Short-term and prolonged depressive reactions
Among the psychological and social influences that contribute to the onset of depressive reactions, the patient’s attitude to his own disease plays a primary role . Distinguish between short-term and protracted reactions to the disease.
Short-term depressive reactions are more often associated with the traumatic effects of hospitalization (fear of an unfamiliar environment, separation from loved ones) and begin with relatively mild manifestations of depressed mood, transient anxiety with concern for one’s health, combined with a tendency to dramatize the situation, a feeling of helplessness, and one’s own powerlessness in the face of somatic suffering … Short-term depressive reactions often go without treatment, and their reverse development occurs as the manifestations of the disease of internal organs disappear and the ability to work is restored.
Prolonged depressive reactions
Prolonged depressive reactions (their duration may exceed 6-12 months), as a rule, are associated with the psycho-traumatic effects of a long illness (often recurring subjectively severe symptoms, multiple hospitalizations with prolonged treatment, painful procedures accompanied by side effects, disability, a decrease in the quality of life ). The “soil” for the formation of protracted depressive reactions can be the personality traits of patients with an emphasis on the sphere of bodily self-awareness, the predominance of traits of anxious suspiciousness, a tendency to hysterical reactions. Among the factors contributing to the protracted course of such depressions, there may be concomitant mental illnesses (schizophrenia, organic lesions of the central nervous system, etc.), as well as reactive states, the manifestation of which is not associated with a somatic illness (Smulevich A.B., 2001).
Prolonged depression is manifested by more pronounced mood disorders. Their clinical picture most often corresponds to hypochondriac depression and includes various fears with obsessive thoughts about a somatic illness or memories of a previous surgery. There is also an increased vulnerability with ideas of physical inferiority associated with damage to internal organs. Patients reproach themselves for causing inconvenience to relatives and medical personnel by their helplessness, and are a burden for them.
Prolonged depression is significantly more common in patients with severe, life-threatening or disability somatic diseases. Such depressions are detected in more than 1/3 of patients who have had myocardial infarction, suffering from oncological pathology (lung cancer, pancreatic cancer), systemic connective tissue diseases, as well as in persons with primary tuberculosis.
In patients with a chronic course of a somatic disease, depressive neurotic states often turn into neurotic personality development, predominantly of the hypochondriac and depressive types. Deformation of the personality structure due to its neurotic development persists in cases of somatic recovery. Psychological depressive states in somatic patients are mainly characterized by an anxious – depressive type of experience of the disease. This contributes to the formation of a certain “internal picture of the disease” colored by depressive inclusions. a complex of ideas and emotional experiences associated with the sensation and awareness of painful changes, as well as with an understanding of the social consequences of the disease.
Of particular importance are depression in persons abusing alcohol. The initial presence of emotional and personal characteristics leads to the use of alcohol and the subsequent formation, in turn, of mood disorders that contribute to alcoholism. Alcohol consumption against a background of low mood can intensify the manifestations of depression and , due to the weakening of ego control, lead to suicide attempts .