Психические расстройства в общей медицине. №4 2007

Соматические симптомы депрессии

H.-P.Kapfhammer

Германия

Стр. 53-61

3334 просмотров

Опубликовано: 1 апреля 2007

Аннотация / Abstract

История концепций депрессии В феноменологической психопатологии традиционно акцентируется внимание на телесных проявлениях депрессивных расстройств как на их ключевых симптомах. Так, C.Wernicke использовал термин “витальные чувства” для описания определенных соматических симптомов, возникающих при аффективных психозах [1]. Витальные чувства касаются тесной взаимосвязи телесности и самосознания, того, как мы ощущаем собственное тело и какое впечатление производит на окружающих наш внешний вид. Витальные чувства представляют собой соматический аффект, происходящий из различных частей тела. Если в норме витальные чувства формируют общий фон телесного самоощущения, то при депрессии они могут выступать на первый план. Например, страдающие депрессией часто жалуются на необычные головные боли, описываемые как непереносимое давление, сравнимое с повязкой, стягивающей голову. Другие нарушения витальных чувств затрагивают грудную клетку и область живота, вызывая неприятные ощущения тяжести, напряжения или заторможенности, на которых концентрируется внимание пациента. Аналогичным образом E.DuprО говорит о коэнестопатических состояниях, представляющих собой тягостные качественные изменения нормального телесного чувства в различных частях тела при эпизодах депрессии. При этом происходит тотальная потеря витальности, при которой нарушения могут охватывать тело и его функции целиком, подавляя нормальную жизнедеятельность [2]. K.Schneider [3] относил подобные расстройства витальных чувств к числу признаков, определяющих картину эндогенной депрессии. В психопатологической квалификации автора проявления депрессивной болезни обладают первостепенной диагностической значимостью, аналогичной симптомам первого ранга при шизофрении. G. Huber проводил различие между витальными расстройствами, с одной стороны, и вегетативными симптомами депрессии – с другой [4]. Витальные расстройства (потеря общего телесного тонуса, доминирование усталости/утомляемости, а также раз...

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