Masked depression

Last updated

Masked depression (MD) was a proposed form of atypical depression [1] in which somatic symptoms or behavioural disturbances dominate the clinical picture and disguise the underlying affective disorder. [2] The concept is not currently supported by the mental health profession. [3]

Contents

Clinical manifestations

Somatic manifestations of MD are distinguished by an extreme diversity [4] : 110  and include headaches, back pain, abdominal pain etc. Pathological behaviour masking depression may take the form of compulsive gambling, compulsive work, changes in arousal or orgasmic function, decreased libido or, on the contrary, impulsive sexual behaviour, alcoholism, or drug addiction.

Chronic pain is more often noted as a connection to MD by non-psychiatrists than psychiatrists, while lack of concentration is often noted by psychiatrists. [5]

Dispute about the concept

MD has been variously described as "depression equivalent, a vegetative equivalent, a depression without a depression, and a hidden depression. [5] [6] Most investigators, especially those in the German-speaking countries, assumed masked depression (German : die larvierte Depression [7] ) to be endogenous depression. [8] The term was largely used in the 1970s and 1980s, but at the end of the 20th century there was a decline in interest in the study of masked depression. Today this diagnosis does not play a significant clinical or scientific role. [9]

Epidemiology

MD is supposed to be a common clinical phenomenon. [10] According to some authors, masked depression is as frequent as overt depression. [11] Although masked depression can be found at any age, it has been observed more commonly after mid-life. [11]

Making the diagnosis and the management of MD in clinical practice are complicated by the fact that he who has got MD is unaware of his mental illness. Patients with MD are reluctant to associate their physical symptoms with an affective disorder [12] and refuse mental health care. As a rule, these patients attribute their disturbances to physical illness, seek medical care for them, and report only somatic complaints to their physicians, [13] with the consequence that many of such depressions are not recognized or are misdiagnosed and mistreated [10] Estimates of depressed patients who are correctly identified and treated range from 5% to 60%. [14] Data show that about 10% of people who consult a physician for any reason, originally has affective disorders disguised by physical symptoms. [11] [15]

Official diagnostic status

Current classifications: ICD-10 and DSM-5 [16] do not contain the term "masked depression". [1] Some[ who? ] Ukrainian psychiatrists claim that MD is to be qualified as "depression with somatic symptoms" in the ICD-10 (F 3x.01). [17] This means that those who struggle with masked depression often have more physical symptoms such as back pain, abdominal pain, headaches, and even pain during sexual activity or painful periods. For those with more clinical depression, while they still may have physical symptoms, their symptoms are usually more mental or emotional. This includes feelings of helplessness, extreme and/or persisting sadness, numbness, tiredness, drowsiness, exhaustion, and even suicidal thoughts or feelings.

Diagnostic criteria

Affective disorders in patients with MD can only be detected by means of a clinician-administered diagnostic interview. [4] : 408  [18] : 576  [19] Organic exclusion rules [19] and other criteria are used in making the diagnosis of MD. [20] : 185–188  Some physical symptoms of masked depression include general aches, pains including headache, backache, musculoskeletal aches, and other non-painful symptoms such as changes in appetite and libido, lack of energy, sleep disturbance, dizziness, palpitations, dyspnea, and gastrointestinal tract disturbances. [21] Some of the main recorded symptoms of MD are insomnia, a general lack of interest in normal activities, headache, anorexia, and fatigue in that order. [5]

See also

Related Research Articles

A psychiatrist is a physician who specializes in psychiatry. Psychiatrists are physicians who evaluate patients to determine whether their symptoms are the result of a physical illness, a combination of physical and mental ailments or strictly mental issues. Sometimes a psychiatrist works within a multi-disciplinary team, which may comprise clinical psychologists, social workers, occupational therapists, and nursing staff. Psychiatrists have broad training in a biopsychosocial approach to the assessment and management of mental illness.

<span class="mw-page-title-main">Hypochondriasis</span> Medical condition

Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. Hypochondria is an old concept whose meaning has repeatedly changed over its lifespan. It has been claimed that this debilitating condition results from an inaccurate perception of the condition of body or mind despite the absence of an actual medical diagnosis. An individual with hypochondriasis is known as a hypochondriac. Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they have, or are about to be diagnosed with, a serious illness.

In medicine, comorbidity refers to the simultaneous presence of two or more medical conditions in a patient; often co-occurring with a primary condition. It originates from the Latin term morbus prefixed with co- ("together") and suffixed with -ity. Comorbidity includes all additional ailments a patient may experience alongside their primary diagnosis, which can be either physiological or psychological in nature. In the context of mental health, comorbidity frequently refers to the concurrent existence of mental disorders, for example, the co-occurrence of depressive and anxiety disorders. The concept of multimorbidity is related to comorbidity but is different in its definition and approach, focusing on the presence of multiple diseases or conditions in a patient without the need to specify one as primary.

<span class="mw-page-title-main">Depression (mood)</span> State of low mood and aversion to activity

Depression is a mental state of low mood and aversion to activity. It affects about 3.5% of the global population, or about 280 million people of all ages. Depression affects a person's thoughts, behavior, feelings, and sense of well-being. Experiences that would normally bring a person pleasure or joy give reduced pleasure or joy, and the afflicted person often experiences a loss of motivation or interest in those activities.

Conversion disorder (CD), or functional neurologic symptom disorder (FNsD), is a functional disorder that causes abnormal sensory experiences and movement problems during periods of high psychological stress. Individuals with CD present with highly distressing neurological symptoms such as numbness, blindness, paralysis, or convulsions, which are not consistent with a well-established organic cause and can be traced back to a psychological trigger.

Pain disorder is chronic pain experienced by a patient in one or more areas, and is thought to be caused by psychological stress. The pain is often so severe that it disables the patient from proper functioning. Duration may be as short as a few days or as long as many years. The disorder may begin at any age, and occurs more frequently in girls than boys. This disorder often occurs after an accident, during an illness that has caused pain, or after withdrawing from use during drug addiction, which then takes on a 'life' of its own.

Intensive short-term dynamic psychotherapy (ISTDP) is a form of short-term psychotherapy developed through empirical, video-recorded research by Habib Davanloo.

Post-concussion syndrome (PCS), also known as persisting symptoms after concussion, is a set of symptoms that may continue for weeks, months, or years after a concussion. PCS is medically classified as a mild traumatic brain injury (TBI). About 35% of people with concussion experience persistent or prolonged symptoms 3 to 6 months after injury. Prolonged concussion is defined as having concussion symptoms for over four weeks following the first accident in youth and for weeks or months in adults.

Medically unexplained physical symptoms are symptoms for which a treating physician or other healthcare providers have found no medical cause, or whose cause remains contested. In its strictest sense, the term simply means that the cause for the symptoms is unknown or disputed—there is no scientific consensus. Not all medically unexplained symptoms are influenced by identifiable psychological factors. However, in practice, most physicians and authors who use the term consider that the symptoms most likely arise from psychological causes. Typically, the possibility that MUPS are caused by prescription drugs or other drugs is ignored. It is estimated that between 15% and 30% of all primary care consultations are for medically unexplained symptoms. A large Canadian community survey revealed that the most common medically unexplained symptoms are musculoskeletal pain, ear, nose, and throat symptoms, abdominal pain and gastrointestinal symptoms, fatigue, and dizziness. The term MUPS can also be used to refer to syndromes whose etiology remains contested, including chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity and Gulf War illness.

Somatization is a tendency to experience and communicate psychological distress as bodily and organic symptoms and to seek medical help for them. More commonly expressed, it is the generation of physical symptoms of a psychiatric condition such as anxiety. The term somatization was introduced by Wilhelm Stekel in 1924.

<span class="mw-page-title-main">Victor Kandinsky</span> Russian psychiatrist (1849–1889)

Victor Khrisanfovich Kandinsky was a Russian Empire psychiatrist, and was 2nd cousin to famed artist Wassily Kandinsky. He was born in Siberia into a large family of extremely wealthy businessmen. Victor Kandinsky was one of the famous figures in Russian psychiatry and most notable for his contributions to the understanding of hallucinations.

Oneiroid syndrome (OS) is a condition involving dream-like disturbances of one's consciousness by vivid scenic hallucinations, accompanied by catatonic symptoms (either catatonic stupor or excitement), delusions, or psychopathological experiences of a kaleidoscopic nature. The term is from Ancient Greek "ὄνειρος" (óneiros, meaning "dream") and "εἶδος" (eîdos, meaning "form, likeness"; literally dream-like / oneiric or oniric, sometimes called "nightmare-like"). It is a common complication of catatonic schizophrenia, although it can also be caused by other mental disorders. The dream-like experiences are vivid enough to seem real to the patient. OS is distinguished from delirium by the fact that the imaginative experiences of patients always have an internal projection. This syndrome is hardly mentioned in standard psychiatric textbooks, possibly because it is not listed in DSM.

A depression rating scale is a psychometric instrument (tool), usually a questionnaire whose wording has been validated with experimental evidence, having descriptive words and phrases that indicate the severity of depression for a time period. When used, an observer may make judgements and rate a person at a specified scale level with respect to identified characteristics. Rather than being used to diagnose depression, a depression rating scale may be used to assign a score to a person's behaviour where that score may be used to determine whether that person should be evaluated more thoroughly for a depressive disorder diagnosis. Several rating scales are used for this purpose.

<span class="mw-page-title-main">Pyotr Gannushkin</span> Russian psychiatrist

Pyotr Borisovich Gannushkin was a Russian psychiatrist who developed one of the first theories of psychopathies known today as personality disorders. He was a student of Sergei Korsakoff and Vladimir Serbsky. Not only did he manage to delineate certain organizational tasks of social psychiatry, but he also clearly formulated the main methodological aim of social psychiatrists, to combine methods of individual clinical analysis with sociological research and generalization.

Functional disorders are a group of recognisable medical conditions which are due to changes to the functioning of the systems of the body rather than due to a disease affecting the structure of the body.

Somatic symptom disorder, also known as somatoform disorder, or somatization disorder, is defined by one or more chronic physical symptoms that coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not deliberately produced or feigned, and they may or may not coexist with a known medical ailment.

The Patient Health Questionnaire (PHQ) is a multiple-choice self-report inventory that is used as a screening and diagnostic tool for mental health disorders of depression, anxiety, alcohol, eating, and somatoform disorders. It is the self-report version of the Primary Care Evaluation of Mental Disorders (PRIME-MD), a diagnostic tool developed in the mid-1990s by Pfizer Inc. The length of the original assessment limited its feasibility; consequently, a shorter version, consisting of 11 multi-part questions - the Patient Health Questionnaire was developed and validated.

Unitary psychosis (Einheitspsychose) refers to the 19th-century belief prevalent in German psychiatry until the era of Emil Kraepelin that all forms of psychosis were surface variations of a single underlying disease process. According to this model, there were no distinct disease entities in psychiatry but only varieties of a single universal madness and the boundaries between these variants were fluid. The prevalence of the concept in Germany during the mid-19th century can be understood in terms of a general resistance to Cartesian dualism and faculty psychology as expressed in Naturphilosophie and other Romantic doctrines that emphasised the unity of body, mind and spirit.

The Somatic Symptom Scale - 8 (SSS-8) is a brief self-report questionnaire used to assess somatic symptom burden. It measures the perceived burden of common somatic symptoms. These symptoms were originally chosen to reflect common symptoms in primary care but they are relevant for a large number of diseases and mental disorders. The SSS-8 is a brief version of the popular Patient Health Questionnaire - 15 (PHQ-15).

The term functional somatic syndrome (FSS) refers to a group of chronic diagnoses with no identifiable organic cause. This term was coined by Hemanth Samkumar. It encompasses disorders such as fibromyalgia, chronic widespread pain, temporomandibular disorder, irritable bowel syndrome, lower back pain, tension headache, atypical face pain, non-cardiac chest pain, insomnia, palpitation, dyspepsia and dizziness. General overlap exists between this term, somatization and somatoform. The status of ME/CFS as a functional somatic syndrome is contested. Although the aetiology remains unclear, there are consistent findings of biological abnormalities, and major health bodies such as the NAM, WHO, and NIH, classify it as an organic disease.

References

  1. 1 2 Miodek, Anna; Szemraj, Paweł; Kocur, Józef; Ryś, Anna (2007). "Depresja maskowana – historia i współczesność" [Masked Depression – History and Present Days](PDF). Pol. Merk. Lek. (in Polish). XXIII (133). MEDPRESS: 78–80. ISSN   1426-9686 . Retrieved 2013-01-04. The paper is accompanied with an abstract in English.
  2. ↑ Verster, G. C.; Gagiano, C. A. (August 1995). "Gemaskerde depressie" [Masked depression](PDF). South African Medical Journal (in Afrikaans). 85 (8). Health and Medical Publishing Group: 759–762. ISSN   0256-9574. PMID   8553144. Revue : Anglais
  3. ↑ Treating Child and Adolescent Depression. Lippincott Williams & Wilkins. 2012. p. 5. ISBN   978-1-4511-5303-3.
  4. 1 2 (in Russian) Коркина М. В., Лакосина Н. Д., Личко А. Е. Психиатрия: Учебник. — М.: Медицина, 1995. — 608 с.; ил. — [Учеб. лит. для студентов мед. вузов] ISBN   5-225-00856-9
  5. 1 2 3 Shetty P, Mane A, Fulmali S, Uchit G (2018). "Understanding masked depression: A Clinical scenario". Indian J Psychiatry. 60 (1): 97–102. doi: 10.4103/psychiatry.IndianJPsychiatry_272_17 . PMC   5914271 . PMID   29736070.
  6. ↑ For more detail, see: Katon, W.; Kleinman, A.; Rosen, G. (Jan 1982). "Depression and somatization: a review. Part I.". Am. J. Med. 72 (1): 127–35. doi:10.1016/0002-9343(82)90599-x. PMID   7058818.
  7. ↑ Steffen Walter's entry at ProZ.com.
  8. ↑ (in Russian) Вертоградова О.П. К проблеме депрессий в общесоматической практике // Сб. Депрессии в амбулаторной и общесоматической практике (вопросы диагностики и терапии). М., 1984, с. 12–17.
  9. ↑ Frank, R.G. (2018). "Masked Depression". In Kreutzer, J.S.; DeLuca, J.; Caplan, B. (eds.). Encyclopedia of Clinical Neuropsychology. Springer. doi:10.1007/978-3-319-57111-9_2130. ISBN   978-3-319-57111-9.
  10. 1 2 Fisch, R.Z. (1987). "Masked depression: its interrelations with somatization, hypochondriasis and conversion". Int J Psychiatry Med. 17 (4): 367–379. doi:10.2190/cr7j-wu5n-hc5x-2jq5. PMID   3326856. S2CID   39199561.
  11. 1 2 3 Alexopoulos, George S. (1990). "Clinical and Biological Findings in Late-Onset Depression". In Tasman, Allan; Goldfinger, Stephen M.; Kaufmann, Charles A. (eds.). American Psychiatric Press Review of Psychiatry. Vol. 9. American Psychiatric Press. p. 250. ISBN   978-0-88048-248-6.
  12. ↑ Koenig, Thomas W. (2004). "Physical Symptoms in Depression" (PDF). Advanced Studies in Medicine. 4 (1 A): S11–4.
  13. ↑ Brody, D.S.; Thompson, T.L.; et al. (March 1995). "Recognizing and managing depression in primary care". Gen Hosp Psychiatry. 17 (2): 93–107. doi: 10.1016/0163-8343(94)00093-s . PMID   7789790.
  14. ↑ Carney, Patricia A.; et al. (December 1999). "Recognizing and Managing Depression in Primary Care A Standardized Patient Study". The Journal of Family Practice. 48 (12).
  15. ↑ Schneider, Frank; Kratz, Sandra; et al. (February 26, 2004). "Insufficient depression treatment in outpatient settings". Ger Med Sci. 2: Doc01. PMC   2703210 . PMID   19675684.
  16. ↑ "DSM-5 / PsychiatryOnline Renewal 2020-2021". Electronic Health Library of British Columbia. 2020-08-04. Retrieved 2021-03-20.
  17. ↑ (in Russian)Подкорытов В. С., Чайка Ю. Ю. Депрессии. Современная терапия Archived 2017-12-29 at the Wayback Machine . — Харьков: Торнадо, 2003. — С. 54. — ISBN   966-635-495-0
  18. ↑ (in Russian) Психиатрия: Учебник. / Коркина М. В., Лакосина Н. Д., Личко А. Е., Сергеев И. И. — 2-е изд., доп., перераб. — М.: МЕДпресс-информ, 2002. ISBN   5-901712-12-9
  19. 1 2 (in Russian) Жариков Н. М., Тюльпин Ю. Г. Психиатрия: Учебник. — М.: Медицина, 2000. — С. 193. ISBN   5-225-04189-2
  20. ↑ (in Russian) Психиатрия. Национальное руководство / Под ред. Т.Б. Дмитриевой, В.Н. Краснова, Н.Г. Незнанова, В.Я. Семке, А.С. Тиганова. — М.: ГЭОТАР-Медиа, 2011. — 1000 с. — (Национальные руководства). — 3000 экз. — ISBN   978-5-9704-2030-0
  21. ↑ Tylee, André; Gandhi, Paul (2005). "The Importance of Somatic Symptoms in Depression in Primary Care". Primary Care Companion to the Journal of Clinical Psychiatry. 7 (4): 167–176. doi:10.4088/pcc.v07n0405. PMC   1192435 . PMID   16163400.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.