Involutional melancholy
Involutional melancholy usually develops gradually, its initial period is an average of 2-3 months. Patients complain of weakness, fatigue, lethargy, and these phenomena do not disappear after rest. Attention is focused on discomfort in the internal organs, mood is reduced. If the disease begins during menopause, then vegetative disorders intensify. With a later onset of psychosis, autonomic symptoms are less pronounced. In the initial period of the disease, asthenovegetative, senestopathic, phobic, hypochondriacal, hysterical, and dysthymic syndromes are usually observed (V.N. Ilyina, 1980). The forerunners of mental disorders are most often sleep disorders, indecision, fatigue, excessive suspiciousness, obsession, which are often triggered by a change in familiar living conditions: retirement, a traumatic situation in the family, fear of an imaginary severity of deterioration in somatic health, etc. On this background, sometimes appear thoughts about the unfair attitude of others, a tendency to exaggerate the severity of their suffering. In some patients, the onset of psychosis is acute after mental trauma or somatic illness.
In the nonpsychotic stage of involutional melancholy, patients do not complain of a sad mood, tend to explain a decrease in mood by poor general health or unpleasant events, describe their feelings vividly, figuratively. Some patients have a suspicion that they fell ill with a serious somatic disease, but the degree of conviction is subject to fluctuations – they can, at least for a while, be convinced of the groundlessness of fears.
According to V. L. Efimenko (1975), at the height of psychosis, anxiety and anxiety-depressive, depressive-hypochondriacal and astheno-depressive syndromes are most often observed, most rarely melancholic.
The most pronounced disorders in the emotional sphere are anxiety and longing. Anxiety is usually accompanied by motor anxiety, especially in the initial stage of psychosis. It sometimes increases with a change in situation, for example during hospitalization. Longing does not prevail in the picture of the disease. An anxious and dreary mood is often accompanied by fear. Irritability, anger, weak-heartedness, emotional lability, that is, symptoms more characteristic of cerebral atherosclerosis, can be observed at the height of psychosis in patients with preoperative depression. The sound of premorbid emotional features, the sharpening of characterological personality traits, the introversion of emotional experiences with outwardly active interest in family and other circumstances are characteristic. Patients with presenile depression at the height of the disease state may have obsessive, overvalued, delusional and paranoid ideas, reminiscent of being stuck in certain traumatic situations. Unlike reactive psychoses, these ideas are saturated not so much with the content of real mental trauma as with delusional formations, which are a kind of development of a long-past psycho-traumatic situation. For example, the delusional belief in the death or arrest of loved ones, as a rule, reflects fears about situations that were observed in a past life, then lost their relevance and reappeared in experiences when psychosis occurred. In patients with presenile depression, delusions of self-incrimination, persecution, poisoning, hypochondria (sometimes reaching the degree of hypochondriac delirium of Kotar) are noted. The future seems sick in a gloomy light, they expect catastrophe, misfortune, prepare for this, distributing their property among loved ones. With agitated depression, patients become fussy, groan, make a lot of unfocused movements, make various requests and complaints to others. In rare cases, motor inhibition is observed, sometimes reaching the sub-stage. Sometimes anxiety, fear, a delusional assessment of what is happening lead to an illusory interpretation of the words of others, some people experience bodily or fragmentary verbal hallucinations, which are usually unstable and with a partial critical assessment. Often in the clinical picture of involutional melancholy asthenia occurs, which manifests itself in complaints and patient behavior, confirmed by experimental and psychological studies. In recent years, due to pathomorphism, the clinic of involutional melancholy has changed in the direction of the prevalence of less severe forms, more often in the form of “involutional hypochondria” neurosis-like and hypopsychotic symptoms (N.F. Shakhmatov, 1980; V.N. Ilyina, 1980).