Symptome dépression
Symptome dépression
Anxiety is characterized by feelings of apprehension, tension, uneasiness, terror faced with the risk of indeterminate nature. It is often expressed by the patient in terms of nervousness or worry. The anxiety must be distinguished from fear responding to a threatening situation real.
We differentiate panic disorder (corresponding to acute anxiety attacks occur periodically) and the constant anxiety (generalized anxiety disorder or anxiety neurosis), which affects individuals in a sustainable manner.
This distinction is important because treatments are different. Panic disorder has a preventive treatment for the occurrence of seizures by antidepressants while GAD is available on conventional tranquilizers.
Anxiety disorders are common, they affect each year about 2-8% of the adult population and are more common in women. The average age of onset of symptoms is between 20 and 30.
Anxiety can be normal, even necessary to life by its adaptive function, or conversely, debilitating disease. The boundaries between normal anxiety reaction that involves the subject to face a difficult situation and pathological anxiety is unclear.
It is generally considered that anxiety is normal when it is well tolerated by the subject, he can control it, he does not perceive as unreasonable hardship, it has no impact on its daily life and it is unlikely somatisée. Anxiety is normal experience that each of us has experienced: fear before an exam, concern for the health of a parent, anxious reactions in accidents, disasters … Anxiety is an emotion so helpful. It is a psychological reaction to stress. It is a state that is part of our adaptive responses to external stimuli by allowing us to engage our attention, to raise our vigilance in situations of novelty, choice, crisis or conflict.
In addition to neurotic disorders (generalized anxiety and panic disorder) whose actual cause is unknown and is the subject of various theories, there are easily identifiable causes.
In the hysterical neurosis, anxiety is converted into physical symptoms with no organic support. But this conversion is often incomplete and some anxiety persists in general.
In social phobia, anxiety is attached to specific situations (crowds, enclosed spaces or very wide open, animals …), and anxiety is manifested only to those situations and disappears along with them.
The posttraumatic stress disorder (PTSD) is due to an extraordinary event that would cause obvious symptoms of distress in most people. The event is constantly relived as memories, dreams, feeling it will happen again …The subject tries to avoid anything that reminds him of the event and suffers from hypertension autonomic (irritability, hypervigilance, hyperreactivity to stress, difficulty falling asleep …).
Finally anxiety can be a single personality trait (anxious person) and thus is a permanent arrangement, is a transient state occurring in certain circumstances.
Anxiety is a symptom experienced as a vague feeling of pain and waiting for a vague danger, always imminent. This suffering is very often accompanied by various somatic signs that sometimes dominate the clinical picture: they are mainly respiratory symptoms, cardiac, digestive, urinary, neurological. They say that patients somatizers their anxiety, that is to say that they express through their bodies.
Anxiety neurosis is a chronic anxiety state where anxiety is present over a two-day, for at least six months. It is independent of a phobic situation (which can cause phobias, anxiety), an obsessive fear as in obsessional neurosis, and not n’émaille the evolution of a psychotic disorder or depression.She has at least six symptoms from a list of eighteen:
Generalized anxiety disorder is manifested by a feeling of permanent insecurity with ruminations on the past and various fears about the future. The chronic anxiety is very difficult to make a decision or choice, being subject to perpetual doubt. It is hyperemotional, unstable, and reacts strongly to external stimuli. Phobias and depression are common.
The anxious wait is the most constant symptom. Everyday worries are magnified enormously. The anxiety apprehends the worst for him and his family. Very dependent on his entourage, he can not bear the separation.
In the interval between episodes of acute anxiety, most patients have no trouble. Others continue to feel fatigue, headache or other manifestations of anxiety.
In anxiety neurosis, anxiety is floating and isolated pure. Against this background of permanent anxiety can occur without acute attacks paroxysmal obvious precipitating cause.
The disease progresses through phases of remission and exacerbation of symptoms. Some decompensation are possible: depression, suicide, drug addiction, alcoholism … The patient may develop into an organization neurotic phobic, hysterical or hypochondriacal.
The basic treatment is based on psychotherapy and relaxation. Tranquilizers or anxiolytics (benzodiazepines in particular) are used by periods.
The treatment of acute anxiety attack based on the attitude of the physician who must be calm and understanding, isolation, anxiolytics by injection for a rapid and powerful.
Panic disorder is characterized by the occurrence of anxiety attacks or acute anxiety attacks. By definition, to speak of panic disorder, the patient must make at least four panic attacks in four weeks (or at least if it is followed by the persistent fear of having another attack). These panic attacks are unpredictable and not triggered by particular situations (trac) or organic factors.
Panic disorder (acute anxiety) is sudden onset.The patient feels a sense of imminent, violent, imprecise (fear of imminent death, going crazy, not to control his thoughts or actions, disaster …), next feeling of helplessness, helplessness, intense fear, not applicable.
The patient is pale, covered with sweat, agitated or prostrate, uptight, tense, covered with sweat, lively tremor. It can be frozen by the anguish or suffering from a feverish excitement. Breathing is rapid, irregular. Nausea, vomiting, diarrhea, aches and pains, palpitations, tremor, feelings of dizziness, blurred vision, sharp reflexes are common. The heart is quick and wards can be dilated.
The hyperventilation syndrome associated with tachypnoea, shallow breathing, numbness around the mouth, tingling and numbness of the extremities and is closer to tetany (spasmophilia).
In mild forms of anxiety are prescribed as anxiolytics benzodiazepines at low doses.
In panic attacks, tranquilizers are sometimes inadequate and then antidepressants are the only active ingredient. They are also used in prevention.
Psychotherapy is useful when the patient seeks dialogue. It is more efficient that anxiety is related to a psychological problem, especially if the patient is isolated, with little help from friends. Relaxation yields good results in generalized anxiety.
In specific phobias (agoraphobia, fear of driving, airplane, shops, lifts, etc..) Behavioral techniques give excellent results when patients adhere fully to the program of desensitization and daily tasks to home. Adherence to treatment is a prerequisite for the success of this type of care.
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Drug therapy plays an important role in the management of bipolar patients.Meanwhile, the dissemination of detailed information about the disease and its treatments, the development of psycho-educational measures, the rules of life, initiation of psychotherapy, participation in discussion groups, will complete support.
The salt treatment is the treatment the oldest and the most specific characteristic of bipolar disorder. They are officially listed in the curative treatment of manic states. However, the delayed onset of action involves the joint use of neuroleptics in manic states characterized.
United States, lithium salts are the only ones to have the official indication in the prevention of recurrence. Their prescription remains limited in France because of unwarranted fears about their toxicity and their terms of limitation. They reduce the risk of suicide (10 to 6 times less according to studies) and lower the mortality rate that is identical to that of the general population.
The cons-indications are rare.Kidney malfunction, severe cardiac disorders, a low salt diet, prescription diuretics are cons-indications. Pregnancy requires special measures. The decision to continue treatment with lithium salts in a pregnant woman depends on the severity of previous episodes, history of suicide and risk of avulsion that could cause the appearance of a new episode. This decision will be made jointly with the psychiatrist, the obstetrician and patient. Tolerance is generally good, provided you follow certain rules prescribing and better adjust the dosage of lithium based on numbers of serum lithium levels, that is to say the concentration of lithium in the blood .
Anticonvulsants are preferably indicated in the treatment of mixed states (entanglement of excitation and depressive symptoms in the same episode), shapes rapid cycling (four episodes at least a year), in the absence of family history, and in the so-called secondary forms (where there is an organic cause).It is recommended to use an association with lithium salts in case of resistance. Conventional antipsychotics are commonly prescribed in the cure of a state of manic excitement. It is conventional to restrict the prescription of neuroleptics because of adverse neurological effects and a possible depressogenic effect. Limiting the duration requirement may nevertheless be a factor for relapse. The new generation antipsychotics appear to be more specific to this type of disorder, due to their good tolerance and lack of depressogenic effect.
Drugs mood stabilizers do not always protect against the onset of depressive episodes. Antidepressants may be justified in cases of major depression, knowing that they are exposed to risk turning manic excitation and acceleration of disease cycles. The new generation products (Seroxat, Seropram, Norset …), would expose the patient to a lower risk of provoking a state of excitement.
In psychiatry the term depression (or depression), Latin depressio, ‘draft’ is a relatively recent, it is around the nineteenth century it appeared in its psychological use.
He gradually – in part – supplanted the old term of melancholy which had become ‘lypemania (‘ madness sad ‘) with Esquirol (1819) and’ manic depressive ‘in the late nineteenth century Emil Kraepelin to describe syndromes is now called ‘major depression(Bipolar disorder, or mild: cyclothymia, etc..). Note that Kraepelin’s heard mostly in the direction of psychosis with the alternation of manic episodes – or hypomania – and depression.
So far the outset that all these terms are often used to refer to entities that contours are not clearly established. If one adds that the countries where they were not all used the same psychiatric tradition, whether for the terminology or the nature of the disorders described it is understandable that some confusion has not been fully abolished by the new international classification ICD or DSM U.S.. It is not trivial nor absurd to say that – or – depressions in psychiatry today are antidepressants that treat and although this is far from satisfactory in terms of epistemology! Roland Gori wonder how we arrived at the spread of diagnosis ‘depressing’ ranked as one of depression scourges of health at the time.He questions the fact that it has come to a diagnosis which he said is as much related to social norms with the reality of a real entity that would be the depression-diagnosed ‘liquid’ to a civilization ‘liquid’ (…) Perhaps the concept of soft depression is that it hides the misery of this civilization that disavows the value of melancholy? wonders there yet. He goes on to say that beyond a pathology resident in melancholia, the foundations of the subjectivity of the individual.
- Sommaire:
- 1 Entities according to different classifications
- 1.1 Major depressive episode (ICD DSM)
- 1.2 Endogenous depression and neurotic-reactive depression
- 1.2.1 Melancholy
- 1.2.2 Lows hostile, aggressive
- 1.2.3 Masked depression
- 1.2.4 Anxious depression, agitated
- 1.2.5 Seasonal depression
- 2 Causes of depression
- 2.1 Hypotheses about the biological
- 2.2 Assumptions about the psychological factors
- 2.3 Assumptions about the genetic factors
- 2.4 Assumptions about the social
- 3 History of depression
- 4 Diagnosis
- 5 Treatments
Entities according to different classifications
Major depressive episode (ICD DSM)
This term, proposed by the DSM, actually means ‘major depression’. Although they are not unanimous, the U.S. criteria of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition) of major depressive disorder are: A person must have at least 5 of 9 symptoms following a period at least two weeks, most of the time, causing a change in the mode of operation.At least one of these two criteria must be present: sad mood, anhedonia.
Endogenous depression and neurotic-reactive depression
This classification has some sort of historical basis, but the distinction is hardly used nowadays. […] Endogenous depression is characterized by a latent grief contrasts with emotional indifference (also called emotional anesthesia) for the exterior, a pessimism, a marked inhibition, themes of self-accusation autodévaluation and ideas delusions of ruin, disaster, incurable, insomnia with early awakening, anorexia with weight loss, a distaste for life inaccessible to any argument. The fluctuation of symptoms during the day is special in endogenous depression: very sharp in the morning (morning), they tend to fade late in the day. Overall, the depressed melancholic ignores the pathological aspect of his condition and refused any medical use, unnecessary.Health unipolar and bipolar depression: endogenous depression is often an expression of bipolar disorder (formerly called ‘manic-depressive’). It was initially well defined, tends to be divided into categories because of the evolutionary aspects, family history and therapeutic responses to the same unequal treatment. The form consists of bipolar depression and access to episodes of euphoric excitement, separated by a free interval. Unipolar form is itself defined by the repetitive occurrence of a single type of access generally depressed.
There are also secondary depression due to drugs, organic disease, psychiatric illness, or depression alexithymic or involution.
Melancholy
The term melancholia was used in psychiatry to describe a severe and acute depression with high risk of acting out suicidal.It has now been abandoned and most commonly used the term major depression. There was also talk of melancholy stupor to describe conditions characterized by severe psychomotor retardation that can range up to total immobility, a state prostrate and unable to drink or eat.
Lows hostile, aggressive
The subject’s personality seems to have changed radically. He became more aggressive, more impulsive, poorly mastered his anger, he has to sudden unusual … This comes from the fact that the subject can not stand the thought of being subjected to offensive remarks (existing or imagined) to her: ‘Shake it’, ‘You have everything to be happy’, etc.. It is a condition that can be summarized in few words: vomiting of his unhappiness on others through words or behavior sometimes much more than offensive.
Masked depression
Masked depression or hypochondriacal, are characterized by an absence of symptoms of depressed mood with a preponderance of somatic complaints.They often take the aspect of an atypical pain, continuous set, which remains despite prescription painkillers. The subject is often unaware that he suffers morally is the reason why he ‘somatizes’ (see also hysteria).
Anxious depression, agitated
These subjects are at high risk of suicide. Contrary to common features of depression, agitation and psychic driving are major, they are prone to panic attacks.
Seasonal depression
Seasonal depression settles in the fall or early winter and lasts until spring. Its symptoms are those of any depressive episode: constant sadness, loss of interest generally, irritability, insomnia, weight loss or gain, thoughts suicidaires.Les symptoms of SAD are distinct from those winter blues, which does not prevent us from continuing to fulfill our daily activities. Those who suffer from seasonal depression are much affected in their daily lives (work, relationships …).The exact cause is not known, but the decrease in the intensity of natural light and its duration seems to play an important role.
Causes of depression
Increasingly, and as for many psychiatric disorders, depression is understood as resulting from the interaction of a range of psychological, biological, social and genetic. This formula is conventionally and who can represent the form of a star: depression is the result of a factor present crisis presents itself as ‘a trigger’ that – it’s a trend – too often retains the attention of the clinician who bank and the synchrony neglecting diachrony, including life history of the subject and the interaction of:
Hypotheses about the biological
Every psychological state could correspond to physiological state. We are used to treat this aspect with regard to stress, for example, that we connect to adrenaline. This is part of popular language.Studies have shown the presence of different neurobiological dysfunction in depressed people. Among others, levels of serotonin and norepinephrine (neurotransmitters) are implicated in depression.
A number of biological abnormalities have been found in blood or brain of depressive patients. It is not always clear whether these abnormalities are causes or consequences of the disease, which may explain some failures of drug treatment. However, they open the door to new pharmacological therapies.
Research into the causes of depression have led researchers to examine brain chemistry. In the early fifties, some of the class of neurotransmitter monoamines attracted attention. These neurotransmitters, all derived from an amino acid, included dopamine, norepinephrine and serotonin.We know now that a system malfunction of noradrenaline or serotonin contributes to depression in some individuals, but the neurotransmitters are just beginning to reveal their mysteries and even today we do not yet know all their implications for the behavior human. One hypothesis is that the presynaptic reuptake of monoamines is too high, which creates a lack of these neurotransmitters. It has also been shown that neurotransmitters are destroyed during their passage through enzymes, monoamine oxidase. Norepinephrine is destroyed in a substance that is the dose in urine or MHPG méthoxyhydroxyphénylglycol gold was seen in many depressed urinary excretion of MHPG (from norepinephrine) decreased. The action of this enzyme would be too strong. The hyperactivity of this enzyme has been demonstrated in some depressed by a brain scan study. This would explain the effectiveness of certain treatments previously prescribed type monoamine oxidase inhibitor, commonly known as MAOIs.
Another hypothesis is the presence of an abnormality in brain receptors. This theory suggests an abnormality in the number of postsynaptic receptors. It also relates monoamines neurotransmitters but on a different model. The number of receptors that bind neurotransmitters come after crossing the synapse is not fixed but it changes depending on the quantity to maintain a fairly constant transmission of impulses:
The role of cortisol, a hormone whose production is increased under stress, seems also crucial. The rate is significantly increased in cases of depression, secondary to increased CRH. By cons, drugs targeting the inhibition of its production proved a disappointing effectiveness.
It is sometimes found a deficit of intracerebral BDNF (Brain-derived neurotrophic factor), an enabling factor for the growth of neurons and plasticity of synapses (junctions between neurons). This decrease is however not specific as found in several psychiatric disorders.
Other markers are being studied. Among these include homocysteine and omega-3.
Assumptions about the psychological factors
The biological aspect is not exclusively ‘the cause’ of the first depression. As most experts believe that depression is multi-factorial (overdetermined), all these factors interact with each other. The psycho-dynamic models explain in their own way, sometimes complementary sometimes contradictory mental processes e / or behavioral patterns of depression (see behaviorism, psychoanalysis, etc.)..
For specialists from the behaviourism, explains that when people are depressed, they tend to see reality more negatively. In turn, this more negative emotions amplifies depressive. On the other hand, negative interpretations of reality and the depressing emotions influence behavior (leading example of passivity) that in turn have an impact on thoughts and emotions.For psychoanalysts, there are also factors that are often unconscious intrapsychic by examples of processes of mourning, a fear of object loss or other conflicts. Freud in Mourning and Melancholia, Karl Abraham and Melanie Klein, etc.., Opened the field of a deep understanding of depression.
Apart from these views that are important to treatment, all kinds of scales have been established typologies (cf. Ernst Kretschmer) and the predisposing factors, with depression (see for example the profiles of depression Fr . Lelord and C. André). There are several more like those who put forward the ‘rate’ of stress events (death, accident, moving, etc.. Etc.) Classified by the impact they are supposed to have the appearance of a depression. All these scales involve external events on and try and explain the so-called reactive depressions.
Assumptions about the genetic factors
It is recognized that for certain depression hereditary factors play a role in creating the chemical imbalance in the brain when a person is experiencing depression. Although some genes are involved in depression, it does not appear that they inevitably trigger the disease. They would be content to transmit susceptibility to more easily enter a state of depression. Susceptibility when an event outside a particular personality might turn into a real depression. The genetic contribution of depression is approximately one-third (which is less than schizophrenia or bipolar syndrome). This heritability is more important in severe or occurring early. It is also important to realize that regardless the factor that precipitated a person into a depressive state, the final common pathway for depression, so to speak, involves an imbalance of certain neurotransmitters in the brain.
Several genes are being studied.Among these, the presence of a gene polymorphism of the serotonin transporter (5-HTTT) would be significantly associated with the occurrence of a reactive depression to the stress of everyday life.
Separations in early childhood or early childhood often make it more prone to depression in adulthood (cf. studies of Rene Spitz).
A difficult environment (hectic lifestyle, professional concerns and / or family, unemployment, divorce, bereavement, isolation, displacement, relocation) could make it more prone to the appearance and / or maintenance of depression. The importance and quality of support we receive through our interpersonal relationships (relatives, spouses, children, friends …) can protect us against stress and tensions of daily life, and reduce physical and emotional reactions stress, one of which may be depression. On the other hand, the absence of a close relationship, trust may increase the risk of depression.
History of depression
Depression has always existed: Homer spoke in song VI of the Iliad about Bellerophon who suffers the wrath of the gods: Object of hatred for the gods, he wandered alone in the plain Alcion, heart devoured grief, avoiding the footsteps of men. Homer is also the first extols the healing power of a mixture of herbs pharmakon virtues relieving. Hippocratic Aphorisms in writing: When the fear and sadness lingers long, it’s a sad state. Here then appears the ‘black bile’ and the theory of humors which he initiated and which will remain in force until the advent of modern medicine. Galen, rediscovered in the eighteenth century, for example, maintain that this theory also promotes a series of treatments ranging from medical and pharmaceutical cures ‘philosophical’ (entities), religious or even music, etc.. With Pinel and Esquirol primarily assumed the role of the brain is implicated as causes so-called ‘moral’ (today we would say psychological).Essentially an evil psychic calls and psychological remedies, Esquirol (1772-1840) wrote this: The moral medicine (now it looks like psychotherapy), which seeks in the heart of the leading causes of evil, who complains, cries, console , which shares the pain and awakens hope, is often preferable to any other. Ideas evolve much until 1900 but the proposed cure compete imagination. Everything was good for distracting the dark depressed moods!
Psychoanalysts, Sigmund Freud, Karl Abraham and Melanie Klein have allowed the emergence of a processual vision of depression located in the depression as the result of a psychic conflict (oedipal or narcissistic) and not as a passive carrier disease to cure. For Freud it’s sagit resolve the conflict repressed by analyzing strengths, so that the patient finds the freedom ‘to decide for this or that.’
It is also the success of pharmacology who gave depression its present size.Failing to know how to explain it enough thought at least now be able to heal. It is the Swiss psychiatrist Roland Kuhn, psychoanalytic circles close in 1956, discovered the antidepressant effects of imipramine. The Geigy pharmaceutical company initially refused to fund the development, judging, so the market is too narrow depression but views have evolved on this subject. These first antidepressants were mainly prescribed to hospital by psychiatrists for fear of side effects. From the late 1980s, new antidepressants coming on the market with less adverse effects. They are therefore required by all physicians, not just psychiatrists and sometimes below the usual indications. It has been thought that the lesser state of sadness could justify a requirement, however, minimizing side-effects like weight gain and decreased libido. The issue of depression – in fact we should rather speak in the plural – is largely become a matter of pharma market.
The German psychiatrist Hubertus Tellenbach theorized the various aspects of the problem of depression in a comprehensive and advanced on the psychopathological point of view. His book is a reference to the international level. One of his statements was that it was not about to see the melancholy in a bid to strict physico-chemical models. For him disciplines like philosophy (Heidegger in particular), psychology, the contributions of psychoanalysts such as Sigmund Freud and Karl Abraham, psychiatry through the contributions of Kraepelin and Kretschmer are complementary and indispensable to fully understand the phenomenon. Pharmacology does not solve everything, nor the time of the first antidepressant that today!
Diagnosis
The diagnosis of depression has become an important epistemological question. Indeed, given the evolution of ideas in psychiatry, clinical practice tends to lose ground to systems by the self-or hetero-administered (eg.: The Hamilton Depression Scale, the Beck that of Yesavage, or HAD …) Which have the advantage of providing quantifiable responses and the disadvantage of too often substitute for clinical evaluation, the only way to update the subjective factors unique to each patient, including suicidal ideation. This diagnosis ‘syndromic’ leave ‘completely in the dark anything that might resemble or indirectly, to something like a structural diagnosis, knowing that the reference is less than a countable set continuous ‘. Just also noted that the forms of these scales are often distributed free to all specialties physicians by pharmaceutical companies to measure what is at stake economically. The psychological examination is a diagnostic technique practiced by clinical psychologists and aims to clarify the nature of the / or / and depression / s in their structural foundation to delineate, for example, which relates to one of melancholy (psychotic) a depression (neurotic or borderline cases). There is also and so far no biological marker of depression.DSM and ICD classifications were initially thought to research and are not intended to substitute for clinical knowledge and reflection psychopathological practitioners (psychiatrists and clinical psychologists). The dissemination of these classification systems, the impact had left there the pharmaceutical companies in their development, ask questions of scientific interest where the concern is not the only cause. Note that the specialized areas tend increasingly to reclaim their approach in psychopathology to avoid commercial biases that have served their patients.
Treatments
We do not treat depression in the same way the infant, child, adolescent, adult or elderly person! For adults, the chapter on treatment is extremely difficult to deal: everything is said, tried and ‘sold’ about the treatment of depression: from walking, exercises, positive thinking, psychoanalysis through the tcc , light therapy, travel, etc.. etc.., to ECT or psychosurgery.The fact that under ‘depression’ are heard a range of disorders does not simplify things and the commercial aspect (antidepressants) relating thereto. We must also deal carefully with statistical research that sometimes – too often – again demonstrating the bias of those who were doing that reliable results and meaningful long term. It is best to first seek assistance from specialists (psychiatrists, psychologists, clinicians) before moving lightly. Basically, it is generally accepted that psychotherapy and antidepressants act at best, often jointly, psychotropic only rarely. It all depends also, of course, and again the patient age, type of depression and their own history as well as any identifiable causes of ‘the’ depression (trauma, childbirth, burnout, etc.)..