Organic and somatogenous (symptomatic) depression

In contrast to nosogenic depressions, reflecting the individual’s response to the disease (ie, psychogenic reaction), this group of affective disorders is implemented mainly at the pathophysiological level and reflects the central nervous system response to biochemical and physiological processes in the body associated with severe organic (neurological) or somatic diseases. When analyzing the conditions for the formation of affective disorders in these cases, great importance is attached to the imbalance of the functional activation of the cerebral hemispheres. The manifestation of depressions may be associated with predominant irritation and / or relative activation of the right hemisphere, since it plays the main role in the regulation of emotions and mood at the cortical level.

Depression in organic brain diseases. Depression in the form of both erased subsyndromic and severe conditions can occur with a number of organic brain diseases.

Neurological pathology, complicated by depression
• Diseases with a primary lesion of the extrapyramidal system:
– parkinsonism;
– Chorea of Huntington ;
– hepatocerebral dystrophy.
• Demyelinating diseases:
– multiple sclerosis.
• Vascular diseases of the brain:
– atherosclerosis of cerebral vessels;
– acute violation of cerebral circulation;
– residual effects after an acute violation of cerebral circulation;
– dyscirculatory encephalopathy.
• Traumatic brain injury:
– traumatic encephalopathy.
• Brain tumors:
– tumors of the temporal lobe;
– tumors of the frontal lobe.

The frequency of affective disorders in some types of CNS damage is quite high (Fig. 1). RG Robinson et al . [1983] found that about 50% of patients in the immediate post-stroke period show clear signs of depression. The prevalence of depression in parkinsonism, according to V.L. Golubeva, I.I. Lewin and AM Wayne [1999], exceeds that in other disabling neurological diseases, which, as shown in Fig. 1 data, consistent with data from other researchers.

In some organic lesions of the central nervous system (parkinsonism, Huntington ‘s chorea , multiple sclerosis, brain frontal lobe tumors) depression at the initial stages of the pathological process can act as one of the early symptoms that “mask” the manifestation of the underlying disease. So, in Parkinson’s disease, affective disorders in 12% of cases precede the manifestation of motor manifestations. The vestigiality and incompleteness of affective manifestations (reduced mood, tearfulness, intermittent anxiety, sleep disturbances) interpreted by N. Wieck [1959] as a transitional syndrome, which are replaced by organic symptoms and disturbed consciousness, draw attention to themselves .

Among the distinctive signs of depression associated with organic diseases of the central nervous system, indicate the phenomenon of dementia (a distinct lack of cognitive function, impaired attention, memory, and praxis ). With the growth of focal changes and the deepening of dementia, the severity of affective disorders may increase. In some cases, many intellectual disorders are not a sign of dementia (pseudodementia). In the process of the reverse development of affective disorders, these disorders, as a rule, are reduced.

The clinical picture of more pronounced organic depressions is dominated by signs of negative affective – adynamia, sustainability , akinesia, asthenia. So, for affective disorders in parkinsonism is characterized by a predominance of violations of the asthenic pole. Along with hypotension, lethargy, complaints of general weakness, fatigue, lack of strength, loss of appetite, and sleep disorders appear to the fore.

However, there may be depressive states with a predominance of dysphoria or disorders of the depressive- hypochondriac or anxiously depressing circle. When illness Parkins-on, for example, along with asthenic described disforiche skie depression occurring with irritability, anxiety, pessimistic assessment of the future, suicidal thoughts (but without the ideas of sin and self-incrimination); in tumors of the left temporal lobe – affective disorders with an acute sense of melancholy, anxiety, suicidal tendencies.

For vascular depression, an abundance of somatic and hypochondriacal complaints, monotony and intrusiveness of behavior – “complaining”, “aching” depressions are characteristic [ Shternberg E.Ya., 1983]. In the acute post-stroke period, the complication of the picture of depression with pathological (forced) crying is possible; possible outbreaks of anxious and timid arousal and nightly delirious episodes.

Depression associated with traumatic brain injury occurs at different times: sometimes in the acute period, but more often at remote stages, with symptoms of traumatic encephalopathy. Among the affective disorders dominated by signs of dysphoria – discontent, angry mood with organic exhaustion with tearfulness, sleep disorders and irritability. Anhedonia phenomena are also observed , accompanied by a loss of interest in the environment and the monotony of the affect. In some cases, psychopathic disorders with impulsiveness, explosive reactions, touchiness, and hysteroform manifestations come to the fore .

Somatogenic depression
Somatogenic depression is a frequent disorder that occurs in many somatic diseases and, as a rule, occurs in their severe, chronic course.

As can be seen from the enumeration given separately (by body systems) of somatic diseases that are fraught with depression, their formation may be associated with diseases of the cardiovascular system and respiratory tract, kidney damage with uremia, liver cirrhosis, and systemic lupus erythematosus. In the series of endocrine disorders of depression are more often with hyperparathyroidism, hypothyroidism, diabetes. Affective disorders occur with avitaminosis, iron and vitamin B12-deficiency anemia.

Symptomatic depressions are formed in close dependence on the dynamics of somatic pathology: manifestations of affective disorders manifest with increasing severity and are reduced as the symptoms of somatic disease develop backward. The clinical picture of somatogens often takes the form of asthenic depression with hyperesthesia, symptoms of irritable weakness, increased exhaustion, weakness, tearfulness. Along with this, anhedonia and psychomotor retardation, weakness of concentration with absent-mindedness, forgetfulness, inability to concentrate, as well as pronounced vascular manifestations, complaints of noise and tinnitus, headaches, dizziness can be observed . In some cases, anxiety prevails with flashes of irritability (nagging, excessive demands, capriciousness), sometimes reaching a level of dysphoria. When the somatic state is weighted in the clinical picture of depression, adynamia, lethargy, indifference to the environment increase.

In cancer, especially in pancreatic cancer, depression can be one of the earliest symptoms of underlying suffering. In the foreground in the picture of depression in these cases is anxiety, accompanied by a premonition of approaching death. In other cases, cancer pathology in the foreground astenodepressivnyh -ipohondricheskie and depressive states, as well as affective disorders with a predominance of anhedonia, apathy, loss of interest in surroundings, suicidal thoughts. However, most often depressions occur at remote stages of the development of malignant tumors, their severity, reaching the level of a major depressive episode, increases in proportion to the severity of the condition. According to J. Bukberg et al? obtained on the material of an oncological hospital, the frequency of depression in those with long-term cancer reaches 77%.

There are a number of factors that increase the risk of developing depression in cancer patients, which can be grouped into 3 categories related to the cancer itself, its therapy, and social factors. It should be noted that among them the greatest importance is attached to the psycho-traumatic effect of establishing the diagnosis of a cancer and the side effects of conservative treatment methods – radio and chemotherapy. A list of these adverse effects is provided below.

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