Melancholy is a common and normal emotional component. It is a common phenomenon that people encounter mental stress and pain, resulting in depression. So, how to judge whether a person is a normal mood change or a pathological depressive symptom? The following are the clues to identify and judge:
(1) Normal depression is based on a certain objective background, that is, everything happens for a reason. Pathological depressive affective disorder is usually caused for no reason, lacking objective mental stress conditions, or making a mountain out of a molehill regardless of unfavorable factors, which is not enough to really explain clinical signs.
(2) The average person's mood changes have a certain time limit, which is short-term. People can regain psychological balance through self-regulation. The symptoms of pathological depression often persist, and it is difficult to alleviate even without treatment. Generally, mentally healthy people should not change their melancholy mood for more than two weeks. More than a month, even months or half a year, is definitely a symptom of pathological depression.
(3) Normal depression is generally mild, and pathological depression is severe, which affects study, work and life, can not adapt to society, can produce serious negative and suicidal words and deeds, and the social function and quality of life are obviously reduced.
(4) Depression often recurs. Careful analysis and tracing of medical history show that there are often similar medical histories in the past, and the symptoms of each attack are similar.
(5) Typical depression has the characteristics of rhythmic symptoms, showing the changing law of morning weight and night light. Many patients complain that every morning is the hardest time. After 3-4 pm, their mood gradually improved, and at night, their symptoms were greatly alleviated, and they fell into pathological depression the next morning.
(6) People in the families of patients with depression often have a history of mental illness or similar episodes.
(7) Persistent intractable insomnia, multiple psychological behaviors blocked and inhibited at the same time, and decreased weight, appetite and sexual desire are also common signs of depression.
In practical clinical work, it is helpful to classify depression into three types: mild, moderate and severe, which is helpful to judge the severity and prognosis of the disease and to correctly apply the treatment measures. Especially, it has practical significance for the preventive measures of passive suicide patients and the protection work in family therapy.
2. Symptoms of mild depression
Such patients are not uncommon in real life. Often because of normal appearance and deep depression, they may not be able to identify themselves, and generally cannot take the initiative to go to the outpatient clinic of psychiatric prevention and treatment institutions. Because people around you, including patients' families, can't understand and give spiritual support, it often delays the illness, which not only affects social function for a long time, but also leads to avoidable suicide.
The first notable feature of mild depression is the existence of symptoms of internal suffering and external pleasure. This kind of patients have no abnormal behavior, appearance, conversation and contact. Without in-depth mental examination and psychological measurement, they can't see the essence of depression, and even give people the illusion of happiness and optimism. However, after in-depth examination, we can find many signs of physical discomfort, such as inner pain, pessimism, over-thinking, negative inferiority, unavoidable decline in energy, physical strength and intelligence, stubborn insomnia and so on. Patients often feel distressed because of physical and mental pain, and they can't find the reason and can't solve it themselves, although taking Chinese and western medicines or taking sick leave, recuperation, entertainment and drinking can't be eliminated. The average patient has a clear consciousness, a correct appearance, a profound experience of his own disease and a strong desire to seek medical treatment. They often seek medical treatment everywhere for this, and finally they can't get rid of it.
The second feature is the decline of social function. Patients can show a sudden decline in their academic and training performance, which is often mistaken for ideological problems or other diseases. Some officers will suddenly fall into a state of incompetence or inaction, unable to complete their daily work, and their thinking ability will decline.
The third feature is persistent insomnia-centered sleep disorder. Early awakening, anorexia, emaciation, constipation and other physical discomfort symptoms are more prominent, which are typical signs of recessive depression.
3. Symptoms of moderate or typical depression
(1) Depression, bad mood, lack of interest, and decreased vitality and energy are typical manifestations and characteristics of this kind of depression. It seems that patients are not interested in everything around them, or even in what they used to be interested in and good at, which makes them very confused. Turn a blind eye to external emotions, and melancholy is dominant. Negative emotions such as depression, sadness, disappointment, distress and demoralization are quite significant and persistent, and it is difficult to change. Another feature is that normal people can usually improve their emotional state by changing their environment and lifestyle, but patients can't. Patients often feel that the world around them and everything is covered with a gloomy color, full of anxiety in sync with their mood.
Typical patients present a special Ω face (Ω face)-frowning, sullen, drooping corners of the mouth, and less blinking. At the same time, it can be accompanied by bending, bowing, little change in posture, casual clothes and no modification, giving people a decadent and tired look. Crying, especially dark crying and inner painful tears, is a common clinical symptom.
(2) Psychomotor block. The typical performance is slow exercise, and patients rarely exercise spontaneously. Laziness and weakness are an important feature of this disease. Other clinical features include:
People who have always been hardworking, agile and active suddenly become lazy to do housework, with low working ability and slow movements, and even find it difficult and very difficult to do the simplest things;
2 I feel weak when I get up in the morning, worried about my day's work and rest activities, and full of failure;
③ No other physical and mental diseases and normal physical examination;
④ The patients themselves can't explain the causes of the above manifestations. Essentially, it is caused by the pathological inhibition of nerve function of muscle motor system by depression. Patients don't like to go out to socialize. Serious people stay indoors all day, don't talk and move less, are too lazy to take the initiative to contact and talk with people, or ask questions, or remain silent for a long time.
(3) Brain dysfunction and depression cognition. These are both related and different pathological signs. The former shows the inhibition of brain function and thinking efficiency. Patients feel dull thinking, memory loss, distraction, thinking difficulties, brain efficiency decline, unable to work normally. Many patients describe their subjective experience like this: the whole brain is like a bucket of paste. The latter refers to the negative pessimism and inferiority caused by melancholy, which is called melancholy cognition. This is another important characteristic symptom of depression, which is manifested as the cognitive triad of depression: ① The first group of symptoms is about the status quo. Patients feel unhappy, unhappy and full of difficulties and setbacks. They think they must be losers and have no hope or chance of success. ② The second group of symptoms is related to the past. Patients often look back on the past and feel that they have lived all their lives, full of mistakes, shortcomings and mistakes, all blaming themselves. The conclusion is that I am sorry for others, my family, and my society. Living is useless and meaningless. ③ The third group of symptoms is about the future. I feel that my future is bleak and I can't escape the guilt. There will be bad luck of family destruction and health decline. The patient feels isolated and helpless, and people in the world will not forgive him or tolerate him. Desperate thoughts are often accompanied by the idea that life is worse than death. If people with strong negative thoughts can't get timely medical help, the suicide rate can be as high as 12%~ 14%.
(4) Anxiety and agitation. Depression patients are often accompanied by anxiety symptoms, accounting for about 70%. Clinical SDS and SAS psychological scale showed that anxiety score and depression score of most patients increased at the same time, but depression score was greater than anxiety score. The common symptoms of anxiety are fidgeting, fidgeting, pathological tension, inexplicable panic and anxiety. For patients with depression who have obvious panic, irritability and anxiety in clinic, it is called agitation depression. Such patients are not uncommon in menopausal depression.
(5) physical symptoms. Refractory sleep disorder has become an important feature of the disease, which has a suggestive value in the early stage. Insomnia can often appear before all other symptoms, and the return to normal sleep is often the first sign of the disease returning to normal. It is manifested as insomnia that has no reason, is stubborn, is difficult to cure for a long time and lasts for a long time. It is characterized by early awakening, difficulty in falling asleep, shallow sleep, easy awakening, and inability to sleep after waking up in the middle of the night. Experience shows that after antidepressant treatment, sleep disorders are eliminated first, followed by the gradual improvement of other depressive symptoms. The application of other sleep AIDS that try to eliminate sleep disorders is counterproductive and makes sleep worse. Depression patients wake up in the morning, especially at 4: 00 to 5: 00, which is the lowest period of mood (in line with the law of the lowest secretion of corticosteroids), and it is also the most difficult and painful time, with the strongest suicidal thoughts and certain symptoms.
Emotional disorders, accompanied by loss of appetite, weight loss, menstrual disorders, sexual dysfunction and so on. , is an important physical symptom with characteristic values.
Depression is actually a systemic disease that mental illness leads to physical and mental dysfunction, so it has systemic and multi-system somatic symptoms. The incidence of somatic symptoms in a group of patients with endogenous depression is as follows: 98% suffer from sleep disorder, 83% are tired, 75% have contracted throat and chest, 765,438+0% have abnormal appetite, 67% have constipation, 63% lose weight, 42% have headache, 42% have pain (neck and spine, etc.). ) and 36% other symptoms from the gastrointestinal system.
4. Symptoms of major depression
In addition to the above clinical symptoms, there are many psychotic symptoms: delusions with pessimism and negative depression as the background, such as self-blame, poor research delusion, nihilistic delusion, hypochondriasis or victimization delusion; Auditory hallucinations are mostly auditory hallucinations with self-condemnation. Strong suicidal behavior, depressive stupor, severe psychomotor block, agitation disorder and serious refusal to eat are also symptoms of severe depression.
5. Depression The problem of suicide in depression is called "the first psychological killer", and the suicide rate is as high as 12%~ 14% (suicide or attempted suicide). Suicide is often the first or last symptom of patients with depression, and it is also the primary symptom that attracts attention to this disease.
Identifying and preventing negative suicidal behavior in time is the first principle to deal with depression, and it must not be taken lightly. Every patient with depression, once diagnosed or diagnosed, doctors must clearly explain the suicide risk of the disease to the patients, especially the leaders and family members of their units. No matter the severity, type, frequency of attacks and whether there have been similar behaviors in the past, the leaders of the unit are required to immediately send people for close monitoring and careful nursing until the peak period and critical period of the disease are safely passed. Patients with mild to moderate depression can be diagnosed and treated in health institutions of teachers, brigades and regiments. Patients with serious and strong suicidal tendencies must be hospitalized immediately.
Patients with depression are prone to suicidal behavior in the following situations, please be highly vigilant and strictly guard against it: patients have threatening remarks, men have negative words and deeds, and the probability of attempted suicide is high, especially those who are determined; Depression patients who have committed suicide over 30 years old; People suffering from chronic physical illness or alcoholism; Lack of social support and serious symptoms; People with a family history of suicide, especially those who try to commit suicide by clever means.
(3) Treatment of depression
1. Antidepressant therapy
Antidepressants are the best drugs to treat depression at present, and also the most important routine therapy. Antidepressants can be regarded as specific drugs to relieve depression. A large number of clinical practices have also proved that antidepressants are effective, simple and painless, and patients are willing to accept them. Commonly used antidepressants include imipramine, amitriptyline, doxepin, clomipramine, maprotiline and so on. Because the therapeutic effect and side effects of drugs vary greatly among individuals, clinical treatment should not be the same. Only under the close observation of clinicians and on the basis of week-by-week follow-up, can we find out the best treatment plan, so I won't go into details here.
2. Psychotherapy
(1) Suitable targets for psychotherapy: ① those with mild symptoms and no suicidal words and deeds; (2) those with prominent personality defects, obvious cognitive deviation, inferiority complex and poor psychological defense function; ③ Depressed patients with obvious psychological factors and no negative behavior of world-weariness.
(2) During psychotherapy, the following items should be avoided: ① Try to cheer up patients; (2) Advise patients to take a vacation or recuperate and not take the initiative to use antidepressants; ③ Forcing patients to make important decisions; (4) doubt the patient's delusion; (5) Before the patient really gets better, announce that the patient has recovered.
In the process of psychotherapy, it is very important to inform patients in detail about their illness and treatment methods, and repeatedly assure patients that depression can be cured through appropriate treatment.
(4) Prevention and control measures
Early identification and diagnosis of depression is of great significance to individuals and troops. First, depression can produce negative words and deeds that seriously threaten the life safety of patients, and the suicide rate is high, which can bring huge losses and adverse effects to individuals and troops. Secondly, the symptoms are mild, special types (such as hidden depression) are difficult to identify, and the misdiagnosis rate is high (sometimes even difficult for specialists to identify), which leads patients to seek medical treatment everywhere, causing losses to the army and suffering from patients. Therefore, timely and early identification of depression is the key to actively treat this disease and prevent patients from committing suicide. Therefore, it is urgent to carry out mental health education for the army. Popularizing scientific knowledge of mental health and strengthening publicity and education are important measures to actively prevent and treat depression.
It is worth noting that depression is a mental illness that can be completely recovered, which is different from schizophrenia or other serious mental diseases. Most patients are not afraid of seeking medical treatment, and are willing to come to the medical psychological clinic for consultation and treatment actively or passively. In order to reduce patients' psychological burden and ideological concerns, we should take confidential measures as far as possible to safeguard patients' reputation, make them happy physically and mentally, and recover as soon as possible.
mania
Mania and bipolar disorder have obvious mental symptoms, and lithium salt, a commonly used drug, is toxic, which is difficult to master and deal with in the psychological counseling clinic of teachers' brigade. It is best to make diagnosis and treatment in the psychiatric department. So here's a brief introduction to this disease.
(1) definition and overview
The basic clinical manifestations are marked and lasting emotional changes, that is, emotional high or excitement, accompanied by corresponding changes in thinking and behavior. There is a tendency of recurrent attacks, and mental activity is normal during the intermission. People with mild symptoms can't reach the level of psychosis, which is called hypomania.
(2) Clinical manifestations
1. Pathological excitement and mania
High spirits, happy mood, feeling very good about myself, endless unprovoked joy and abnormal excitement seem to be in the ocean of happiness all day. This is the best living situation I have never seen in my life, and this subjective psychological experience is very vivid. Joking, talking and laughing, abnormal conceit, exaggeration (hypomania attacks are often playful, with emotional contagion, the patient's cheerful, relaxed and optimistic mood makes people around him feel the same way strongly). At the peak of manic episode, patients can make fun of others completely regardless of their faces, which is beyond the normal limit. Due to the serious illness, emotions can be flashy, jubilant, and overly helpful until they are willful, irritable, uncontrollable, and disturbing others. At this time, all the usual manners and civilized behaviors are gone, and you can show the point of being overbearing and not listening to others' advice.
2. Psychomotor excitement
There are many actions, dancing, busy all day, and extensive social activities, as if there were no people in the world he didn't know. Life is extravagant, extravagant and wasteful, which is why it is often heavily in debt. The characteristics of emotional excitement and increased movements are often manifested in an environment that is completely unsuitable for this state, and self-awareness is seriously lacking. I can't persist in doing things in an anticlimactic way. Severe patients have chaotic movements and changeable thoughts, which obviously disturb the normal order around them, just like acute mental illness.
3. Hyperfunctional thinking
It is characterized by accelerated thinking and association process, agile thinking, diverse changes, abnormal thinking function and amazing memory, so patients often feel that they are the smartest people in the world. In this context, patients have exaggerated delusions and are very conceited. Correspondingly, there are too many words and boasting, such as runaway horses, which are uncontrollable. The patient's tongue can't keep up with the speed of thinking until it is hoarse, and typical cases have symptoms of thinking escape. There are also special symptoms such as distracted thinking, voice connection and Italian connection. What the patient says and thinks does not depend on the content, but on the superficial association: similar pronunciation, homophony, puns, and various witticisms. All kinds of things in the external environment can quickly enter his erratic attention field, thus producing all kinds of superficial and rapid associations. It must be pointed out that the idea formed by this superficial impression is not only superficial, but also often wrong, and its scope is actually extremely narrow. Transfer with the environment is an important characteristic symptom of mania. The patient's attention is very strong, but it is short-lived and superficial. One object of concern can be completely replaced by another, so that he can say whatever he sees and constantly change the subject. Everything in his living environment can affect him immediately, and will soon be dispersed by other things, so that the patient is in rash and superficial beliefs all day.
4. Excitement and attack
When the excitement reached its climax, the patient became irritable and unreasonable, and his six parents denied him. He scolded, abused, attacked and even impulsively threw things at the people he usually loved and respected the most. Transient sadness, venting inner dissatisfaction and pain, crying and other manifestations can not deny the diagnosis of manic episode. Because many clinical psychiatrists have pointed out that manic excitement has a sad and melancholy background.
5. Physical symptoms
Physical symptoms of mania are not as common as depression. Because patients feel good about themselves, even some physical symptoms or discomfort are not taken for granted. The common symptoms are less sleep, increased appetite and weight loss. In severe cases and elderly patients, dehydration and exhaustion may occur. Hypersexuality often leads to sexual teasing and disorder of sexual excitement.
6. Clinical manifestations of hypomania
Hypomania is a patient with hypomania. In the definition of mania, it refers to this type when it is mentioned that it has not reached the level of mental illness. Patients with hypomania are often neglected and easily overlooked or misdiagnosed. Such patients don't look sick and have obvious abnormalities, and I won't feel sick. Clinical examination often gives people a very healthy appearance. Many of these patients are depressed before the manic episode.
The patient sleeps for a short time every night, and after getting up early, he begins his continuous happy activities all day. Energetic and busy, but not as serious as mania, it will give people a feeling of being diligent outside. Visit friends everywhere, whether others welcome them or not. The work seems hectic, and it is difficult to complete a decent task from beginning to end. As a decision-maker, he shows the courage to take risks, loves all kinds of new ideas and plans, and is blindly optimistic about his maturity. Take risks when you implement it, and don't learn from it after you fail. Arrogant and arrogant. He bosses others around, and whoever goes against his wishes will be furious and argue and scold. I feel good about myself, satisfied with the past and present, and optimistic about the future. Hypersexuality, sexual teasing and frivolous behavior will become prominent symptoms. Relatives and friends will really think that the patient's personality and temper are completely different. This should be called alternative schizophrenia.