Affective syndromes. Affective (emotional) syndromes are psychopathological conditions in the form of persistent mood changes

Affective syndromes include conditions that manifest themselves primarily as mood disorders. Depending on the nature of the affect, depressive and manic syndromes are distinguished. Depression syndrome. Typical depression is characterized by the classic triad, which consists of low mood (hypotymia), motor and ideational retardation. (depressive triad). Depressive states (especially mild ones - cyclothymic) are characterized by mood swings during the day with improvement general condition, a decrease in the intensity of depression in evening time, low severity of ideational and motor retardation. With the same mildly expressed depression, one can note in patients a feeling of unmotivated hostility towards loved ones, relatives, friends, constant internal dissatisfaction and irritation. The more severe the depression, the less pronounced the mood swings are during the day. Depression is also characterized by sleep disorders - insomnia, shallow sleep with frequent awakenings, or lack of a sense of sleep. Depression is also characterized by a number of somatic disorders: patients look older, they have increased brittleness of nails, hair loss, slow pulse, constipation, impaired menstrual cycle and often amenorrhea in women, lack of appetite (food is “like grass”; patients eat through force) and weight loss. In domestic psychiatry, it is customary to distinguish between simple and complex depression, within which almost all psychopathological variants of the depressive syndrome encountered in clinical practice are considered. Simple depressions include melancholic, anxious, adynamic, apathetic and dysphoric depression. Melancholic, or sad, depression characterized by low, depressed mood, intellectual and motor retardation. Patients, along with a depressed mood, experience an oppressive, hopeless melancholy. Often it is experienced not only as mental pain, but also accompanied by physical painful sensations (vital melancholy), an unpleasant sensation in the epigastric region, heaviness or pain in the heart. Everything around is perceived by patients in a gloomy light; impressions that gave pleasure in the past seem to have no meaning and have lost relevance; the past is seen as a chain of mistakes. Past grievances, misfortunes, and wrong actions come to mind and are overestimated. The present and future seem gloomy and hopeless. Patients spend whole days in a monotonous position, sitting with their heads bowed low, or lying in bed; their movements are extremely slow, their facial expression is mournful. There is no desire for activity. Suicidal thoughts and tendencies indicate the extreme severity of depression. Ideation inhibition is manifested by slow, quiet speech, difficulties in processing new information, often with complaints of a sharp decrease in memory, inability to concentrate. The structure of melancholic depression is largely related to the age of the patient at the time of its occurrence. Classic options are typical for middle age. At a young age, the initial periods of these types of depression have their own characteristics and are distinguished by reflection, pronounced dysphoric disorders, and apathetic manifestations. These same patients usually develop typical melancholic depression in adulthood. They are also characteristic of late age. Anxiety depression can be both agitated and inhibited. With anxiety-agitated depression, the picture of the condition is dominated by motor excitation in the form of agitation with accelerated speech; there is nihilistic delirium, and often Cotard's syndrome. In inhibited depression, the psychopathological picture is largely determined by anxiety. In cases of depression of moderate severity, daily fluctuations in the condition of patients are noted, but in more severe cases they are absent. In the depressive triad, motor retardation is expressed, the pace of thinking does not change, and ideational inhibition is manifested by the anxious and melancholy content of thinking. Anxiety is felt physically by patients, which allows us to talk about its vital nature. There are also feelings of melancholy, ideas of self-blame and inferiority, suicidal thoughts and the somatic signs of depression described above. Anesthetic depression are characterized by the predominance in the picture of the disease of the phenomena of mental anesthesia, i.e. loss of emotional reactions to the environment. Such depressions can be purely anesthetic, melancholy anesthetic and anxious-anesthetic. In purely anesthetic depression, anesthetic disorders are the most significant sign of the syndrome, while other symptoms of depression may be erased, absent or slightly expressed. This applies to ideomotor inhibition, daily mood fluctuations and somatic signs of depression. Some patients have depersonalization disorders and adynamia, a depressive “worldview,” as well as interpretive hypochondriacal delusions, the plot of which is anesthetic disorders. Melancholy-anesthetic depression is characterized by a feeling of melancholy localized in the heart area, daily mood swings, ideas of self-blame and self-deprecation, suicidal thoughts and intentions, somatic signs of depression, as well as adynamia in the form of a feeling of physical or (less often) so-called moral weakness. The feeling of loss of feelings is regarded by patients as evidence of their real emotional alteration and is the main plot of the ideas of self-accusation. Typical signs of the disease are also agitation, external manifestations of anxiety, ideation disorders in the form of influxes and confusion of thoughts, inverted nature of daily fluctuations in state in the absence of ideomotor inhibition, suicidal thoughts, and ideas of self-blame. In the evening hours, patients' anxiety increases for a short time. A feature of mental anesthesia in anxiety-anesthetic depression is a state of poorly differentiated feeling of internal emptiness. Often in the picture of anxiety-anesthetic depression there are various depersonalization disorders that go beyond the scope of mental anesthesia (an automated feeling of one’s own actions, unrealistic perception of one’s own self, a feeling of duality). Adynamic depression. The foreground in the picture of these depressions is weakness, lethargy, impotence, impossibility or difficulty in performing physical or mental work while maintaining impulses, desires, and desire for activity. There are ideational, motor and combined variants of these depressions. In the ideational version, manifestations of adynamia prevail over depression itself. The mood is low, patients express ideas of inferiority, but the main plot of their experiences consists of adynamic disorders. Adynamia is expressed in complaints about the lack of “moral strength,” “mental exhaustion,” “mental impotence,” and poor intelligence. In the depressive triad, ideational inhibition dominates over motor inhibition. The motor version of adynamic depression is characterized by a predominant feeling of weakness, lethargy, muscle relaxation and powerlessness. The affective radical is represented by depression with a feeling of inner restlessness and tension. In the depressive triad, motor retardation dominates over ideational retardation. Somatic signs of depression (sleep disorders, appetite disorders, weight loss) are clearly expressed. Delusional ideas of one's own inferiority are noted, the content of which is determined by the characteristics of adynamia. The combined variant of depression is characterized by the phenomena of both ideational and motor adynamia. In depressive syndrome great place occupied by anxiety, a feeling of melancholy of an indefinite nature. The depressive triad is marked by disharmony - a significant predominance of motor retardation over ideational retardation. There are no distinct daily fluctuations in the state. Ideas of self-blame are not typical for this option, and ideas about one’s own inferiority are accompanied by a feeling of self-pity. Adynamia is manifested by a lack of physical and moral strength, the inability to do any work. Severe somatic disorders are noted. Apathetic depression. In the clinical picture of apathetic depression, the foreground is the impossibility or difficulty of performing mental or physical activity as a result of the lack of desire and desire for any type of activity, a decrease in the level of motivation and all types of mental activity. This type of depression is characterized by a significant severity of apathy and the dullness of other manifestations of the depressive syndrome - melancholy, anxiety, ideas of self-blame, and somatic signs of depression. There are apatomelancholic and apatoadynamic depressions. Apatomelancholic depression is expressed by low mood with a feeling of melancholy, ideas of self-blame, and suicidal thoughts, but the patients themselves rate apathy as one of the most severe disorders. There is an inverse relationship between the severity of apathy and melancholy. Some patients may experience episodes of anxiety along with melancholy. As the name suggests, apatoadynamic depression is characterized by a combination of apathy and adynamia. Actually, melancholy is atypical for these depressions and anxiety in the form of vague “internal restlessness” and tension occurs extremely rarely. The patients' ideas of self-blame and inferiority reflect the presence of apathy. Dysphoric depression - conditions characterized by the occurrence of dysphoria against a background of decreased mood, i.e. irritability, anger, aggressiveness and destructive tendencies. In this case, objects and situations that did not attract his attention shortly before may suddenly become a source of irritation. The behavior of patients during the period of dysphoric depression can be different: in some, aggression and threats towards others, destructive tendencies, and obscene language predominate; for others, a desire for solitude associated with hyperesthesia and “hatred of the whole world”; still others have a desire for vigorous activity that is unfocused, often absurd in nature. At the time of development of dysphoria, a feeling of internal mental tension with the expectation of an impending catastrophe sometimes prevails. In the clinical picture of simple depression there may be hallucinatory, delusional and catatonic inclusions, when, along with depression, melancholy and anxiety, verbal hallucinations of a threatening or imperative nature, ideas of influence, persecution, guilt, damage, ruin, and impending punishment appear. At the height of depression, acute sensory delirium with staging and episodes of oneiric stupefaction can develop. Quite often, depressive states take on the character of melancholic paraphrenia with corresponding delusional experiences from “mundane” interpretations to mystical constructions. In existing classifications, in addition to those described above, it often appears tearful and ironic depression(with the latter, a smile wanders on the patients’ faces, they mock their condition and helplessness), stuporous depression etc. But the characteristics reflected in the names of these depressions are not significant. They only emphasize certain features depressive state, which can be observed in the picture of depressions of various structures. The presented typology of simple depressions, naturally, does not exhaust all their diversity and in this regard is largely relative. This is primarily due to the fact that, along with the classical pictures of the described depressions, there are conditions that are often difficult to attribute to a specific type of depression due to their significant variability and polymorphism of the main manifestations. Complex depressions include senestohypochondriacal depression and depression with delusions, hallucinations and catatonic disorders. They are distinguished by significant polymorphism and depth of positive disorders, as well as variability due to the presence in the clinical picture of the disease of manifestations that are outside the framework of disorders obligatory for depression. Senestoipochondriacal depression are particularly complex. In these cases, affective disorders themselves recede into the background and complaints about extremely unpleasant, painful sensations in various parts bodies, sometimes of extremely pretentious, bizarre content. Patients are focused on feelings of somatic ill-being and express alarming concerns about their health. In structure depressive states with delusions and hallucinations Catatonic disorders occupy a large place - from individual manifestations in the form of increased muscle tone, negativism to pronounced pictures of substupor and stupor. The relationship between affective disorders themselves and disorders that go beyond the boundaries of obligate symptoms of depression is considered differently by researchers: some believe that non-affective disorders arise regardless of affective disorders, others consider affective disorders to be secondary to more severe psychopathological phenomena. Along with simple and complex depressions, the literature describes protracted (protracted) and chronic depressions. Protracted, or prolonged, depression can have a monomorphic structure, if the condition does not change its psychopathological picture for a long time, and a polymorphic structure, if the picture of depression changes during the course of the disease [Pchelina A.L., 1979; Tiganov A.S., Pchelina A.L., 1983]. The clinical picture of monomorphic depression is characterized by relative simplicity, low variability, insignificant dynamics of individual manifestations, and uniformity of the picture throughout the entire course of the disease. Such depressions are usually characterized by anxious adynamic, anesthetic, dysphoric or senestohypochondriacal disorders. In these cases, lethargy, adynamic, anesthetic and anxiety states without a certain sequence and patterns replace each other. In patients with a variable (polymorphic) clinical picture and deep psychopathological disorders during an attack, simple hypothymic disorders can transform into complex states (with delusions, hallucinations, catatonia), and it is not possible to identify any pattern in the change in the described disorders. Chronic depression differs from prolonged depression not only in its protracted nature, but also in the signs of chronicity, manifested by uniformity and monotony of the psychological picture of depression. Exist general features chronic depression, which includes the predominance of melancholic, depersonalization and hypochondriacal disorders in the clinical picture of the disease, as well as the disharmony of the depressive triad, characterized by a combination of low mood and motor inhibition with monotonous verbosity, dissociation between the richness and variety of complaints of an affective nature and an outwardly calm, monotonous appearance and behavior patients, hypochondriacal coloration of ideas of self-blame, obsessive nature of suicidal thoughts with an attitude towards them as alien. In these cases, hypomanic “windows” may also appear, as well as symptoms of the neurotic register in the form of senestopathic, obsessive-phobic and vegetophobic paroxysmal states. Manic syndrome characterized by elevated mood, acceleration of associative processes and an excessive desire for activity (manic triad). Patients are characterized by cheerfulness, distractibility, variability of attention, superficiality of judgments and assessments, an optimistic attitude towards their present and future; they are in excellent spirits, feel extraordinary vivacity, a surge of strength, and fatigue is alien to them. The desire for activity is revealed in patients in different ways: either they take on a lot of things without completing any of them, then they spend money thoughtlessly and randomly, making unnecessary purchases, at work they interfere in the affairs of colleagues and superiors, they propose to radically reorganize enterprise, etc. Intellectual arousal is manifested by an acceleration of the pace of thinking, variability of attention, and hypermnesia (memory sharpening). Patients are extremely verbose, talking incessantly, causing their voice to become hoarse; sing, read poetry. A leap of ideas often develops - a sharp acceleration of thinking, in which there is a continuous change from one unfinished thought to another. Characterized by confusion and inconsistency of statements, reaching the level of incoherence. Intonations are usually pathetic and theatrical. Everything that happens around, significant or insignificant, equally arouses the patient’s interest, but his attention does not linger on anything for a long time. In some cases, distractibility and variability of attention are so intense that the patient consistently records and often comments on everything that comes into his field of vision (hypervariability of attention, or a symptom of hypermetamorphosis). Patients tend to overestimate their own personality: they discover extraordinary abilities, often express a desire to change professions, intend to glorify themselves as an outstanding researcher, artist, writer, etc. or pretend to be such. As a rule, we are talking about rather unstable, overvalued ideas of greatness. Patients look younger, they have increased appetite, decreased sleep duration or persistent insomnia, and increased sexuality. In manic states, increased heart rate and hypersalivation are observed, and in women the menstrual cycle is disrupted. As with depression, there is a division of manic syndromes into simple and complex. The identification of individual variants of simple manic states is associated either with the predominance in the structure of the syndrome of one of the ingredients of the manic triad, or with the appearance of disorders that modify the nature of the manic syndrome. If gaiety predominates in the picture of mania, and the acceleration of thinking and the desire for activity are not clearly expressed, then in these cases they speak of unproductive, or cheerful, manic. If the acceleration of the associative process in patients reaches the degree of incoherence, and the desire for activity reaches disorderly, chaotic excitement, then we speak of confused mania. The predominance of irritability, anger, and pickiness in the picture of mania indicates angry mania. At the height of this state, excitement with anger, rage, destructive tendencies, aggression may occur - manic rampage. Sometimes, as an independent variant of manic syndromes, they distinguish psychopathic manic states, having a number of features: manic affect here is extremely unstable, there is no desire for various types activities. Distractibility, which at times reaches the degree of hypermetamorphosis, is combined with irritability: everything that attracts the patient’s attention causes an extreme degree of displeasure and irritation. Patients often experience impulsive desires. Patients can be aggressive, and aggressive tendencies are most often found in relation to family and friends. Complex manic syndromes are accompanied by the development of disorders of quite deep lesion registers mental activity beyond the obligate symptoms of mania. In the picture manic state Hallucinations, delusions, phenomena of mental automatism, and catatonic disorders may develop. There are delusional manic states, manic states with foolishness, manic states with acute sensory delirium and manic states with oneiroid. Delusional manic states are characterized by the development against the background of a manic state of delirium, hallucinations, signs of mental automatism without clouding of consciousness. In some patients, these disorders arise as scattered, unsystematized ones, in others they have a clear tendency to systematize, in others they form a formalized delusional system. Manic states with foolishness. The psychopathological picture of these conditions consists of high mood, a tendency to make ridiculous and flat jokes, grimaces, a tendency to commit ridiculous acts. Delusional ideas, verbal hallucinations, and mental automatisms are possible. At the height of the state, the phenomena of puerilism and pseudodementia are observed. Manic states with the development of acute sensory delirium. In cases of manic states with the development of acute sensory delirium, attention is drawn to an ecstatic shade of heightened mood, pathos, exaltation, and volubility. With the development of acute sensory delirium, a staging occurs with a change in the perception of the environment, with the feeling that a performance is being played out, in which the patient plays the main role; The content of the play being played is usually heroic deeds allegedly committed by the patient in the past, or the patient’s cloudless future. The development of antagonistic fantastic delusions and ideas of grandeur is possible, which allows the condition to be qualified as acute manic paraphrenia. Often, manic states with acute fantastic delusions and ideas of grandeur are accompanied by the development of verbal pseudohallucinations (acute manic pseudohallucinatory paraphrenia) or confabulations of fantastic content (acute manic confabulatory paraphrenia). Manic states with the development of oneiric-catatonic disorders. In these cases, oneiroid does not develop suddenly in the picture of manic states - its occurrence is preceded by states of acute sensual and acute fantastic delirium. Oneiric disorders of expansive content can occupy a significant place in the picture of a manic attack; sometimes oneiroid develops as an episode at the height of the attack. Catatonic disorders in the form of agitation, stupor, substupor or individual catatonic disorders are characteristic.

Obsessiveness.

Obsessions are experiences in which a person, against his will, has any special thoughts, fears, doubts. At the same time, a person recognizes them as his own, they visit him again and again, it is impossible to get rid of them, despite a critical attitude towards them. Obsessive disorders can manifest themselves in the emergence of painful doubts, completely unjustified, and sometimes simply ridiculous thoughts, in an irresistible desire to count everything. A person with such disorders may check several times whether the light in the apartment has been turned off, whether front door, and as soon as he moves away from the house, doubts take possession of him again.

This same group of disorders includes obsessive fears - fear of heights, enclosed spaces, open spaces, traveling in public transport and many others. Sometimes, to relieve anxiety, internal tension, calm down a little, people experiencing obsessive fears and doubts perform certain obsessive actions or movements (rituals). For example, a person with obsessive fear contaminated person can spend hours in the bathroom, wash his hands repeatedly with soap, and if he is distracted by something, start the whole procedure again and again.

Affective syndromes.

These mental disorders are the most common. Affective syndromes are manifested by persistent changes in mood, most often decrease - depression, or promotion - mania . Affective syndromes often occur at the very beginning of mental illness. They may remain predominant throughout, but may become more complex and coexist for a long time with other, more severe mental disorders. As the disease progresses, depression and mania are often the last to disappear.

Speaking of depression We, first of all, have in mind its following manifestations.

Decreased mood, feeling of depression, depression, melancholy, in severe cases physically felt as heaviness or chest pain. This is an extremely painful condition for a person.

Decreased mental activity (thoughts become poorer, shorter, more vague). A person in this state does not answer questions immediately - after a pause, gives short, monosyllabic answers, speaks slowly, in a quiet voice. Quite often, patients with depression note that they find it difficult to understand the meaning of the question asked of them, the essence of what they read, and complain of memory loss. Such patients have difficulty making decisions and cannot switch to new activities.

Motor inhibition - patients experience weakness, lethargy, muscle relaxation, talk about fatigue, their movements are slow and constrained.

In addition to the above, characteristic manifestations of depression are:

feelings of guilt, ideas of self-blame, sinfulness;

a feeling of despair, hopelessness, impasse, which is very often accompanied by thoughts of death and suicide attempts;

daily fluctuations in condition, often with some relief of well-being in the evening;

sleep disorders night sleep superficial, intermittent, with early awakenings, disturbing dreams, sleep does not bring rest).

Depression can also be accompanied by sweating, tachycardia, fluctuations in blood pressure, sensations of heat, cold, chilliness, loss of appetite, weight loss, constipation (sometimes from digestive system Symptoms such as heartburn, nausea, belching occur).

Depression is characterized by a high risk of suicide!

Read the text below carefully - this will help you to notice in time the appearance of suicidal thoughts and intentions in a person with depression.

If you have depression, the possibility of a suicide attempt is indicated by:

statements of a sick person about his uselessness, guilt, sin;

a feeling of hopelessness, meaninglessness of life, reluctance to make plans for the future;

sudden calm after long period anxiety and melancholy;

accumulation medicines;

a sudden desire to meet old friends, ask forgiveness from loved ones, put your affairs in order, make a will.

The appearance of suicidal thoughts and intentions is an indication to immediately consult a doctor and decide on hospitalization in a psychiatric hospital!

Manias (manic states) are characterized by the following symptoms .

Increased mood (fun, carefree, rosy, unshakable optimism).

Acceleration of the pace of mental activity (the appearance of many thoughts, various plans and desires, ideas of overestimation of one’s own personality).

Motor excitement (excessive liveliness, mobility, talkativeness, feeling of excess energy, desire for activity).

Manic states, like depression, are characterized by sleep disturbances: usually people with these disorders sleep little, but a short sleep is enough for them to feel alert and rested. With a mild version of the manic state (so-called hypomania), a person experiences an increase in creative powers, an increase in intellectual productivity, vitality, and performance. He can work a lot and sleep little. He perceives all events with optimism.

If hypomia turns into mania, that is, the condition becomes more severe, the listed manifestations are accompanied by increased distractibility, extreme instability of attention and, as a result, loss of productivity. Often people in a state of mania look lightweight, braggarts, their speech is replete with jokes, witticisms, quotes, their facial expressions are animated, their faces are flushed. When talking, they often change their position, cannot sit still, and actively gesticulate.

Characteristic symptoms manias are increased appetite, increased sexuality. The behavior of patients can be unrestrained, they can establish multiple sexual relationships, and commit thoughtless and sometimes ridiculous actions. A cheerful and joyful mood can be replaced by irritability and anger. As a rule, with mania, the understanding of the painfulness of one’s condition is lost.

Senestopathies.

Senestopathies (Latin sensus - feeling, sensation, pathos - illness, suffering) call the symptoms of mental disorders, manifested by extremely diverse unusual sensations in the body in the form of tingling, burning, twisting, tightening, transfusion, etc., not associated with any disease internal organ. Senestopathies are always unique, unlike anything else. The vague nature of these disorders causes serious difficulties when trying to characterize them. To describe such sensations, patients sometimes use their own definitions (“rustling under the ribs,” “squelching in the spleen,” “it seems like the head is coming off”). Senestopathy is often accompanied by thoughts about the presence of some kind of somatic disease, and then we are talking about hypochondriacal syndrome.

It is better to cry at a psychologist's appointment than to laugh in a psychiatrist's office.

Folk wisdom

When considering the structure of affective syndromes (from Lat. affectus– emotional excitement, passion) it is customary to focus on three main parameters.

1. Pole of affect– depressed, manic or mixed.

2. Composition, structure of the syndrome– typical or atypical, simple or complex, harmonious or disharmonious.

3. Depth, power of manifestation– psychotic or non-psychotic level.

With typical syndromes everything is more or less simple; they are characterized by triads.

Depressive triad:

1) low mood;

hypobulia(“Can I? Do I want? Do I need it?”).

Manic triad:

1) elevated mood;

2) accelerated thinking;

3) motor excitement and hyperbulia(“Oh, how I can! Oh, how I want! Everything, and more!”).

Be that as it may, it is the mood that is the main, leading symptom. Yes, there may be ideas of one’s own Napoleon-likeness in a manic syndrome and one’s own plankton-likeness and futility in a depressive syndrome, desires and attractions - respectively, a yoke or a bug, as well as intentions or attempts to leave the mortal world in a depressive affect. But these will be additional, or optional, syndromes. That is, they may or may not be present.

Standard typical manic or depressive syndrome may well act as such when endogenous psychosis- let’s say MDP (okay, okay, let it be BAR). And, since we’re talking about endogeneity, it’s worth mentioning its characteristic features: firstly, daily fluctuations (“There’s no such thing as a good morning!”), when a person subjectively feels better in the afternoon than in the morning, and secondly, Protopopov's triad:

1) increased heart rate;

2) pupil dilation;

3) tendency to constipation.

This is due to a malfunction of the autonomic nervous system with a predominance of the tone of its sympathetic part. Menstrual irregularities, changes in body weight - this is a catch-up, as well as seasonality (well, at least just periodicity) and autochthony(from Greek autochthon- local, born here) - that is, the condition arose on its own, and not some bastards provoked it.

For atypical affective syndrome is characterized by the fact that it is not the main, but optional signs that come to the fore (anxiety, fear, obsessive, or obsessive phenomena, hallucinations or derealization with depersonalization, etc.).

For mixed affective syndrome is characterized by the addition to the main signs of one affect of any one of the opposite triad: for example agitated depression(when inhibition would be expected) or manic stupor (when excitement should be expected).

Affective syndromes of a non-psychotic level include subaffective syndromes – hypomania And subdepression.

When it comes to complex affective syndromes, What they mean is 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 lead the listener into a state of mind for a long time. stupor.

Let's look at each of the groups of affective syndromes - depressed, manic And mixed.

Why is it so bad - and that’s all for me?!

Cry from the heart

So, depressive syndromes. I’ll make a reservation right away so as not to tempt the reader into finding something similar in his own home without sufficient reason. Depressive syndrome- this is not just a bad mood due to a poorly spent night, an overly expressive salesman in a store, an abundance of moral monsters around and one individual crow-sniper, who aimed a bomb on the head of the only sane person within the radius of her duty patrol. Depressive syndrome is a truly painful, painful and disabling mental disorder. It cannot be eliminated simply by using dense anti-aircraft fire, shooting at a feathered bandit, or letting off steam on the one who pushed you into the subway (genocide, or at least massacre), with a eugenic purpose.

Depressive syndromes can be divided into typical, represented by classic depressive and classic subdepressive syndromes, and atypical. Atypical ones, in turn, are represented by atypical subdepressive syndromes, simple, complex and masked atypical depressions. Now briefly point by point.

Classic depressive syndrome

This is the depressive triad:

1) low mood;

2) slow-paced thinking;

3) motor retardation and hypobulia(“Can I? Do I want? Do I need it?”). These are daily fluctuations in the state, characteristic of an endogenous process (i.e., a process that arose internally, without 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) pupil dilation;

3) tendency to constipation;

or the predominance of the tone of the sympathetic part of the autonomic nervous system.

This is also insomnia. Thoughts in the spirit: “I am a nobody, a worm, a trembling creature, I have achieved nothing in life and am unworthy of it, and only I am to blame for all my troubles” (perhaps in some ways these thoughts are fair, but they are very destructive) . This is hopelessness, this is melancholy, which is so strong that it is felt as real pain, tearing, tearing apart the chest from the inside, scratching its way out with its claws (it is also called vital longing), the melancholy is so unbearable that it is sometimes easier for a person to commit suicide than to endure it. This Vergout's sign– when the skin fold upper eyelid and the eyebrow at the border of the middle and inner thirds does not form, as usual, a smooth arc, but makes an angle - a kind of mournful house, which makes the patient’s facial expression even sadder. This is a complete lack of visible prospects. And yes, there is always a danger of suicide.

Classic subdepressive syndrome

With him, the mood is not reduced so sharply. The melancholy is present, but not vital, not painfully tearing to pieces, but more like sadness, depression, pessimism (not militant, but already raised its paws).

Slowness in the motor and mental sphere does occur, but more in the form of lethargy, a decrease in the desire to strain the mind, memory and body - not because you are quickly exhausted, but because there was no strength and is not expected. There are desires, but ( hypobulia, remember?) somehow timid, lethargic, already initially adjusted for the general fatigue of the whole precious self.

Self-esteem is naturally reduced. Decision-making, among other things, is also hampered by constant doubts about their correctness (confidence requires 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 appear: weakness, rapid physical and mental exhaustion, fatigue, emotional lability(easily explodes, gets irritated easily, cries easily, but calms down relatively quickly) and hyperesthesia(the patient is extremely sensitive either to sharp sounds, or to bright colors, or to strong odors, or jumps when touched).

Adynamic subdepression. With it, the mood is low, but the prevailing feeling is physical powerlessness, the inability to make unnecessary movements, general indifference (“Whether there is will or not, it’s all the same...”), lethargy, drowsiness, jellyfish-likeness and jelly-like appearance.

Anesthetic subdepression. Here, in addition to a depressed mood and a general pessimistic orientation, all urges to do or undertake anything disappear, and the so-called narrowing also occurs. affective resonance: First of all, this is noticeable in the disappearance of feelings of sympathy and antipathy, intimacy and kinship, the ability to empathize - there are simply no emotions and feelings for this, there is only one dull product of digestive activity, which painfully experiences their loss.

ABOUT masked depression I will go into more detail in the section on private psychopathology.

Simple atypical depression

They differ from classical depression in that in the first place they have one or two additional, optional symptoms for which they are named, and not the classic depressive triad, individual symptoms which are either absent or erased and poorly expressed. Based on which of the optional symptoms predominate, it is customary to call simple atypical depression. Do not forget that the smoothness and mild severity of depressive symptoms does not mean that atypical depression is harmless: the level is psychotic, and this should not be forgotten. Like the masked one, it can always suddenly change its course, get worse and even lead to suicide. But let's get back to the varieties.

Adynamic depression. The symptoms are similar to those of the subdepression of the same name, but lethargy, impotence and lack of motivation are more global and comprehensive; There are not just no forces - it’s as if they never existed and are not foreseen in principle; and the patient’s ability to hold occupied horizontal surfaces rivals the polyps of the Great Barrier Reef. We also do not forget about signs of endogeneity (worse in the morning, better in the evening, plus Protopopov's triad, plus greasy hair and facial skin).

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 part with their mother, and their living conditions are far from normal. Such children are inhibited, self-absorbed, developmentally delayed, nothing makes them happy, they don’t laugh, and they eat poorly.

Anhedonic depression. What are you used to getting pleasure from in life? Introduced? Now imagine that there are the most worthy representatives of the opposite sex, and exquisite drinks, and the opportunity to go shopping, and not at a close glance, but as an adult, but... Sex seems like a set of meaningless gymnastic exercises, the liquid in a glass simply fogs the brain, but has no the same taste, smell and play, and shopping simply lost its meaning, since the brain receives nothing from this activity except counting what was spent and listing what was purchased. Not to mention the balloons, which are just right to be returned to the store - not happy!

Anesthetic depression. Like anesthetic subdepression, proceeds with the painful awareness that there are no feelings - to to my own child, to parents, to spouse. There should be, but in their place there is a painful hole. Plus, again, signs endogeneity.

Asthenic depression, or astheno‑depressive syndrome. Similar to asthenic-subdepressive, but, in addition to the fact that mood disorders are more intense and deeper, and fatigue and exhaustion appear with any even minimal activity, asthenic signs (when in the morning everything is more or less, but the later, the worse, since all tired) are layered on endogenous ones, when you feel bad in the morning, and in the evening it goes away a little. As a result, it was uniformly bad all day.

Vital depression(from lat. vita- life). More precisely, the basis for the name was the syndrome of vital, or pre-cardiac, melancholy - the same one that tears, scratches the chest, tears the heart - with sensations specifically physical pain in the chest, from which nothing helps.

Grouchy depression. You don’t even have to decipher it, the main symptom is grumbling, grumbling, dissatisfaction with everything - from the government to the personal genotype.

Dysthymic depression. As a rule, it does not meet the criteria for depression itself, since its main symptom is low mood. But! It lasts for months and years, with short (day, week) timeouts for a more or less acceptable state. At the same time, there seem to be no external reasons for such a mood. Or, somewhere in the past, there was some kind of trauma or loss, but so much time has passed that all the deadlines for reactive depression have long passed.

Dysphoric depression. With her, the gloomy mood has an explosive connotation of depressed, embittered, hostile, dissatisfied with everyone and everything - for example, “I would have hit you with an impudent, satisfied face.”

Ironic depression. This is depression with a mournful smile on the lips, with bitter irony towards oneself and, what makes this depression quite dangerous, with a willingness to die like that, smiling. The risk of suicide is quite high.

Also distinguished tearful depression with a predominance of tearfulness and weakness, and anxious depression, with a predominance of anxiety against a general dreary background.

Complex atypical depression

Their structure combines depressive symptoms and syndromes from other psychopathological groups (paranoid, paraphrenic).

The most common are:

Depressive-paranoid syndrome, when depression is combined with delirium (if they want to kill you, poison you, shoot you three times in a particularly perverted form - what fun is that).

Depressive-hallucinatory-paranoid syndrome, when, among other things, there are hallucinations that only reinforce the patient’s conviction that everything is bad (voices and the clatter of hooves of the Wild Hunt are heard, the smell of gas is heard, which has already begun to penetrate the room, an infernal voice is heard that says offensive, but in general fair dirty tricks).

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 - these are cosmic, apocalyptic and epochal events with the patient in leading role. As a rule, the culprit or the victim. In any case, he will suffer forever, a lot, and for good reason.

If bliss and joy overshadow you,

Know that things are bad, and quickly run to the doctor...

No, don't, I'm kidding!

M. Shcherbakov

As one of the patients suffering from manic-depressive psychosis put it, “the disease would be completely unbearable if it were not for these wonderful manic phases.” In fact, one of the main problems of treating manic syndrome is that the patient feels great - both physically and mentally, and is sincerely perplexed: what can be treated for, why is everyone suddenly attached to me, and come on , nasty!

As in the case of depressive syndromes, manic syndromes can also be divided into several groups: classic, atypical And complex.

Classic manic syndrome. This is, first of all, manic triad:

1) Elevated 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. This is delight, sometimes and at times turning into ecstasy. This is joy from every second of life. This feeling is something like “what a mess!”

2) Fast-paced thinking. The associative process accelerates, 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 current moment. Everything is subordinated to the persistent conviction that EVERYTHING IS EXCELLENT and EVERYTHING IS BEST - and it doesn’t matter what it takes to open a new company for growing sturgeon in wastewater treatment plants the apartment is sold - in ten years we will be swimming in black caviar and shoveling money (by the way, we have already bought it for this occasion).

3) Motor agitation and hyperbulia. This is when it is difficult to sit still, when energy simply permeates the whole body, when it seems as if your feet do not touch the ground, as if one push and you will fly. In addition, there are so many ideas and plans, and they all require immediate execution... By the way, about ideas and plans. There are really a lot of them. The brain gives birth to more and more new ones with feverish speed, which is why sometimes there is a “leap of ideas”: before you have time to put one into words, it is replaced by another, and a third is already trampled in line - what kind of implementation is there when you don’t really have time to generate! Therefore quite often hyperbulia remains unproductive, or several grandiose projects at once are stuck in the project stage (if you’re lucky) or at the preparatory work(if you're less lucky). In relation to the opposite sex - the same song. It seems as if he is ready to love, if not everyone, then the vast majority. And given the burning gaze, extraordinary ease of communication and overflowing energy (including through the RIGHT EDGE) - those looking for adventures on their awl-pricked basis usually find them.

By the way, there is a phenomenon that explains how a manic friend easily gets along with everyone mutual language and many people like it - syntony. 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 counterpart not charm? True, the greatest degree of expression and subtlety syntony has in a hypomanic state, in a manic state the patient in some places begins to simply go ahead, like an armored train with drunken anarchist drivers, but nevertheless.

Unforgettably Protopopov's triad:

1) increased heart rate;

2) pupil dilation;

3) tendency to constipation.

It is also present here as an indicator endogeneity(if we are talking about the manic phase of MDP). In addition, as with most psychoses, sleep is disturbed. The shade of this insomnia is interesting. If you are depressed or paranoid syndromes Such a sleep disorder is difficult and painful to bear, but with mania, any patient will tell you: “What are you talking about! What dream! Everything is fine with me, my body just doesn’t need that much time to rest! An hour, maybe two or three, and I’m fresh and alert again.” And really fresh and disgustingly cheerful...

Classic hypomanic syndrome. This is practically the same, except that there is no such leap of ideas, and the vastness of plans does not look so intimidating. It’s just that your mood is steadily elevated, your thinking is accelerated – but not so much as to become unproductive. Yes, you need less time to sleep, yes, the attitude towards yourself, your condition and your problems is somewhat easier, but even a professional may 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 would develop into a psychotic level of manic syndrome, it would be a pity to adjust anything.

Atypical manic syndromes

Cheerful, or unproductive, or "clean"(as Leonhard called her) mania. Her mood is elevated, with a sort of euphoric tinge. The patient behaves as if he has learned the Tao: everything, the highest wisdom has been acquired, the person is happy, therefore, you can no longer do anything, and everything is fine. So he doesn’t, he just enjoys being.

Angry mania. Imagine a slightly intoxicated, cheerful warrant officer with a unit of nerdy recruits entrusted to him, who not only slow down, but also try to show arrogance. Bye, damn it, you bring it into line with the charter and general concepts internal service, you will break more than one mop on your backbone. And it’s really easy to rip someone’s throat off here. Unproductive activity and inconsistency of thinking are a bonus.

Expansive mania. In addition to heightened mood and accelerated thinking with ideas of greatness, there is an irresistible thirst to immediately implement all plans, which causes a lot of trouble for others, and especially for household members, since money for returning the Aral to full water through the efforts of beer lovers and by drinking a couple of trains with a foamy drink is withdrawn from a single family budget.

Resonating mania. With it, there is no unquenchable thirst for activity. But this doesn’t make it much easier for those around you, since words can bore you just as much as deeds. If not more. And the patient will talk a lot, regardless of your willingness to listen to him. The reasoning will be as extensive as it is fruitless, the philosophizing will be extremely crafty. It is possible to shut up the fountain of eloquence only mechanically.

Complex manic syndromes

Manic-paranoid. A combination of mania with delusions of grandeur or relationships (they hate me for being like this - below is a list of advantages), persecution (the intelligence services of as many as six states want to steal my design for a rubber ballistic missile, over which it will presumably jump).

Manic-hallucinatory-paranoid. The same plus verbal true or pseudo-hallucinations (special services swear dirty, counting the expected damage, blowing foul-smelling gases).

Manic-paraphrenic. Here the nonsense takes on fantastic features and a truly galactic scope: if you are already rich, then Forbes refuses to print the size of your fortune so as not to upset the rest of those included in the list; if you are important, then no less than the Emperor of the Galaxy. Well, okay, let him be the empress's lover. If illegitimate children - then a million, no less. Yes, with one glance.

Mixed affective syndromes presented agitated depression And manic stupor. Why mixed? Because in their structure, in addition to the main one, there are symptoms from the opposite sign of the syndrome: excitement and motor disinhibition in depressive and, on the contrary, motor and mental inhibition in manic.

Agitated depression. Her mood is sharply reduced, ideas of self-accusation, insignificance, worthlessness and other things are present, BUT. Instead of, as it should be with classical depression, everything was sedate, sedate, with a mask-like face, meager movements and thoughts per hour, a teaspoon, here everything is different. Instead of inhibition - restlessness, anxiety and bustle, with wandering around the room and sighs “oh, how is this!”, “oh, what is it I!”, “oh, what will happen, what will happen!”. And it is quite likely that it will happen. At the peak of this fussy rustling, it may very well arise melancholy raptus(from Greek melas– dark, black, chole- bile and from lat. raptus– grabbing, sudden movement) – when the patient seems to explode from within with his melancholy, pain and despair. He sobs, he groans, he rushes about, tears his clothes and hair, hits himself or literally kills himself against the wall. The risk of suicide at such a moment is extremely high. A similar condition was first described in the psychiatric literature by Yu. V. Kannabikh in 1931.

Manic stupor. The mood is so elevated that it is enough for one small subdepressive nation. Everything is not just good for a person: he is better than everyone else. It’s so good that it’s simply beyond words. Buddha under it ficus religiosa at the moment of enlightenment it didn’t feel nearly as good. All the other manic citizens are gushing with ideas, jumping in thoughts (yes, the whole crazy squadron) and making a lot of unnecessary body movements - well, pure kindergarten, pants with straps! But a person already feels good, he has already gained, known and is enjoying with all his might. What's the hurry? Allowed to be envious.

A wide variety of emotional processes certainly occur in the human psyche, which are part of his being. We are sad from losses, rejoice when pleasant moments come, and grieve when parting with loved ones. Feelings and emotions are not only the most important component of personality, but also have a significant impact on one's motivation, decision-making, perception, behavior and thinking. Based on the current situation, people periodically experience mood swings. And this is quite natural process. After all, a person is not a machine, and he is not able to smile around the clock. Nevertheless, it is emotionality that makes people’s psyches most vulnerable. In this regard, escalating stressful situations, changes in internal biochemical processes, as well as other negative factors can become causes of all kinds of mood disorders. What disturbances occur in the emotional sphere? What are their signs? How can a person regain his mental health?

Affective disorders

In medicine they stand out psychological disorders, which are characterized by a change in a person’s emotional state towards either depression or upliftment. This group of pathological phenomena includes the most various shapes mania and depression, dysphoria, lability, increased anxiety and manic-depressive psychosis.

The prevalence of these ailments is quite widespread. The fact is that their formation occurs not only within the framework of an independent mental pathology. Affective emotional syndromes are often complications of neurological as well as various somatic diseases.

Based on available data, such disorders in varying degrees of their severity occur in 25% of the world's population. However, he turns to a specialist and receives qualified assistance only the fourth honor of these people. Those patients whose depression is seasonal in nature and worsens only from time to time, usually in the winter, are also in no hurry to consult a doctor.

Causes

Why do affective pathology syndromes arise? They are caused by both external and internal reasons. Their origin may be neurotic, endogenous or symptomatic. But regardless of the source of the pathology, for its formation a person must have a certain predisposition in the form of central nervous system imbalance, schizoid and anxious-manic character traits. All the reasons that contribute to the development of affective instability syndrome are divided into several groups. Among them:

1. Adverse psychogenic factors. Affective syndrome can be triggered by prolonged stress or a traumatic situation. The most common reasons for this group are violence and quarrels in the family, loss of financial stability, divorce, death of loved ones (parent, spouse, child).
2. Somatic diseases. Affective syndrome is sometimes a complication of another pathology. Its occurrence is provoked by dysfunction of the nervous system or endocrine glands, which produce neurotransmitters and hormones. Severe symptoms of the disease in the form of weakness and pain can worsen your mood. arise negative emotions and if the prognosis of the disease is unfavorable in the form of disability or likelihood fatal outcome.
3. Heredity. Affective disorder syndromes are sometimes caused by a genetic predisposition to them. It is expressed in such physiological reasons, such as the structure of brain structures, as well as the purposefulness of neurotransmission. An example of this is affective bipolar disorder.
4. Natural hormonal changes. An unstable state of affect is sometimes associated with endocrine changes that occur during puberty, during pregnancy, after childbirth, or during menopause. The resulting imbalance in hormonal levels affects the functioning of those parts of the brain that are responsible for human emotional reactions.

The most common mental disorders

According to the International Classification of Diseases ICD-10, affective pathologies are understood as pathologies, the main disorder of which is a change in mood and emotions towards depression (with or without anxiety), as well as towards elation. All this is accompanied by a decrease or increase in human activity. Other symptoms, as a rule, are secondary to the affective syndrome. Or they can be easily explained by changes in activity and mood.

The occurrence of such syndromes is a sign of a transition to the next deepest level of human mental disorder. After all, such a condition is accompanied by a change in the functioning of the brain, which leads to a negative change in the biotone of the whole organism. The most common mental disorders in such conditions are depression and mania. They are in first place in terms of the frequency of their occurrence in psychiatric practice. Depression and mania are often observed in cases of borderline mental illness.

Depressive syndrome

This condition is sometimes called melancholy. The following main symptoms are characteristic of depressive affective syndrome:

• Feeling of melancholy with unreasonably depressed and low mood.
• Psychomotor retardation.
• Slow pace of thinking.
• Autonomic and somatic disorders.

Depressive affective syndrome most often manifests itself in the form of depressed mood. The patient loses interest in his surroundings and experiences heaviness in his soul, and also feels it in his head and in the chest and neck area. He is haunted by a feeling of melancholy. Such a person suffers from mental pain, which he experiences more painfully than physical discomfort.

When sufficiently pronounced, the melancholy depressive effect takes over the patient’s entire consciousness. It begins to determine his behavior and thinking. Such people see only bad things in the space around them. Patients begin to perceive the whole world only in gloomy colors. They blame only themselves for all failures and see no way out of the current situation.

Such a difficult state of mind corresponds to appearance sick. His head is lowered, his body is bent, his gaze is dull, and on his face you can only see a mournful expression. Having reached such a state, a person stops enjoying even the best events that are very important to him.

Retardation in movements is also quite pronounced in such patients. They lie or sit a lot, always in a bent position. People suffering from depression complain of weakened memory and lack of desire. The slowing down of their thinking and the course of associative processes become clearly expressed. Such patients are more silent. If they begin to speak, it is only in a quiet voice. People susceptible to depression answer questions either with a nod of the head or give an answer with a long delay.

Endogenous depression

All depressed mental states are divided into two groups. These are reactive and endogenous (circular). The first of these occur during unexpected stress. These are situations of separation, death of relatives or dangerous illness. Affective-endogenous syndrome becomes a consequence of a person’s internal disease. It is caused by a decrease in the level of hormones, including norepinephrine, dopamine and serotonin. An insufficient amount of them in the body leads to the appearance of ridiculous thoughts. A person begins to think that no one needs him in this world. At the same time, he develops a feeling of worthlessness, oppression and severe apathy.

The most vulnerable category for the development of affective-endogenous syndrome are people whose character contains such traits as integrity and responsibility, modesty and self-doubt, as well as a sense of duty. Melancholic and phlegmatic people often become hostage to this type of depression.

Affective-endogenous pathopsychological syndrome sometimes occurs unexpectedly. Sometimes against the backdrop of complete family well-being. The following manifestations are typical for this condition:

• mood swings during the day (sadness in the morning and lack of it in the evening);
• sleep disturbance in the form of early awakenings at 4-5 am;
• somatovegetative disturbances.

At endogenous depression Appetite decreases sharply or disappears completely. This leads to patients losing weight. Their skin turns pale, their face becomes sallow, and their mucous membranes lose moisture. Sexual and other instinctive impulses are suppressed. Women during depression are characterized by the development of amenorrhea, and men by a lack of libido. Doctors describe the presence of a triad characteristic of such patients, including constipation, dilated pupils and tachycardia.

With affective-endogenous syndrome, the secretory functions of the glands decrease, which leads to the absence of tears. Patients also complain of brittle nails and hair loss.

The most dangerous symptom of such a depressive state is the presence of suicidal thoughts. They are preceded by a reluctance to live, which is not accompanied by specific plans. This is the initial stage of suicidal ideation, which is passive.

Affective-delusional syndromes

Often, against the background of a melancholy mood, special conditions may arise. An affective-delusional syndrome develops, accompanied by absurd statements. This condition, in turn, is classified into several pathologies that have their own distinctive features. Let's look at some of them in more detail.

Delusions of poisoning and persecution

Such statements are typical for In this case, a person who has a thinking disorder is haunted by the idea that they are being watched or wanted to poison him. Moreover, all these actions are performed either by one person (creature) or by a group of persons. Patients are firmly convinced that they are being spied on, watched, and plotted to harm them. The persecutors in this case can be neighbors, relatives, friends or fictitious persons. Such patients become suspicious and withdrawn. They develop anxiety and the ability to adequately assess what is happening disappears.

The cause of this affective-delusional syndrome is mental illness of an endogenous nature, an intoxicating effect on the central nervous system, as well as degenerative neurotic pathologies. Factors predisposing to this condition include:

• psychoses caused drug poisoning, alcohol addiction or paranoid schizophrenia;
• personal predisposition in the form of initial suspicion and distrust;
• negative experiences resulting from acts of humiliation, violence and psychological pressure.

The occurrence of hallucinations

Affective-delusional syndrome, accompanied by the patient’s fantasies, can be chronic or sharp character. In the first variant of the course of the pathology, it is characterized by an increasing deterioration. As for acute affective-hallucinatory syndrome, it is eliminated quite quickly with timely treatment.

This type of depressive state is accompanied by a delusional perception of the world around us. Acute sensory hallucinations also occur.

The cause of this type of depressive-affective syndrome is many mental disorders, including epilepsy, schizophrenia, encephalitis and other ailments. Another cause of this disorder is infectious pathologies. Often, a delusional perception of the world around us occurs with sexually transmitted diseases and neurosyphilis that affect the brain. In this case, the patient experiences auditory hallucinations. The patient hears swearing, insults, and sometimes sexual cynical reproaches addressed to him. In the future, a person sometimes becomes uncritical of such manifestations. He believes that he is being pursued by murderers or thieves. In such cases, another affective state psyche. It is expressed in the appearance of delusions of persecution.

Sometimes it occurs with organic brain damage. Similar processes develop in cerebral atherosclerosis. Hallucinations also occur in some somatic diseases. Thus, clouding of consciousness occurs in a person during psychosis. Hallucinations are also possible with sepsis caused by a wound that does not heal for a long time, as well as with pellagra - one of the types of vitamin deficiency caused by a deficiency nicotinic acid and proteins.

Mental disorders accompanied by hallucinations are also observed when a person is poisoned with bromine. With such intoxication, patients hear voices that discuss their intimate experiences. There are also visual hallucinations.

Manic syndrome

Affective disorders of this type are characterized by a person’s elevated mood, accompanied by his inexplicable optimism. In the presence of this syndrome, mental activity accelerates. The patient exhibits excessively active body movements.

The cause of mania is diseases of the central nervous system. Patients with this syndrome feel groundless joy and happiness. They often overestimate their strengths and capabilities, which leads to delusions of grandeur. Accelerating the emergence of updated ideas and thoughts is accompanied by constant distraction. Patients with affective-manic syndrome have quite active speech and a great desire to expand its activities, despite existing obstacles. People with this diagnosis react very aggressively to critical remarks addressed to them. They often act senselessly and thoughtlessly. With general excitability, they may experience increased appetite, sleep disturbances, or sudden weight loss.

Pathology in children

Affective symptoms are possible not only in adults; young patients also suffer from them. With affective syndrome in children, the description of symptoms is similar to those observed in the older generation. This is depression and a decrease in mood or an increase in it. All this is accompanied by a decrease or increase in the activity of the motor and speech spheres, as well as somatic abnormalities.

Very often, affective disorders in childhood are combined with tics and obsession. After 3 years of age, in addition to these signs of pathology, hallucinatory, catatonic and depersonalization phenomena also occur.

Affective-respiratory syndrome, which is one of the types of mood disorders, is also listed in the ICD. It is a seizure that develops in a child after excessive exposure to a physical or emotional stimulus on the nervous system. A small patient holds his breath and stops breathing for a short time. Attacks that occur during affective-respiratory syndrome in children usually pass without consequences. Nevertheless, such patients require supervision by a cardiologist and neurologist.

Children whose age ranges from 6 months to 1.5 years suffer from such pathological phenomena. Sometimes they can appear in children as young as 2-3 years old.

The main causes of affective-respiratory syndrome in children are hereditary. At risk for pathology are children who are already overly excitable from birth, and, most likely, their parents also experienced similar conditions in infancy.

Factors provoking affective-respiratory syndrome are:

• fright;
• adults ignoring the demands made by the child;
• stress;
• fatigue;
• excitation;
• family scandals;
• burns and injuries;
• communication with relatives who are unpleasant to the child.

Diagnostics

A psychiatrist is involved in identifying affective syndrome. He examines the patient's medical history and determines the patient's family history of mental disorders. To clarify the symptoms of the pathological condition and its initial manifestation after the onset stressful situations a specialist conducts a clinical interview with the patient’s closest relatives, who can provide objective and more full information. If there is no pronounced psychogenic factor in the development of abnormalities, examinations by specialists such as a therapist, endocrinologist and neurologist are prescribed to identify the true causes of the existing condition.

Apply to patients and specific methods research. These include:

1. Clinical conversation. During its implementation, the psychiatrist learns from the patient about the symptoms that bother him, and also identifies some speech characteristics that may indicate the presence of an emotional disorder.
2. Observation. In a conversation with a patient, the doctor evaluates his facial expressions, gestural features, focus and activity of motor skills, as well as autonomic symptoms. Thus, drooping corners of the eyes and mouth, stiffness of movements and grief on the face will indicate the presence of depression, and excessive smiling and increased tone facial muscles- to mania.
3. Psychophysiological tests. Similar studies are conducted to assess the stability and expression of emotions, their quality and direction. Tests will confirm existing psycho-emotional disorders thanks to a system of unconscious choices.
4. Projective techniques. These techniques are designed to assess the patient’s emotions due to his unconscious personal qualities, social relationships, and character traits.
5. Questionnaires. The use of these techniques requires the patient to be able to assess his own character traits, emotions, health status and characteristics of relationships with loved ones.

Treatment

Affective disorders are eliminated by therapeutic methods, which must be prescribed by a doctor individually for each patient and take into account clinical manifestations diseases, nature of course and etiology. In general, the doctor strives to stop acute symptoms, eliminate the causes of the problem if possible, and also carry out social and psychotherapeutic work with the patient.

As part of drug treatment, patients suffering from depression are prescribed antidepressants. Anxiety symptoms can be treated with anxiolytics. To get rid of manic moods, mood stabilizers are used. Antipsychotic drugs are designed to eliminate hallucinations and delusions.

Psychotherapeutic assistance to patients with affective syndrome consists of individual sessions of cognitive as well as cognitive-behavioral therapy with the gradual inclusion of the patient in group sessions. With increased anxiety, patients are encouraged to master relaxation and self-regulation techniques, as well as work with erroneous attitudes.

Social rehabilitation plays an important role in the recovery of patients with affective syndrome. To work in this direction, the psychotherapist and psychologist hold meetings at which the patient’s family is present. They discuss issues of proper nutrition and physical activity the patient, his gradual involvement in everyday activities, joint walks and sports.

Prevention

How to avoid the development of affective syndrome? For disorders caused by hereditary factors, the patient is advised to undergo periodic courses of therapy. This will allow you to maintain normal well-being and avoid relapses.

Among the preventive measures is also the refusal of existing bad habits, maintaining a rational daily routine, including adequate sleep, alternating work and rest, allocating time for interesting activities, as well as maintaining trusting relationships with loved ones.

Mood disorders are often characterized by a certain set of symptoms that already indicate that a particular illness is developing. There are such a large number of symptoms, in all their variations and degrees of severity, that the diseases themselves carry different names. But there is one common sign that determines whether a person has an affective syndrome—mood disturbance.

During the day, every person's mood changes. The sun shone - the mood rose, someone was rude - the spirit fell. Of course, all people undergo changes in their mood during the day, but at the same time they do not become sick! We are not talking about easy and completely manageable changes, but about constant emotional states in which a person remains for a long time in the absence of a good reason.

The main signs of an affective disorder are the presence of depressive or elevated mood, anxiety. The constant presence of a person in these states without justifiable reasons indicates a violation of mental health. We repeat once again that all people’s moods change after the occurrence of certain pleasant or shocking events.

But a healthy individual eventually returns to his normal calm state, forgets about what happened, switches to something else. A sick person gets stuck in his emotional state for a long time, sometimes not being able to change it, because he is not aware that this is an anomaly.

Often side effects These conditions are psychosomatic diseases - the mood begins to affect the health of the physical body. If you do not eliminate the harmful mood, you will not cure the disease.

Depressive disorder

Depressed mood, decreased energy, lack of ability to enjoy life, lethargy, and a pessimistic outlook characterize a disorder called depressive disorder. This is included in the category of symptoms that form depressive affective syndrome. The person is in a constantly depressed mood. However, other signs accompanying this deviation are so diverse that it seems as if the person is suffering from several diseases at once.

Elation or mania

The flip side of a depressed mood is an elevated one. In a healthy person emotional condition changes for the better when he is in appropriate conditions, such as fun, holiday, celebration, receiving good news, etc. Where a person encounters luck or happiness, his mood rises.

The pathological condition is mania syndrome, characterized by the following symptoms:

• Hyperactivity
• Ideas of self-importance (greatness)
• Mood changes towards elation or irritability

Previously, the term “hypomania” was applied to illnesses with less severe degrees of mania. But the symptoms of these disorders are almost the same, so it was customary to call mania “mild,” “moderate,” or “severe.”

As you can see, a person’s natural ability to change his mood may indicate psychopathic illness. If a person is in conditions that cause completely natural reactions that do not last long, we are talking about a healthy individual.

But if a person, after a certain situation, plunges into his own state and continues to experience it in other conditions of life, then we are talking about a sick individual. And the degree of the disease also differs depending on the condition of the sick person.