One tends to
underestimate the number of the depressions at the old
nevertheless the most frequent
existence of a disease, an accident or death of a child
in the years which precede.
depressions of the old subject in their complete and
according to authors'.
Clinical and etiopathogenic
A - FORM NEVROTIQUE AND REACTIONAL:
frequent at the old subject.
bound to an event.
cannot separate some.
without apparent reasons.
centered on painful topics.
is absorbed by death and can have ideas of
feels useless and tests a feeling of trouble, of
somatic complaints of pace hypochondriaques.
all to dramatize.
think of a hysteria.
does not test any pleasure.
existence is directed towards the suffering.
INHIBITION OR PSYCHOMOTOR DECELERATION:
interest and taste for any activity.
for the things and the people.
lapses of memory of the recent facts.
confusion with an irrational state.
of the intellectual concentration appearing by a
lability of the attention preventing the old person
getting information, and especially from
emotional level, one finds this indifference.
about emotional anaesthesia.
can also appear on the behavioral level by:
• A voice
• A very
poor speech: monoideism
DISTURBANCES KNOWN AS “INSTINCTUAL”:
unperceived master key because one regards it as normal
accompanied by digestive disorders.
a diurnal somnolence with clinophilie.
inversion of the cycle takes care/sleep can lead.
hypotension which can result from this.
repeated low volume: polakiurie.
Fear of a
vital and imminent danger.
physical demonstrations of the anguish mask the
can completely carry out a passage to the suicidal
disorders which express the anxiety.
become irritable with respect to the entourage.
depressions are called reactional because they are
regarded as normals in reaction to certain
factors are important to know:
a) Social insulation:
Cut of with
the close relations.
particular by the retirement.
of the social status.
mournings, which weaken the individual
of a fragile personality.
THE MELANCHOLIES PSYCHOTICS:
qualify them the endogenous ones, even if one can
sometimes find a starting event.
ACCESSES FRANK MELANCHOLIC PERSON:
the same symptoms as in the depression but thorough with
culpability: to have made impression reprehensible
Self-accusation taking the form of one is
unworthiness and incurability.
is different with these patients.
after often smell themselves pushed back.
are very slowed down.
about sideration of the psychic life.
often morning: alarm clock with 4 or 5 hours of the
OF MELANCHOLY KNOWN AS Of INVOLUTION:
Characterized by the dramatized expression of the
simulate a hysterical state.
Demonstrations suitable for old age.
as from 50 years.
agitated people, expressing many complaints.
person does not seek the contact with the looking after
contrary: tendency to push back any help.
It is what
makes the difference with a décompensée hysteria.
to the care.
ideas: be delirious of negation of bodies.
damnation, punishment, or contrary to
hallucinations can be found.
constitutes the syndrome of Cotard.
symptomatology as the access frank melancholic
demonstrations of the hysterical type.
Differentiated by the fact that the patient does
not seek the contact.
NOSOGRAPHIQUE OF THE MELANCHOLIES:
is in front of a first episode which one can attach to a
is about a new episode of an old PMD.
or psychogenic depressive State (reactional).
In fact the
somatic symptoms prevail:
symptoms are in the second plan.
It is the
therapeutic test which will confirm the diagnosis: if
the antidepressant treatment makes disappear the somatic
physical signs are noisy.
finds a thyroid problem or a neurologic
proportioning of the TSH systematically is made.
the resolution of a serious physical problem.
keeps the same disorders although the physical problem
without depressive symptoms express, but where one
locates other symptoms which make suspect a real
Disappearance of the symptoms under
patients nevrotic who will know a depressive
BORDERS OF THE DEPRESSION:
SYNDROME OF SLIP:
where a fall of mood is found: syndrome of slip.
Décompensation of the state general in the continuations
of a somatic or psychic affection acute.
the first affection was cured.
Can lead to
dead in a few days.
expressing a great opposition.
of any stimulation
The cure is
possible by antidepressant treatment.
forecast depends on the moment when one will take in
load the depression and of the intensity of the clinical
Death is to
be feared; that it occurs by:
The cure is
nevertheless the most frequent possibility.
repetitions are not rare.
Need for a
follow-up and establishment of a relation of
evolution can be done towards chronicity or an
A - CATEGORIELLE APPROACH:
either lunatic or is depressed.
differential diagnosis is sometimes difficult because
these two affections have very close and badly known
diagnosis of depression is carried by excess.
which appears of no importance practical must be
corrected because there are treatments for certain
addition, certain antidepressants have a worsening
effect on the cognitive disorders of the disease of
question often arises in front of behavioral
CLINICAL ELEMENTS OF DISTINCTION:
depressed patient often only presents himself.
the family at a patient reached of an organic
a) The mnemic complaint:
at the depressed subject.
by somatic complaints.
disorders contrast with the precision of the
patients suffering from a disease of Alzeimer will
minimize their disorders.
present disorders of the memory of the recent
common to both syndromes:
of the activity
Anhédonie: loss of the research of the pleasure
depressed subject, the loss of interest and the
anhédonie are total.
demented person preserves interest for certain
activities which get pleasure to him.
depressed, the disorder of mood is constant.
demented person, it is irregular.
table: deceleration of the simple gestures must make
seek an associated affection or a subcortical
no disorders of the appetite and sleep.
guilt feeling, self-accusation and idea suicidal.
interested in the antecedents: many psychiatric
antecedents, one are directed towards the
beginning of the disorders is difficult to specify in
the degenerative affections.
depression, it is easier to specify.
examination of the memory:
earliest sign among Alzheimer patients is the incapacity
to retain three words over the duration of the
depressed subject, the association of the words improves
the performances; not in the demented person.
allow to distinguish at the beginning the insanity from
scanner or IRM:
localised atrophy at the patient lunatic.
convincing only at the young subjects.
disturbed only at the subjects demented person.
INSANITY AND DEPRESSION CAN COEXIST:
That is to
because the depression would be the bed of the insanity
probable is that the insanity can involve a depressive
depression would be generally secondary with the
The therapeutic biological
A - GENERAL BASES:
antidepressants are more active than the
keep residual symptoms.
majority of the antidepressants are also effective
whatever the age.
medicamentous compliance of the old people is a
70% of the
old patients neglect to take 25 to 50% of their
people present other pathologies which will worsen the
appear more tardily: 6 to 12 weeks.
treatment must be followed to the long course.
MOCLAMINE: tolerance higher than the other IMAO
counter-indications which make them difficult to use at
the old subjects.
Imipraminiques and related:
of recaptures serotonin.
of recaptures serotonin and noradrenalin
REGULATORS OF MOOD:
To check if
counter-indications do not appear.
differs according to the age.
years, the startup must be reserved for certain
AUXILIARY TREATMENTS OF THE
more than 60 years, at which one cannot use
antidepressants any more. Indications:
of the depressive state: suicidal risk
resistant to the antidepressants
on the seasonal depressions.
DIAGNOSIS BY ANTIDEPRESSANT TREATMENT:
Can be a
tool to differentiate the insanity from the
Psychotherapy of support:
consist in establishing a climate of confidence around
It is a
Psychoanalyse and therapies of psychoanalytical
inspiration Vise to restore the regard of oneself
compromised by the senescence
Rest on the
idea that the depression results from a loss of the
supporting the positive interactions compared to the
modification of the irrational beliefs remarks of
oneself, world and future aim at which maintain the
the interpersonal relations of the patients.
necessary that the old subject accepts
inter alia through the looking after team.
To make in
kind centre a network of care which will constitute the
pivot of a psychotherapy of support.
Posting of page 191