Manic Depressive Psychosis (MDP) Depression: Psychological Implications, Symptoms, Diagnosis And Treatment

Several terms such as psychosis depression, endogenous depression, agitated depression, involuntional melancholia, masked depression, etc. are all used to designate MDP depression. The symptoms of MDP depression are subject to diurnal variation, being worse in the morning hours.

Symptomatology

The symptoms of MDP depression are centered around the disturbances in mood. The mood is often sad. The face appears gloomy, with wrinkled forehead, drooping of the eyelids and sagging of the angles of the mouth. Sometimes the mood is agitated. The speech is slow, and the voice is low. They are pessimistic. They may retain ideas of delusions of guilt for imagined crimes and blames. Ideas of worthlessness and hopelessness may be evident in their talk. Out of such thoughts they develop suicidal ideas. Nihilistic and hypochondriacal delusions are common. Sometimes, they may not talk at all (depressive mutism).

Disorders of perception like auditory hallucinations of accusatory nature are sometimes observed. The motor activity is retarded. The movement is slow. The patient tends to stoop while walking or sitting. Depressed patients become self- centered and prefer to be left undisturbed. The routine work may be ignored as a result of feeling of general weakness. In the extreme form, the patient may develop depressive stupor where all the activities are minimal with least response to external stimuli. The slow mental activity of the patient may give an apparent impression of impairment of intelligence or memory (Pseudodementia). The insight and judement may be impaired.

Somatic symptoms: Bodily symptoms such as headache, chest pain, generalized aches, giddiness, amenorrhea, impotence, loss of appetite, constipation, insomnia etc, are common. Insomnia is most marked during the early morning hours. Loss of weight may occur.

Diagnosis: Diagnosis of depression is made on the basis of clinical features. The important clinical features of depression are the depressed mood, the retarded psychomotor activity, pessimistic attitude, feeling of worthlessness, guilt, suicidal tendencies, hypochondriacal delusions, etc. Some cases may present only with somatic symptoms (masked depression). Manic depressive psychosis is to be differentiated from secondary depression and schizophrenia. The causes of secondary depression are atherosclerosis, general paralysis of the insane, hypothyroidism, vitamin B₁₂ deficiency etc.

Course: The illness follows the same course as mania, but the risk of suicide is high.