning, and anxious verbigeration.

Agitation, whether pronounced or barely noticeable, can easily transform into a melancholic raptus—a brief, extremely intense state of excitation accompanied by an urge for suicide or self-mutilation.

Among patients with depression receiving Treatment in psychiatric hospitals, those with agitated depression make suicide attempts most frequently.

Manic syndrome is a combination of elevated mood, accelerated pace of mental activity, and increased motor activity.

It is not always possible to correctly assess the pathological nature of this condition. To many around them, these individuals simply appear energetic—albeit somewhat inconsistent in their actions—as well as cheerful, sociable, and self-confident. The pathological nature of these manifestations becomes evident when hypomania shifts to depression or when manic symptoms intensify.

In mania, all experiences of patients are colored exclusively in rose-tinted hues; they are carefree and problem-free. Past troubles and misfortunes are forgotten, negative events of the present are dismissed, and the future is envisioned in bright colors. However, their cheerful and benevolent mood can at times, particularly under the Influence of External factors, give way to irritability and even anger.

Patients perceive their physical well-being as optimal and feel overflowing with excessive energy. They perceive no obstacles to the fulfillment of their desires, accompanied by a persistently exaggerated sense of self-worth. An overestimation of their professional, physical, and other capabilities arises easily.

Such patients speak a lot, loudly, quickly, and often without pausing, which quickly makes their voice hoarse. The content of their speech is inconsistent, and conversation topics shift rapidly. With intensified speech agitation, an unfinished thought is instantly replaced by another, resulting in fragmentary utterances ("flight of ideas"). Their speech abounds in jokes, puns, foreign words, quotations, inappropriate laughter, whistling, and singing.

The physical appearance of the patients is characteristic: their eyes shine, their face is hyperemic, saliva often sprays from their Mouth during speech, facial expressions are lively, movements are accelerated and impulsive, and gestures are markedly expressive. They are often entirely unable to sit still. During conversations with the doctor, they frequently change posture, jump up, and sometimes begin to walk or run around the office. Appetite is usually significantly increased. They may eat while standing, quickly swallowing poorly chewed food. Sexual drive, especially in women, is typically heightened.

Depending on the predominance of specific disorders within the clinical picture of mania, several forms are distinguished: cheerful (elevated-optimistic mood with moderate speech and motor agitation); angry (a combination of elevated mood with discontent, fault-finding, and irritability); confused (The Emergence of chaotic speech and disorganized motor agitation against a Background of elevated mood); unproductive (a combination of elevated mood and motor agitation lacking the drive for activity, characterized by impoverished thinking, monotony, and unproductive utterances); delusional (a combination of elevated mood with Various Forms of figurative, less commonly interpretive delusions); retarded (a combination of elevated mood, occasionally speech agitation, with motor retardation reaching the intensity of stupor); and mania with mischievousness (a combination of elevated mood, speech and motor agitation with mannerisms, infantilism, clowning, and inappropriate jokes).