Treatment program for anxiety-phobic disorder.

Mental disorders belong to the group of complex neurotic disorders that require medical intervention. If a person experiences anxiety and depression at the same time, they are usually diagnosed with anxiety-depressive disorder, the symptoms and treatment of which depend on the severity of the pathology. The danger of the disease is that in severe cases a person can commit suicide. According to statistics, anxiety-depressive syndrome occurs in 5–15% of the population.

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Fear of “serious illness” is common:

• mental
• oncological
• cardiological
• or some other, unclear but frightening

Fear is accompanied by an obsessive search for signs of this disease.

Long-term anxiety can lead to panic attacks. Often, panic attacks and anxiety coexist with a fear of open or, conversely, too cramped space. There may be a fear of being in an awkward position in crowded places, for example: fainting, committing a senseless act.

The need to seek help

There is a very thin, barely discernible line between the feeling of anxiety normally and pathology due to the fact that the feeling of anxiety is the body’s natural protective reaction to external stimuli. At the same time, it is not permissible to independently diagnose and treat the disease, since this entails complication and aggravation of an existing condition.

In the center of Moscow, at JSC “Medicine” (clinic of Academician Roitberg), specialists provide the necessary assistance in the fight against anxiety disorders of any type and etiology. You can make an appointment by calling +7 or in person at the address: Moscow, 2nd Tverskoy-Yamskaya lane, 10, Mayakovskaya metro station.

Formulations of diagnoses that you may encounter when visiting a doctor

If you have already consulted a doctor or are just planning to do so, then do not be alarmed if you are suddenly given one of the following diagnoses:

• VSD (vegetative-vascular dystonia), NCD (neurocirculatory dystonia)
• neurosis, neurasthenia
• hypochondria, hysteria
• panic neurosis, panic disorder
• post-traumatic stress disorder
• psychasthenia
• generalized anxiety disorder, anxiety neurosis, anxiety-depressive disorder
• astheno-neurotic syndrome, vegetative paroxysms,
• obsessive-compulsive disorder

Unfortunately, many people are accustomed to the fact that an endless state of anxiety is a normal phenomenon, and sometimes they don’t even remember what it’s like to be healthy and live in a good mood.

An anxious state always signals a more global problem - you are not satisfied with your life, and it’s time to do something.

If you have been experiencing emotional discomfort for a long time or have been diagnosed with one of the above, then this treatment and rehabilitation program is for you.

Main factors of occurrence

The etiology of depressive neurosis is always psychogenic (stress due to external or internal factors), and contains the causes of neurosis and depression, as well as part of their symptoms, which often complicates diagnosis in the early stages of development. In addition, the clinical picture of the disorder is complemented by somato-vegetative symptoms, which further complicates diagnosis and differentiation with other pathologies.

Neurotic depression can occur in groups of people with directly opposite psychotypes. The first of them is people who are confident in their beliefs, distinguished by categorical statements, setting new goals and achieving them. At the same time, they hide their inner world from others. A large place in it is given to concerns and worries about personal leadership and the assessment of their actions by those around them.

The second group of people susceptible to neurotic depression includes individuals who poorly adapt to various life complications and even natural changes. They are characterized by low self-esteem, inability to make decisions, daydreaming in the absence of action.

Factors that can cause neurotic disorders such as depression in both groups can be long-term psychotraumatic circumstances: personal failures in professional activities, failures in personal life, social relationships. Among these factors, the most influential are:

• constant suppression of real feelings and emotions, hiding true feelings from others;
• inability to distance yourself from a situation, not to get involved, not to take it to heart;
• an overly heightened sense of responsibility and desire to be the best;
• conflict between the goal and the means to achieve it;
• emotional hunger - the absence of like-minded people, loved ones, friends, relatives, the inability to do what you love, to communicate with the people you want.

The accumulation of these unfavorable factors gives a person the impression that it is impossible to correct the situation; he does not even try to look for ways to solve problems, directing all efforts to hiding the internal conflict. As a result, the nervous system cannot withstand such stress, and the first visible sign of depressive neurosis appears - autonomic-somatic disorders.

Clinical picture (how the disease manifests itself)

Main symptoms include:

• sudden onset of palpitations,
• asthma attack,
• nausea,
• chest pain,
• feeling of unreality (depersonalization and derealization).
• symptom of “cotton legs” - severe weakness in the legs,
• tinnitus, dizziness, darkening of the eyes,
• sensation of hot flashes inside the body.

All this happens against the backdrop of fear of dying, losing control or going crazy. After a panic attack, the patient feels weak and very tired, which is described as a “feeling of soreness.” Between attacks, anxiety persists, the fear that the attack will happen again. After repeated attacks, frightening thoughts appear about the “infinity” of the disease: “it will never end.” Sometimes panic attacks develop against the background of depression.

Causes and mechanism of development

There are two main groups of factors that can cause SDD in a person: psychological and physiological.

Psychological factors

The psychological causes of SDD are most often stressful or traumatic experiences: the death of a loved one, loss of a job, uncertainty of the future due to socio-economic upheavals, a serious illness, etc.

Moreover, the formation and development of TDR does not occur at the time of the stressful event itself, but somewhat later—several weeks or even months later. When thinking about what happened, people of a certain character begin to experience fears like “it will happen again” or “it will happen to me too.”

In their imagination, patients with SDD begin to imagine various, but always pessimistic, options for their own future: the onset of bankruptcy, the discovery of an incurable disease, the outbreak of war, the death of all loved ones, etc. Somewhat less often, these anxious experiences are of a pointless nature, when the patient simply “feels” that something terrifying will happen soon.

The constant expectation of “the collapse of everything and everyone” leads to the development of clinical depression, against the background of which anxious fears only intensify. This creates what is called a vicious circle, where anxiety and depression mutually aggravate each other. The final outcome of untreated SDD is suicide.

Physiological factors

Physiological causes of TDD include hormonal changes (especially in menopausal women), brain disorders, and central nervous system injuries.

In this case, there may not be a primary traumatic event that will initiate the development of SDD. Most often, such patients complain of an unreasonable feeling of anxiety or exaggerate in their minds some insignificant stressful event.

When do you need to use a course treatment program?

You are recommended to undergo the “Not Scary at All” treatment and rehabilitation program if you discover the following symptoms.

• Irritability, fear or anxiety, quickly developing into panic.
• Expectation of trouble or misfortune. Nervous tension. Physical stress. Headache.
• Intestinal dysfunction, diarrhea. Nausea and vomiting. Muscle pain.
• Decreased performance. Insomnia. Sexual disorders.
• Tachycardia (rapid heartbeat), shortness of breath (rapid breathing, lack of air).
• Fear of going crazy or losing control of yourself. A feeling of unreality of the surrounding world, a feeling of time slowing down.
• Fear of “disappearing.” Prostration. Decreased vitality and motivation for life, the perception of the environment is “flat”, “in gray colors”.
• With severe panic disorder, there is a fear that another panic attack will occur spontaneously, “in public.”

Symptoms

The clinical manifestations of anxious depression are extremely diverse and vary depending on the character traits and ideological views of the patient. Common features of TDR traditionally include:

1. Unfounded fears . Patients are not able to reasonably explain why in the near future they “must” die, go bankrupt, witness the Apocalypse, and so on.
2. Personal changes . Patients with TDD demonstrate previously absent nervousness, tearfulness, constant anxiety, and a desire to play it safe in everything. Also in most cases there is a noticeable decrease in self-esteem.
3. Narrowing the circle of interests . The scope of interest is limited to the subject of the phobia: for example, when they are afraid of losing their job, patients constantly study job advertisements “just in case,” and when they are afraid of getting sick, they study medical encyclopedias. Former interests and hobbies lose their former attractiveness.
4. Sadness of mood . The predominant mood pattern of patients with TDD can be described as sadness, fatigue, or detachment. The conversation is dominated by the theme of the purposelessness of any activity or life itself.
5. Somatic disorders . Patients experience tachycardia and pain in the heart, digestive and stool disorders, high blood pressure, general weakness and rapid fatigue, lack of sexual desire, headaches and dizziness, insomnia, a feeling of suffocation, frequent urination, sweating, tremors, muscle tension and convulsions.

Treatment of anxiety and depressive disorders in Neurology

Don’t tolerate illness – seek specialized help!

Anxiety and depressive disorders require immediate medical attention due to the high risk of chronicity of the disease. It is not uncommon for acute attacks of fear to continue to torment for years. Fortunately, panic attacks are well treated with modern methods. Neurology statistics show that when completing the course program, significant improvement occurs in the vast majority of cases.

Every day, specialists at the Neuro-PSI clinic analyze world practice in the field of psychiatry and psychotherapy. The goal is the impartial selection and implementation of those methods of treatment and psychological assistance, the effectiveness of which has been convincingly proven in independent studies.

We are guided only by the principles of evidence-based medicine.

Will depression go away or is it forever?

If the disease lasts for a long time, many people begin to fear that they will never be able to get rid of it. Is it so? If the disease is mild, you can cope with it yourself. Sooner or later a person will experience a traumatic situation, reevaluate it, change his attitude towards the event and recover. In some cases, the use of medications leads to a bad mood, but after their withdrawal the condition returns to normal. Any psychiatrist, psychologist or psychotherapist will tell you that treatment for depression is necessary. This will allow a person to get rid of obsessive thoughts and gain more positive thinking, which will increase the quality of life, and possibly its duration.

Without treatment for depression in women and men, the disease will progress, exacerbating the psycho-emotional state and causing the development of mental disorders, especially for older people. But even for young people the disease does not go away without a trace. You shouldn’t fight it alone, share your problems with loved ones and friends, look at them from the outside, listen to advice, consult a doctor for treatment of panic attacks, moderate and severe depression.

• You can't convince me to get treatment
  ?
• We will help you with motivation for treatment. As a rule, it is difficult for loved ones to persuade or force an addict to undergo treatment. World experts have developed EFFECTIVE motivation schemes, using which you can lead an addict to the decision to seek help. 8

What is the essence of the treatment program for anxiety-phobic disorder?

Any mental disorder greatly affects the quality of life and keeps you in constant tension, so our task is to quickly relieve you of panic attacks and chronic anxiety, teach you self-control skills and return you to a full life.

Clinic specialists (psychologists, psychotherapists, psychiatrists) carry out comprehensive work with the client, taking into account the main factors that create well-being. The main emphasis is on teaching the client the correct reaction to his thoughts, emotions, internal sensations and interpretation of external events.

Publications in the media

Mood disorders are disorders in which the main disturbance is a change in affect or mood towards elevation (mania) or depression (depression), accompanied by a change in the general level of activity. Depressive and manic states can occur in many somatic and almost all mental illnesses, and can also be caused by drugs (for example, narcotic analgesics, antihypertensives, antitumor drugs, sedatives, antiparkinsonian drugs, antibiotics, antipsychotics, GCs).

Frequency. The lifetime risk of developing various forms of mood disorders is 8–9%. Women get sick 2 times more often with a predominance of depressive variants. Only 20% of patients go to medical institutions, half of them do not realize the nature of their disease and present somatic complaints, and only 30% are recognized by a doctor. 25% of patients receive adequate therapy. CLINICAL PICTURE The clinical picture of mood disorders includes depressive and manic syndromes. Depressive syndromes Depending on the number and severity of symptoms, depressive syndromes are classified as mild, moderate and severe. • Moderately severe depressive syndrome •• Decreased mood with a feeling of melancholy, slower pace of thinking and motor retardation are the main signs of depressive syndrome •• The appearance of patients is characteristic: a sad expression on the face, a suffering vertical fold between the eyebrows, hunched posture, head down, gaze fixed down. Despite their difficult mental state, some patients are able to joke and smile (“smiling depression”) •• Motor retardation is a common symptom of depression (although agitation, described below for agitated depression, is not excluded). The patient's movements are slow and performed only when absolutely necessary. With severe motor retardation, patients spend most of their time lying in bed or sitting, without feeling the need for active action. The slowing down of the pace of thinking is reflected in the speech of patients: questions are answered with a long delay, after long pauses •• Patients are especially painfully experiencing a depressed mood with a feeling of melancholy. Patients rarely describe their condition as low mood. More often they complain of sadness, a feeling of melancholy, lethargy, apathy, depression, depression. Melancholy is described by patients as mental heaviness in the chest, in the area of ​​the heart, in the head, sometimes in the neck or abdomen; explain that this mental, “moral” pain •• Other common symptoms of depression are anxiety (see Anxiety disorders) and irritability. The increase in anxiety most often occurs in the evening. As depression deepens, anxiety turns into agitation: patients in this state are unable to sit still, rush about, moan, and wring their hands; often attempt suicide in the presence of medical personnel or other persons. Irritability in depression is manifested by constant irritation, gloominess, dissatisfaction with oneself and others •• Loss of interests and the ability to have fun. Patients complain about their insensitivity, say that the feelings of other people are inaccessible to them, everything around them loses value (here this condition should not be confused with emotional emptiness in patients with schizophrenia). In severe cases, patients claim that they have lost love for people previously dear to them, have ceased to feel the beauty of nature, music, and have generally become insensitive; talking about this, patients have a hard time experiencing their change, so this condition is called painful mental insensitivity (anaesthesia psychica dolorosa) •• Almost all patients with depression complain of decreased energy, it is difficult for them to start something, to finish what they started; academic performance and productivity decreases. Many patients attribute their lack of energy to some physical illness. •• With depressive syndrome, biological symptoms are often observed. These include sleep disorders (early awakenings are the most typical: the patient wakes up 2-3 hours before the usual time of awakening and can no longer fall asleep, experiences anxiety, restlessness, thinks about the coming day), diurnal mood swings (deterioration of mood in the morning), decreased appetite, weight loss, constipation, amenorrhea, decreased sexual function •• Depressive thoughts (depressive thinking) are an important symptom of depression. Identifying depressive thoughts helps the doctor predict and prevent possible suicide attempts. Depressive thoughts can be divided into three groups ••• The first group relates to the present time. Patients perceive their surroundings in a gloomy light and are focused on thoughts of self-deprecation. For example, the patient believes that he cannot cope with his work, and those around him consider him a failure, despite obvious successes ••• The second group concerns the future tense. Patients completely lose hope for anything good in the future, are filled with a feeling of hopelessness, the hopelessness of their situation and the aimlessness of further life. For example, the patient is sure that in the future he will become unemployed or get cancer). Suicidal attempts during depression are most often caused by this particular group of depressive thoughts ••• The third group refers to the past tense. Patients experience an inappropriately strong feeling of guilt, remembering minor misdeeds from a past life, cases when they behaved insufficiently ethically, made mistakes, etc. •• Complaints about somatic symptoms are often noted in depression. They can be very diverse, but the most common complaints are constipation and pain (or discomfort) in any part of the body •• With depressive syndrome, other mental disorders are observed: depersonalization, obsessive states (see Obsessive-compulsive disorder), phobias (see Disorders phobic), etc. •• Patients often complain of memory impairment, which is associated with impaired concentration. However, if the patient makes an effort, then the processes of memorization and reproduction themselves turn out to be intact. But sometimes these memory impairments, especially in the elderly, become so severe that the clinical picture is similar to dementia. • Masked depression •• Masked (larved, hidden) depression is a subdepressive state combined with somatic disorders dominant in the clinical picture that mask low mood. The frequency of masked depression exceeds the number of overt depression by 10–20 times. Initially, such patients are treated by doctors of various specialties, most often by therapists and neurologists. Masked depression is most often observed in mild and moderate depressive syndrome, and much less frequently in severe depressive syndrome. •• The most common complaints are complaints about disorders of the cardiovascular system (attacks of pain in the heart) and digestive organs (decreased appetite, diarrhea, constipation, flatulence, abdominal pain). Various sleep disorders are very often noted. Patients complain of a feeling of loss of strength, weakness, loss of interest in favorite activities, a feeling of vague anxiety, rapidly developing fatigue when reading a book or watching television •• There are often cases when masked depression causes alcohol abuse.

• Severe depressive syndrome •• With further development and severity of the depressive syndrome, all of its symptoms described above appear with greater intensity. A distinctive feature of severe depressive syndrome is the addition of psychotic symptoms: delusions and hallucinations (therefore, some authors call this disorder the term “psychotic depression”) •• Delusions in severe depressive syndrome are represented by ideas of self-abasement, guilt, the presence of severe somatic diseases (hypochondriacal delusions) •• With severe depressive syndrome, patients most often experience auditory hallucinations, the content of which reflects the painful depressive state of the patients. For example, a patient hears a voice reporting the hopelessness and meaninglessness of his suffering, recommendations to commit suicide, or the groans of dying loved ones, their calls for help, etc. Much less often, patients experience visual hallucinations, which also reflect a depressive mood (for example, scenes of death or execution). • Agitated depression - depression with agitation. Agitation is motor restlessness combined with anxiety and fear. Patients are extremely tense and do not find a place for themselves: they stereotypically rub their hands, finger their clothes with their hands, walk a lot, persistently turn to the staff and others with some kind of request or remark, sometimes they stand at the doors of the department for hours, shifting from foot to foot and grabbing clothes passing.

• Inhibited (adynamic) depression. With inhibited depression, the leading symptom is psychomotor retardation. In some cases, the severity of psychomotor retardation reaches the level of stupor (depressive stupor). If symptoms reverse during treatment, when depression is still strong and motor retardation disappears, the risk of suicide increases sharply! • Mild depressive syndrome (subdepression) - depression of mild severity. The affect of deep melancholy and motor retardation are absent, outwardly the behavior of patients can remain orderly, although devoid of energy and activity. The patients' condition is dominated by anhedonia, lack of mood, anxiety, and self-doubt. Patients note that in the morning it is difficult to force themselves to get out of bed, get dressed, and wash; Carrying out the usual duties at home and at work requires a lot of effort, there are no desires, there is no confidence in the success of any undertaking. When waking up, there is no sensation of transition from sleep to wakefulness - hence the unfounded complaints of “complete insomnia.” Anxiety, common in subdepression, is often accompanied by hypochondria, obsessive thoughts and phobias.

Manic syndrome Manic syndrome is a combination of elevated mood, accelerated tempo of thinking and increased motor activity. • Patients' appearance often reflects elevated mood. Patients, especially women, tend to dress brightly and provocatively, and use cosmetics excessively. The eyes are shiny, the face is hyperemic, and when talking, splashes of saliva often fly out of the mouth. Facial expressions are lively, movements are fast and impetuous, gestures and postures are emphatically expressive. • High spirits are combined with unshakable optimism. All the experiences of patients are painted only in rainbow tones. Patients are carefree and have no problems. Past troubles and misfortunes are forgotten, the future is painted only in bright colors. Patients describe their own physical well-being as excellent; the feeling of excess energy is a constant phenomenon. At first glance, such patients may give an outside observer the impression of being mentally healthy, but unusually cheerful, cheerful and sociable. Other patients experience irritability and easily develop reactions of anger and hostility. Orientation, as a rule, is not impaired, but consciousness of the disease is often absent. • Increased motor activity - patients are constantly on the move, cannot sit still, walk, interfere in everything, try to command the patients, etc. During conversations with a doctor, patients often change their position, spin, jump up, begin to walk and often even run around the office. They take on any task, but only move from one thing to another, without bringing anything to the end. Patients with manic syndrome are very willing to communicate with others and actively intervene in conversations that do not concern them in any way. • Acceleration of the pace of thinking - patients talk a lot, loudly, quickly, often without stopping. With prolonged speech stimulation, the voice becomes hoarse. The content of the statements is inconsistent. Easily move from one topic to another. With increasing speech excitement, a thought that does not have time to finish is already replaced by another, as a result of which statements become fragmentary (“jump of ideas”). The speech alternates with jokes, witticisms, puns, foreign words, and quotes.

• Sleep disturbances manifest themselves in the fact that patients sleep little (3–5 hours a day), but at the same time they always feel cheerful and full of energy. • With manic syndrome, an increase in appetite and increased sexual desire are almost always noted. • Expansive ideas. The possibilities for realizing numerous plans and desires seem limitless to patients; patients do not see any obstacles to their implementation. Self-esteem is always overly elevated. It is easy to overestimate your capabilities - professional, physical, related to entrepreneurship, etc. For some time, patients can be dissuaded from exaggerating their self-esteem. Expansive ideas easily turn into expansive delusions, which are most often manifested by delusional ideas of greatness, invention and reform. • In severe manic syndrome, hallucinations are noted (rarely). Auditory hallucinations are usually of praising content (for example, voices telling the patient that he is a great inventor). With visual hallucinations, the patient sees religious scenes. • The hypomanic state (hypomania) is characterized by the same features as severe mania, but all symptoms are smoothed out, there are no gross behavioral disorders leading to complete social maladjustment. Patients are active, energetic, prone to jokes, and overly talkative. The increase in their mood does not reach the level of conspicuous indomitable gaiety, but is manifested by cheerfulness and optimistic faith in the success of any undertaking. Many plans and ideas arise, sometimes useful and reasonable, sometimes overly risky and frivolous. They make dubious acquaintances, lead an indiscriminate sex life, begin to abuse alcohol, and easily take the path of breaking the law.

CLASSIFICATION OF MOOD DISORDERS Classifications based on etiology • Endogenous and reactive depression. The terms “endogenous” and “reactive” are not included in the modern classification of mental illnesses, but some psychiatrists still use these concepts. With endogenous depression, symptoms are caused by factors not related to the patient’s personality and do not depend on the traumatic situation. In reactive depression, symptoms are directly related to traumatic situations. In practice, only endogenous or only reactive depressions are rare; Mixed depression is much more common. • Primary and secondary depressive syndromes. Secondary depressive syndromes are caused by another mental disorder (for example, schizophrenia, neurosis, alcoholism), a somatic or neurological disease, or the use of certain drugs (for example, GCs). In the case of primary depressive syndrome, it is not possible to detect any cause that caused the depression.

Classification based on symptoms • Neurotic and psychotic depression. With neurotic depression, the symptoms characteristic of psychotic depression (severe depressive syndrome) are more smoothed out, less pronounced, and are often caused by traumatic situations. Neurotic depression is often accompanied by neurotic symptoms such as anxiety, phobias, obsessive-compulsive disorder and, less commonly, dissociative symptoms. In the modern ICD-10 classification, neurotic depression is described as “dysthymia”.

Classification based on course • Bipolar mood disorder •• In the previous ICD-10 classification, these disorders were described under the term “manic-depressive psychosis.” Bipolar mood disorder manifests itself in alternating manic or depressive phases (episodes). Episodes can immediately follow each other (for example, a depressive state is immediately replaced by a manic syndrome) or at intervals of complete mental health (for example, a patient has emerged from a depressive state and after a few months a manic syndrome develops). The disorder does not lead to a decrease in mental functions even with a large number of phases experienced and any duration of the disease •• Bipolar disorders usually begin with depression. To make a diagnosis of bipolar disorder, the development of at least one manic (or hypomanic) episode during the course of the disease is sufficient. • Cyclothymia (cyclothymic disorder) is characterized by a chronic course with numerous and short-lived episodes of hypomanic and subdepressive states. Cyclothymia can be thought of as a milder version of bipolar disorder. Clinical manifestations are similar to those of bipolar mood disorder, but they are either less pronounced or less persistent. The duration of the phases is significantly shorter than in bipolar disorder (2–6 days). Episodes of disturbed mood occur irregularly, often suddenly. In severe cases, there are no “bright” intervals of normal mood. The onset of the disease is usually gradual and occurs between the ages of 15 and 25 years. 5–10% of patients develop drug addiction. The history indicates frequent changes of residence and involvement in religious and occult sects. • Depressive disorders •• Recurrent depressive mood disorder (unipolar depression, unipolar mood disorder) is a disease that occurs in the form of several major depressive episodes throughout life, separated by periods of complete mental health. The first episode can occur at any age, from childhood to old age. Its onset can be acute or unnoticeable, and its duration can range from several weeks to many months. The risk of a person with recurrent depressive disorder never having a manic episode is never completely eliminated. If this happens, the diagnosis is changed to bipolar affective disorder. Depressive disorders do not lead to a decrease in mental functions even with a large number of phases experienced and any duration of the disease •• Seasonal affective disorder - depression that occurs in winter, with a reduction in daylight hours. Decreases and disappears with the onset of spring and summer. Characterized by drowsiness, increased appetite and psychomotor retardation. Associated with pathological metabolism of melatonin •• Currently, neurotic depression and erased forms of recurrent depressive disorder are combined into dysthymic disorder. In the ICD-10 classification, neurotic depression (depressive neurosis) is included in dysthymic disorder (dysthymia). Dysthymia is a less severe form of depression, usually caused by a long-term traumatic situation. The disorder tends to be chronic. With dysthymia, the symptoms characteristic of severe depressive syndrome are more smoothed out and less pronounced.

DIFFERENTIAL DIAGNOSTICS OF MOOD DISORDERS • Grief reaction. Depressive disorders must be distinguished from the normal grief reaction to severe emotional stress (for example, the death of a child). The grief reaction differs from depressive disorder in the absence of thoughts of committing suicide; patients are easily persuaded, and their condition is alleviated when communicating with other people. Treating grief-stricken patients with antidepressants is ineffective. Some patients with grief reactions subsequently develop major depressive disorder. • Anxiety disorder can be difficult to distinguish from subdepressive conditions, especially since anxiety and depression often co-occur. To make a correct diagnosis, it is necessary to assess the severity of anxiety and depression, as well as the sequence of their onset. If the patient’s symptoms of depression are more pronounced and appear first, and then anxiety joins in, then a diagnosis of depressive disorder is more likely. Conversely, if the disease begins with symptoms of anxiety, which are the only manifestations of the clinical picture, and then symptoms of depression appear, then the patient most likely has an anxiety disorder. The same principle is used in the differential diagnosis of obsessive-compulsive and phobic disorders. • Schizophrenia. Delusions and hallucinations are observed in both manic and depressive episodes. Mood disorders do not lead to a decrease in mental functions even with a large number of phases experienced and any duration of the disease. Whereas in schizophrenia, negative symptoms are observed, leading to persistent personality changes. • Schizoaffective disorder. In cases where the clinical picture shows equally pronounced symptoms of a mood disorder (manic or depressive syndrome) and schizophrenia, a diagnosis of schizoaffective disorder is more likely (see Schizoaffective disorder). • Dementia. Memory impairments in depression have a more acute onset and are caused by impaired concentration; The clinical picture also includes other symptoms of depression, such as depressive thinking. Patients with depression who complain of memory impairment usually do not hesitate to answer questions (“I don’t know”), while patients with dementia try to avoid a direct answer. In depressed patients, memory for current and past events is equally impaired; Dementia patients suffer more from memory for current events than for past ones. • Organic brain damage. When a manic state appears in old age in combination with severe behavioral disturbances (for example, public urination) and especially the absence of a history of manic and depressive episodes, one should think first of all about organic damage to the brain (most often the frontal lobe - “frontal lobe syndrome”), for example a tumor. In this case, additional studies are carried out - MRI/CT, ​​EEG. • Mood disorders caused by substance abuse (eg, heroin, amphetamine). Substance abuse and dependence are typically accompanied by mood disorders. In differential diagnosis, anamnesis data and the results of urine tests for the content of psychoactive substances are taken into account. • Mood disorders caused by drug use. When assessing the patient’s condition, it is necessary to find out what medications he is currently taking, which ones in the past, and whether he has previously had changes in mental well-being while taking any drugs. It is important to adhere to the principle that every drug that the patient takes can be a factor causing a mood disorder.

Research methods • Laboratory methods •• General blood and urine tests •• Dexamethasone suppression test •• Study of thyroid function •• Determination of vitamin B12, folic acid • Special methods •• ECG •• EEG •• CT/MRI • Psychological methods •• Zung Self-Esteem Scale •• Hamilton Depression Scale •• Rorschach Test •• Thematic Apperception Test. Differential diagnosis • Neurological diseases (eg, epilepsy, hydrocephalus, migraine, multiple sclerosis, narcolepsy, brain tumors) • Endocrine disorders (eg, adrenogenital syndrome, hyperaldosteronism) • Psychiatric diseases (eg, dementia, schizophrenia, personality disorders, schizoaffective disorder, adjustment disorder with depressive mood). COURSE AND PROGNOSIS Depressive disorders. 15% of people with depression commit suicide. 10–15% make suicide attempts, 60% plan suicide. It should be remembered that the likelihood of suicide is greatest during the recovery period during treatment with antidepressants. A typical depressive episode, if left untreated, lasts about 10 months. At least 75% of patients experience a second episode of depression, usually within the first 6 months after the first. The average number of depressive episodes during a lifetime is 5. The prognosis is generally favorable: 50% of patients recover, 30% do not recover completely, and in 20% the disease becomes chronic. Approximately 20–30% of patients with dysthymic disorder develop (in decreasing frequency) recurrent depressive disorder (double depression), bipolar disorder. Bipolar disorders. About a third of people with cyclothymia develop bipolar mood disorder. In 45% of cases, manic episodes recur. Manic episodes, if left untreated, last 3–6 months with a high likelihood of relapse. Approximately 80–90% of patients with manic syndromes eventually develop a depressive episode. The prognosis is quite favorable: 15% of patients recover, 50–60% do not recover completely (numerous relapses with good adaptation between episodes), in a third of patients there is a possibility of the disease becoming chronic with persistent social and labor maladjustment.

TREATMENT Basic principles • Combination of drug therapy with psychotherapy • Individual selection of drugs depending on the prevailing symptoms, effectiveness and tolerability of drugs. Prescription of small doses of drugs with a gradual increase • Prescription for exacerbation of drugs that were previously effective • Revision of the treatment regimen if there is no effect within 4-6 weeks Treatment of depressive episodes • TAD - amitriptyline and imipramine. For psychomotor agitation, anxiety, restlessness, irritability or insomnia, amitriptyline is prescribed - 150–300 mg/day; for psychomotor retardation, drowsiness, apathy - imipramine 150–300 mg/day • Selective serotonin reuptake inhibitors. If depression is resistant to treatment with high doses of amitriptyline or imipramine, this does not mean that newer antidepressants will be effective in this case. The development of anticholinergic side effects is the main reason for unauthorized discontinuation of TAD treatment. In addition, amitriptyline and imipramine are contraindicated in patients with heart disease, glaucoma and prostatic hypertrophy. It is preferable for such patients to be prescribed selective serotonin reuptake inhibitors, because they are more secure. Selective serotonin reuptake inhibitors are as effective as imipramine and amitriptyline, do not cause anticholinergic side effects, and are safer in overdose. The drugs are prescribed once in the morning: fluoxetine 20–40 mg/day, sertraline 50–100 mg/day, paroxetine 10–30 mg/day. • MAO inhibitors (eg, nialamide 200–350 mg/day, preferably in 2 doses morning and afternoon) are usually less effective for severe depressive disorders than TADs, and have the same effect for mild disorders. But in some patients resistant to TAD treatment, MAO inhibitors have a therapeutic effect. The effect of drugs in this group develops slowly and reaches a maximum by 6 weeks from the start of treatment. MAO inhibitors enhance the effect of vasoconstrictor amines (including tyramine, found in some foods - cheese, cream, coffee, beer, wine, smoked meats, red wines) and synthetic amines, which can lead to severe arterial hypertension. • Electroconvulsive therapy (ECT). Clinical studies have shown that the antidepressant effect of ECT develops faster and is more effective in patients with severe depressive disorder with delusional ideas than with TAD. Thus, ECT is the method of choice in the treatment of patients suffering from depressive disorder with psychomotor retardation and delirium when drug therapy is ineffective. Synonym. Affective Disorders Abbreviations . ECT - electroconvulsive therapy

ICD-10 • F06.3 Organic mood disorders [affective] • F30 Manic episode • F31 Bipolar affective disorder • F32 Depressive episode • F33 Recurrent depressive disorder • F34 Persistent mood disorders [affective disorders] • F38 Other mood disorders [affective] • F39 Mood disorder [affective] unspecified.

What treatment methods are used?

Primary: cognitive behavioral psychotherapy. (the gold standard for the treatment of panic and anxiety disorders throughout the civilized world)

Besides:

• stress exposure,
• breathing techniques training,
• training in progressive muscle relaxation techniques,
• therapy using a biofeedback system,
• self-control training,
• modernization of lifestyle,
• resolving family conflicts,
• assistance in self-realization and establishing relationships,
• specific drug therapy (for severe disease).

Why are these particular methods used?

If you have tried other methods before, then you know that hospitalization, massage, exercise therapy and acupuncture bring only temporary relief, since they do not affect the mental sphere, on which the condition of the entire body depends.

Antidepressant addiction – myth or truth?

It is impossible to say unequivocally that drugs for depression are evil. But also the fact that they are absolutely harmless. Medicine does not stand still, just like pharmacology. Medicines are constantly being improved and improved. Today, those medications that caused drug addiction and posed a real threat to health due to side effects are long gone. The latest generation of drugs is much safer than their predecessors.

In some cases, patients have to take medications for years, not because they become dependent, but because the treatment plan and indications require it. However, most often, when contacting specialists at an early stage of the disease, the use of drugs is not required, or a short course of treatment is required. The dosage is gradually reduced, which prevents the development of drug dependence. A person gradually gets used to living without medications.

However, the truth is that while most of these pills are banned from over-the-counter sales, some people circumvent the law and purchase them illegally. Why is this being done? The fact is that some drugs, when overdosed and used for a long time, can still be addictive. Some of the most common over-the-counter drugs include Lyrica and Fluoxetine (Prozac). When used for other purposes, for recreational purposes, the drugs can cause addiction, which can only be gotten rid of with the help of a narcologist.

You should not self-medicate, increase the duration of use and dose, this can lead to undesirable consequences and side effects. If you feel you cannot stop taking the drug, call your doctor. He can help you get rid of your addiction.

How does the treatment program work?

Each treatment program at the NEUROPSI consists of four stages:

• diagnostics
• working with symptoms of the disease
• working with the causes of the disease
• consolidation of achieved results

Work efficiency is increased by accurately planning the time required to achieve therapy results. This means that each program is adapted to the problem that the client has addressed.

The program method of treatment is predictable, time-limited, productive, and most importantly, understandable to the client.

Of course, treatment takes place in a comfortable manner without interruption from work, study or family. Specialists of various profiles will work with you (team method). This is necessary to minimize the risk of diagnostic errors that could lead to the adoption of a suboptimal treatment plan.

Improvements in well-being and mood (healing) occur in stages: following a decrease in emotional problems, physical symptoms decrease. Working with the causes of anxiety and phobias allows you to avoid relapses in the future.

Cure prognosis

TDR of physiological etiology is easily eliminated during the treatment of the underlying disease, with the exception of irreversible forms of brain damage. The difficulty is in the treatment of anxious depression caused by personal and psychological factors. In this case, early intervention and the assistance of the patient’s immediate environment play a decisive role.

Carrying out a full course of complex therapy helps to remove anxiety and normalize the general emotional mood, but to ensure the absence of relapses, patients are recommended to work on developing stress resistance so that an unexpected “blow of fate” does not provoke a new attack of anxiety and depression.
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What are the results and prognosis?

Upon successful completion of the program, you will get rid of unmotivated fears, panic attacks and multiple vegetative symptoms (sudden surges in blood pressure, rapid heartbeat, dizziness, nausea)

According to statistics, the effectiveness of the methods used is close to 100% if all recommendations of specialists are followed.

Skills you acquire during the program:

• self-control and self-regulation
• constructive analysis of the body's condition
• understanding your own mental and emotional sphere
• ability to act consciously in stressful situations

The emotional and physical state improves significantly, and confidence in oneself and the future is gained. Emotional stress is relieved, sleep and appetite are restored. Performance increases many times over.

What is the difference between depression and just a bad mood?

It is characterized by a number of characteristics. If we turn to the International Classification of Diseases, we will see that a person with depression suffers from low mood, loss of interests and feelings of pleasure, and decreased vital energy. These are the main, basic symptoms of this condition. For a confident diagnosis, the presence of two of them is sufficient. There is also a decrease in the ability to concentrate, a decrease in self-esteem and feelings of self-confidence, and the idea of ​​\u200b\u200bguilty of something. Views on the future are gloomy and pessimistic. Sleep is disturbed and appetite decreases. Ideas arise about the meaninglessness of life. A bad mood persists from day to day, no matter what happens around, and it is especially bad in the morning, immediately after waking up.