Depressive neurosis in the form of a separate clinical form of psychogenic neurological diseases was isolated in foreign literature only in the early 60s of the XX century. In domestic psychiatry, depression was considered as one of the manifestations of affective syndrome, which can be observed in most mental illnesses, current and postponed organic brain lesions.
The main essence of depression is depressed, depressed, melancholy mood, which is often combined with a decrease in motor activity and, as a rule, severe autonomic disorders (pain in the heart, palpitations, loss of appetite, sleep disorders, etc.). A depressive neurosis, studied in detail by V. V. Kovalev (1979), includes mild or moderately pronounced emotional-behavioral depressive disorders arising under the influence of chronic psycho-traumatic influences. At the same time, the role of separation from loved ones, upbringing in an incomplete family, which occurs in almost half of the surveyed, hardships, the suppression of the child’s activities and desires, the presentation of increased demands that exceed the possibilities of fulfillment.
Of great importance is the presence of visible anatomical defects – scoliosis, limb deformity due to congenital or acquired diseases, as well as other physical and mental defects. It seems to the patient that everyone is paying attention to him, mocking him. According to 3. Freud, the depressive state of the mother in the first years of the life of children can be the cause of mental depression. Subsequently, other authors attached particular importance to the violation of relationships with the mother in the first two years of life.
Clinical manifestations of depressive neurosis are usually not clearly represented in children of primary and secondary school age. According to V. V. Kovalev (1990), they have more often the so-called equivalents of depression in the form of increased excitability, uncontrollable behavior, irritability, bitterness towards others, including their own parents, rude protest reactions. For example, in elementary school classes, the most frail pupil with severe physical disabilities can be both the most hooligan and cocky. He offends another, who accidentally looked at him or laughed for any reason. It seems to him that many are looking at his defect and mocking him. In some cases, vegetative disturbances belonging to the group of systemic neuroses (see below), such as bedwetting, inorganic encapsulation, as well as appetite disturbances, diarrheas, and sleep disorders, also join this.
These changes make it difficult to identify a depressive state, and the final decision on the diagnosis can be made only with further observation.
In adolescence, depressive neurosis is usually characterized by reticence, a desire for solitude, a violation of normal communication with comrades. Such persons usually have quiet speech, general slowness, fatigue, reduced productivity of study and work; often there are headaches, discomfort in the heart, insomnia. They love to go to the doctors, to be examined, to listen to sympathy, they willingly take medicines and perform the procedures prescribed by the doctor. An example of this is our observation.
The course of depressive neurosis in children and adolescents is more favorable than in adults. In case of disappearance or normalization of the psycho-traumatic situation depressive disorders decrease or disappear. A less favorable course occurs in cases where a young child for several years is subject to the factor of emotional deprivation (mainly separation from the mother or a substitute person). Such a condition in the foreign literature is referred to as “ anaclitic depression”, which manifests itself initially in the form of frustration (crying, crying, sleep disturbance, refusal to eat, emaciation), and then there is general lethargy and passivity, indifference to the surrounding, and psychomotor development is also lagging.
Neurosis-like states are a group of neuropsychiatric disorders that look like neuroses (disorders of the neurotic level of response), but not caused by psychogenic effects. They occupy an intermediate position between organic diseases and neurosis, closer to the first. In the past, such states were referred to as “organoids”; currently, synonyms such as neurosis-like disorders and pseudo-neurotic states are also used.
The basis of neurosis-like states is mild residual (residual) brain pathology (mainly compensated, less often subcompensated ) due to prenatal dynthogenesis (developmental disorder) or post-birth (more often at an early age) nervous system diseases of traumatic, inflammatory and other etiology, and also somatic pathology – foci of focal infection, diseases of the cardiovascular system, lungs, gastrointestinal tract, allergization of the body. The results of clinical studies reveal in these patients a neurological microorganism and mild dysfunction of the deep structures of the brain – the hypothalamic region, the reticular formation, the limbic system. It also attaches importance to the innate, including hereditary, inferiority of certain functional systems of the brain that regulate the psychomotor and autonomic activity of the organism.
According to V.V. Kovalev, neurosis-like states are divided into two groups: procedural neurosis-like disorders in current neuropsychiatric diseases that are in the nature of a process (schizophrenia, epilepsy, progressive organic brain diseases); non-procedural neurosis-like states in residual-organic pathology of the brain and in general somatic diseases.
Neuroses are reversible mental disorders, manifested by emotional and somatovegetative disorders, caused primarily by psychogenic, due to the short-term impact of stress factors, occurring with the awareness of the disease, without disturbing the reflection of the real world.
Neuroses are mainly divided into three types – neurasthenia, hysterical neurosis, and obsessive-compulsive neurosis.
Neurasthenia is the most common form of neurosis, characterized by a state of irritable weakness.
The clinical picture is represented by two main types. In the first type, the most pronounced symptom is complaints of increased fatigue after mental work, often reduced professional productivity or efficiency in everyday affairs. In another, the main signs of the disease are physical weakness and exhaustion after minimal effort, which are accompanied by a feeling of pain in the muscles and the inability to relax.
The following criteria are required for diagnosis:
– constant complaints of increased fatigue after mental work or weakness after minimal effort;
– the presence of at least two of the following symptoms: a sensation of muscle pain, dizziness, aggravating headache (“neurasthenic helmet”), sleep disturbance, inability to relax, irritability, dyspepsia;
– the existing vegetative and depressive symptoms are not so long and heavy as to meet the criteria of other more specific disorders.
With a protracted course (more than 5-7 years), changes characteristic of neurotic development appear.
The formation of neurasthenia occurs in three conditional stages.
Stage 1 – episodic autonomic disorders: irritable weakness, palpitations, sweating, cold extremities, headache, sleep disturbance (falling asleep) and appetite, fluctuations in blood pressure are possible (these symptoms appear during agitation or exercise).
Stage 2 – sensorimotor disorders: increased sensitivity to various stimuli (hyperesthesia), to sensations from the internal organs. A hypochondriac mood is formed, intensifying and raising alarming expectations and further lowering the threshold of sensations. Exhaustion degrades, first of all, internal inhibition, it is difficult for patients to concentrate, wait, and perform fine, precise work.
In the future, affective disturbances ( hypostezia ) are added: emotional control decreases, on insignificant occasions there are flashes of resentment, irritation, crying, which unexpectedly quickly pass, state of health in the morning is bad, in public – rampant, by the evening fatigue increases.
The next 3 stage: the transition to the ideator level of the disorder, indicating a neuronese formed. There are complaints about impaired memory, inability to concentrate, learn new information.