Cognitive and emotional-affective disorders in dyscirculatory encephalopathy

Depression is a mental disorder that belongs to the affective sphere (sphere of emotions).
This disease, as endogenous, that is, hereditarily burdened, is included as a separate nosological unit in the International Classification of Diseases, 10th edition (“Recurrent depressive disorder” and “Depressive episode”). The term “depression” means a symptom of low mood (synonymous with hypothymia) and is used in the sense of a syndrome, that is, a set of symptoms. Depression syndrome is nonspecific, which means it occurs in a wide variety of mental illnesses. As an independent depressive illness, it is much less common.

In order for a sick person or his loved ones to assume an appropriate diagnosis, it is necessary to know what the manifestations of depression are - this disease has many faces. The diagnosis and treatment of depression is carried out by a psychiatrist; it is this specialist who knows how to recognize the disease, establish a diagnosis and prescribe effective treatment.

Depression can recur at certain intervals, including when the timing of treatment of the previous episode was violated in the case of recurrent depressive disorder. The manifestations of depression can differ even in the same person during different episodes of depression, and even more so among different people. Psychiatrists compare depression to a skilled actress who often changes masks.

Symptoms of depression

The word "depression" comes from the Latin depressio, meaning suppression, oppression. The symptoms of depression are clearly defined in all diagnostic manuals (with some minor variations) currently in use.

Symptoms of this disorder include the following:

• Stably depressed mood, which is not influenced by external circumstances;
• loss of interest in activities that previously attracted a person, inability to experience pleasure (anhedonia);
• asthenia, impotence, decreased energy potential;
• pessimistic attitude, negative assessment of the past, present and future;
• feelings of worthlessness, guilt, anxiety;
• low self-esteem;
• difficulty concentrating, indecisiveness, confusion;
• suicidal tendencies;
• loss of appetite and weight loss (sometimes increased appetite and weight gain);
• difficulty falling asleep, early awakenings, interrupted sleep (sometimes increased sleepiness).

To be diagnosed with recurrent depressive disorder or depressive episode, at least five of these symptoms must be present for two weeks or more.

But depressed patients very rarely turn to a psychiatrist with such complaints, since depression is not always perceived by a person as a mental illness and often manifests itself with a variety of symptoms in different cases.

Kinds

Psychiatry classifies as affective disorders all mental disorders that are based on frequent changes in mood in the direction of its increase or decrease.

Let's look at the ones that occur most often:

1. Depression is characterized by a constant feeling of hopelessness and despondency for at least 2-3 weeks. Hobbies and past interests do not bring joy. A serious illness that requires referral to a specialist.
2. Dysthymia is a chronic type of depression that results in daily depressed mood. The symptoms are not as severe as those of a clinical depressive episode. This diagnosis is made if despondency and apathy do not leave a person for 2 years or more.
3. Bipolar disorder is an affective mood disorder that was previously known as manic depression. It is characterized by 2 main phases: depressive and manic. They can alternately replace each other or mix into one state. In this case, the person exhibits signs of depression with motor activity or delusional thoughts.
4. Cyclothymia is a series of constant changes in mood and physical activity, without depression or manic agitation. At the same time, a person is quite capable of maintaining social activity, even experiencing difficulties with well-being. Without treatment, it can progress to bipolar disorder.
5. Manic syndrome - this type of disorder is characterized by an excited state, euphoria, and motor activity. Rapid speech, insomnia, and confusion of thoughts are often observed. It occurs in the form of attacks, the duration of which depends on the stage of the disease.

Anxiety disorders are also identified. Its main feature is a constant feeling of restlessness and anxiety for no apparent reason. This group includes various phobias and panic attacks.

Manifestations of depression

Manifestations of depression can be roughly divided into changes in the somatic, cognitive, emotional and behavioral spheres, although the biochemical mechanism is always the same - insufficiency of neurotransmitters such as serotonin and norepinephrine in the synaptic cleft - the site of transmission of nerve impulses.

Affective manifestations of depression

Basic disorders include affective manifestations of depression. A person suffering from a depressive disorder experiences sadness for a long time; he feels melancholy, sadness, and often complete despair. Moreover, these sensations during endogenous depression, which occurs without traumatic factors, do not depend on ongoing events. A person is completely immersed in his experiences, and if something positive happens, it not only does not make him happy, but may even worsen the condition. There is often anxiety that is impossible to cope with.

One of the basic affective manifestations of depression is the pronounced pessimism with which a person relates to all events from the past and present, as well as assessments of the future. Often a person with a depressive disorder blames himself for any mistakes, devalues ​​past experiences and his achievements. He often has significantly reduced self-esteem, he easily becomes irritable, may cry often or, conversely, become aggressive. A person suffering from depression may feel detached from other people, envy their well-being, and at the same time strive for communication and be burdened by it.

Somatic manifestations of depression

Depressive disorder is associated with a lack of neurotransmitters such as serotonin and norepinephrine in the synaptic cleft, which reduces the pain threshold and exacerbates those physical sensations that a healthy person does not feel.

Somatic manifestations of depression can be very diverse:

• melancholy can be manifested by a feeling of heaviness behind the sternum, a feeling of difficulty in breathing;
• anxiety is often masked by nausea in the absence of somatic pathology;
• as a result of anxiety, which is often observed with depression, the intensity of the sympathetic autonomic system increases, and this can lead to activation of the cardiovascular system (increased heart rate, increased blood pressure), gastrointestinal tract (flatulence, diarrhea), etc.;
• Pains of various types are often felt, with which a person suffering from depression seeks medical help from somatic doctors. These pains are of an uncertain nature, change localization, and are not relieved by standard means for somatic pathologies;
• in most cases, a decrease in sexual desire is recorded, and in women, menstruation is also more painful;
• Sleep problems, which are typical for depression, play an important role in the deterioration of well-being. Patients with this disorder have difficulty falling asleep, night rest is often interrupted, and early awakenings become especially painful;
• a person with depression feels very tired, he does not have the strength to perform the simplest usual actions.

Cognitive manifestations of depression

People with depression often have problems with cognitive functioning. The pace of thinking slows down in this disorder. The sick person cannot concentrate on solving work or everyday tasks, forgets the sequence of actions that he previously performed automatically, and concentration suffers. Forgetfulness and inability to analyze facts and adequately trace cause-and-effect relationships are often observed.

Learning abilities are significantly reduced - new information is not absorbed, although before the manifestation of the disease the person could be quite educated.

The cognitive manifestations of depression can be very distressing. The sick person is depressed by the feeling of his own intellectual inadequacy, he expects professional collapse, feels mentally retarded, and is afraid that his condition is noticeable to others.

Behavioral manifestations of depression

The complex of affective, somatic and cognitive disorders in depression is also complemented by changes in the behavior of a person who has this disorder. Behavioral manifestations of depression depend both on the severity of the disease and on the personality characteristics of the individual.

It is impossible to even briefly describe all the options that can be observed in depressive disorder, or to highlight the most characteristic ones. Therefore, here are just a few examples of behavioral manifestations of depression.

Hypochondriacal fixation

Since a person with depression feels very unwell, he complains to somatic doctors of various specializations: neurologists, therapists, gastroenterologists, cardiologists. If, after conducting research, the doctor does not detect a pathology or the prescribed treatment does not work (since the basis of the disorders is depression), the patient continues to search for a specialist and suspects the doctors of insufficient competence.

Socialization problems

With a depressive disorder, a person often feels guilty for some actions towards other people. In addition, he envies those who feel good, tries to find support from his social circle, but does not feel relief from communication. Often, as a result of such experiences, which in depression are assessed as negative, the depressed person withdraws into himself. To those around him, his behavior seems inappropriate; friendly or family ties may be disrupted, as well as business ones.

Difficulty with planning

Due to the pessimism inherent in a depressed person, he often refuses any proposals regarding his career or other aspects of life. Due to poor health, a person may quit his job or break up with his partner, become carried away by religious ideas, etc.

Formation of dependencies

It happens that in order to alleviate their condition, a person with a depressive disorder tries different stimulation options, from completely harmless ones, such as excessive shopping, to addiction to drugs. In this way, a person suffering from depression tries to level out their emotional state, which can lead to the formation of addiction.

Risk of suicide

Suicidal thoughts, intentions and actions are symptoms of depression. The most tragic option is a completed suicide attempt.

This is not a complete list of behavioral manifestations of depression. A person suffering from a disease may act completely inappropriately from the point of view of others. It is this change in behavior that should become an alarming signal for loved ones. Depressive disorder is effectively treated with modern medications, which have shown high effectiveness and safety during use.

Cognitive and affective processes

Cognitive processes are mental processes that perform the function of rational cognition (from the Latin cognitio - knowledge, cognition, study, awareness).

The concept of “cognitive”: cognitive processes, cognitive psychology and cognitive psychotherapy - became widespread in the 60s of the 20th century, during the fascination with cybernetics and electronic modeling of intellectual processes, which grew into the habit of imagining a person as a complex biocomputer. Researchers have tried to model all mental processes occurring in humans. What we managed to model was called cognitive processes. What didn’t work out was affective.

Thus, in fact, the concept of “cognitive processes” received a similar, but slightly different meaning. In practice, “cognitive” refers to mental processes that can be represented as a logical and meaningful sequence of actions for processing information.

Or: which can be reasonably modeled in terms of information processing, where logic and rationality can be discerned in information processing.

Cognitive processes usually include memory, attention, perception, understanding, thinking, decision-making, action and influence - to the extent or to the extent that they are occupied by cognitive processes and not by something else (drives, entertainment...). To greatly simplify, we can say that this is competence and knowledge, skills and abilities.

Affective processes are mental processes that cannot be reasonably modeled. First of all, these are the processes of an emotional and sensory attitude to life and interaction with the world, oneself and people. Also, to simplify, these are usually feelings and premonitions, desires and impulses, impressions and experiences.

For example

Rational perception is an analytical, critical perception, different from intuition and living impression. “The ice cream is delicious, but it’s not the right time for a sore throat. Let’s put it off!”

Rational understanding is understanding through concepts and logic, as opposed to empathy, empathy and feeling, that is, emotional, bodily and experiential ways of understanding.

Rational influence is explanation and persuasion that appeals to a person's reason. Suggestion, emotional contagion, anchoring and other means that influence a person in an unreasonable way are classified as irrational means of influence.

Rational thinking is logical and conceptual thinking, or at least directed in this direction. People in the process of life and communication do not always think, quite successfully making do with feelings, habits and automatisms, but when a person turns on his head, he thinks (at least tries to think) rationally. See Rational and irrational thinking

Cognitive processes and emotions

Emotions are classified primarily as affective processes, since they are difficult to model rationally.

No one knows what emotion a woman will sometimes express, including herself...

On the other hand, some emotions arise quite naturally, as a result of understandable programs, established habits or certain benefits. In this case, such emotions can be attributed to cognitive processes, or, in another language, the cognitive component of such emotions can be studied.

Rational and emotional

On the complex relationships between the rational and the emotional, see

Treatment of depression

When a diagnosis of “recurrent depressive disorder” or “depressive episode” is made, the psychiatrist prescribes appropriate therapy. The main place in the treatment of depressive syndrome, including the above diagnoses, is occupied by antidepressant therapy. Antidepressants do not begin to act immediately, but 2-3 weeks after reaching the optimal therapeutic dose. Therefore, during the initial period of therapy, additional means may be recommended to reduce anxiety and improve sleep.

Taking antidepressants leads to relief of depression, but, nevertheless, with endogenous depression, treatment must be continued for a certain time in order for remission to be stable. And also, in order to prevent depression from returning, it is necessary to take mood stabilizers for a long time, the dosage of which is selected individually under laboratory monitoring of their content in the blood. This in most cases leads to stable remission or complete recovery.

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Treatment of mood disorders

Therapy is complex. Initially, it is aimed at stopping an acute depressive and/or manic period. Depending on the symptoms and their intensity, the doctor selects the necessary medications. In most cases, treatment is carried out on an outpatient basis, but in severe situations, inpatient treatment is recommended.

After stabilization of the patient's condition, he must undergo psychotherapy. This is individual, group or family therapy. Its goal is to help a person understand the disease, as well as teach behavioral techniques to control their emotional state.

Treatment of affective disorders involves lifestyle changes, namely:

• reduction of external stress factors;
• proper nutrition;
• adequate activity;
• avoid mental or physical stress;
• exclusion of alcohol and other toxic substances.

After the main treatment, maintenance therapy for affective disorders is recommended. It is aimed at maintaining a long period of remission and preventing relapses.

Treatment may take several months, but if you consult a doctor in a timely manner, the prognosis is favorable.