Affective frustration – the group of mental violations which is characterized by change of an emotional state towards oppression or rise. Includes various forms of depressions and manias, maniac-depressive psychosis, affective lability, the increased uneasiness, a dysphoria. Pathology of mood is followed by decrease or increase in the general level of activity, vegetative symptoms. Specific diagnostics includes a conversation and observation of the psychiatrist, experimental and psychological inspection. For treatment the pharmacotherapy (antidepressants, anksiolitik, mood stabilizers) and psychotherapy is used.
Synonymous names of affective frustration – emotional frustration, frustration of mood. Their prevalence is very extensive as they are formed not only as independent mental pathology, but also as a complication of neurologic and other somatic diseases. This fact causes difficulties of diagnostics – the lowered mood, people refer uneasiness and irritability to temporary, situational manifestations. Statistically, frustration of the emotional sphere of various degree of expressiveness arise at 25% of the population, but the qualified help is received only by a quarter from them. Seasonality is characteristic of some types of depressions, most often the disease becomes aggravated during the winter period.
Reasons of affective frustration
Violations of emotions are provoked by the external and internal reasons. On the origin they are neurotic, endogenous or symptomatic. In all cases there is a certain predisposition to formation of affective frustration – unbalance of TsNS, disturbing and hypochondriac and schizoid traits of character. The reasons defining a debut and development of a disease are subdivided into several groups:
- Psychogenic adverse factors. Emotional violations can be provoked by the psychoinjuring situation or a long stress. Among the most common causes – the death of the loved one (the spouse, the parent, the child), quarrels and violence in a family, a divorce, loss of material stability.
- Somatic diseases. Disorder of affect can be a complication of other disease. It is provoked directly by dysfunction of nervous system, the endocrine glands producing hormones and neurotransmitters. Deterioration in mood also arises because of heavy symptoms (pains, weakness), the adverse forecast of a disease (probability of an invalidization, death),
- Genetic predisposition. Pathologies of emotional reaction can be caused by the hereditary physiological reasons – features of a structure of brain structures, speed and focus of neurotransfer. An example – bipolar affective disorder.
- Natural hormonal shifts. Instability of affect is sometimes connected with endocrine changes during pregnancy, after the delivery, during puberty or a climax. The imbalance of level of hormones influences functioning of the departments of a brain which are responsible for emotional reactions.
Pathological basis of the majority of emotional frustration is violation of functions of an epifiz, limbic and gipotalamo-hypophysial system, and also change of synthesis of neurotransmitters – serotonin, noradrenaline and dopamine. Serotonin allows an organism to resist effectively to stresses and reduces feeling of alarm. Its insufficient development or decrease in sensitivity of specific receptors results in depression, a depression. Noradrenaline supports the awake condition of an organism, activity of informative processes, helps to cope with shock, to overcome a stress, to react to danger. Deficiency of this catecholamine causes problems of concentration of attention, concern, the increased psychomotor excitability and sleep disorders.
Sufficient activity of dopamine provides a pereklyuchayemost of attention and emotions, regulation of muscular movements. Shortage is shown by an angedoniya, slackness, apathy, surplus – the mental tension, excitability. The imbalance of neurotransmitters exerts impact on work of the structures of a brain responsible for an emotional state. At affective violations it can be provoked by the external reasons, for example, a stress, or internal factors – diseases, hereditary features of biochemical processes.
In psychiatric practice classification of emotional violations from the point of view of a clinical picture is widespread. Distinguish frustration of a depressive, maniacal and disturbing range, bipolar disorder. Fundamental classification relies on different aspects of affective reactions. According to it allocate:
- Violations of expressiveness of emotions. Excessive intensity is called an affective giperesteziya, weakness – an affective giposteziya. This group included sensitivity, emotional coldness, emotional impoverishment, apathy.
- Violations of adequacy of emotions. At ambivalence multidirectional emotions at the same time coexist that interferes with normal response to surrounding events. Inadequacy is characterized by discrepancy of quality (orientation) of affect to the influencing incentives. Example: laughter and joy at tragic news.
- Violations of stability of emotions. Emotional lability is shown by frequent and unreasonable variability of mood, explosiveness – the increased emotional excitability with bright uncontrollable experience of anger, rage, aggression manifestation. At faintheartedness fluctuations of emotions – tearfulness, sentimentality, a capriciousness, irritability are observed.
Symptoms of affective frustration
The clinical picture of frustration is defined by their form. The main symptoms of a depression are depression, a condition of long grief and melancholy, lack of interest to people around. Patients experience sense of hopelessness, senselessness of existence, feeling of own insolvency and an otioseness. At easy degree of a disease decrease in working capacity, increased fatigue, tearfulness, instability of appetite, a problem with falling asleep is observed.
The moderate depression is characterized by inability to carry out professional activity and household duties in full – fatigue, apathy amplifies. Patients spend more time at home, prefer loneliness to communication, avoid any physical and emotional activities, women often cry. Periodically there are thoughts of suicide, excessive drowsiness or sleeplessness develops, appetite is reduced. At the expressed depression patients carry out practically all the time to beds, are indifferent to the taking place events which are not able to make efforts for meal and implementation of hygienic procedures.
As a separate clinical form allocate the masked depression. Its feature consists in lack of external signs of emotional frustration, denial of a bolnva of the lowered mood. At the same time various somatic symptoms – head, articulate and muscular pains, weakness, dizziness, nausea, short wind, differences of blood pressure, tachycardia, digestion violations develop. Inspections at doctors of somatic profiles do not reveal diseases, medicines are often inefficient. The depression is diagnosed at later stage, than a classical form. By this time patients begin to feel not clear concern, alarm, uncertainty, decrease in interest in hobbies.
At a maniacal state the mood which is unnaturally increased rate of thinking and the speech is accelerated, in behavior the hyperactivity is noted, the mimicry reflects joy, excitement. Patients are optimistical, constantly joke, make jokes, problems depreciate, cannot be adjusted on a serious conversation. Actively gesticulate, often change a pose, rise from the place. Focus and concentration of mental processes are reduced: patients often distract, ask again, give up just begun business, replacing it more interesting. Sensation of fear becomes dull, care decreases, the feeling of force, bravery appears. All difficulties seem insignificant, problems – solvable. The sexual inclination and appetite raises, the need for a dream decreases. At the expressed frustration irritability increases, unmotivated aggression, sometimes – crazy and hallucinatory states appears. Alternate cyclic manifestation of phases of a mania and depression is called bipolar affective disorder. At weak manifestation of symptoms speak about a tsiklotimiya.
The constant concern, feeling of tension, fears is characteristic of disturbing frustration. Patients are in expectation of negative events which probability is, as a rule, very small. In hard cases uneasiness develops into agitation – the psychomotor excitement which is shown restlessness, "breaking off" of hands, circulation about the room. Patients try to find a convenient pose, the quiet place, but unsuccessfully. Strengthening of alarm is followed by panic attacks with vegetative symptomatology – short wind, dizziness, a respiratory spasm, nausea. The notions of compulsion of frightening character are formed, appetite and a sleep is interrupted.
Long affective frustration without adequate treatment considerably worsen quality of life of patients. Easy forms interfere with full professional activity – at depressions the volume of the performed work decreases, at maniacal and disturbing states – quality. Patients or avoid communication with colleagues and clients, or provoke the conflicts against the background of the increased irritability and decrease in control. At severe forms of a depression there is a risk of development of suicide behavior with realization of attempts of suicide. Such patients need constant surveillance of relatives or medical personnel.
The psychiatrist conducts a research of the clinical record, family predisposition to mental disorders. For exact clarification of symptoms, their debut, communication with the psychoinjuring and stressful situations clinical poll of the patient and his immediate family capable to provide fuller and objective information is carried out (patients can be noncritical to the state or excessively weakened). In the absence of the expressed psychogenic factor in development of pathology for the purpose of establishment of the true reasons inspection of the neurologist, endocrinologist, therapist is appointed. Treat specific methods of a research:
- Clinical conversation. During the conversation with the patient the psychiatrist learns about the disturbing symptoms, reveals the speech features indicating emotional frustration. At a depression patients speak slowly, inertly, quietly, answer questions in monosyllables. At a mania – are garrulous, use bright epithets, humour, quickly change a conversation subject. Inconsistency of the speech, uneven rate, decrease in focus is characteristic of alarm.
- Observation. Natural observation of an emotional and behavioural expression is often made – the doctor estimates a mimicry, features of gesticulation of the patient, activity and focus of motility, vegetative symptoms. There are standardized schemes of observation of an expression, for example, the Detailed method of the analysis of mimic expression (FAST). The result reveals symptoms of a depression – the lowered corners of a mouth and an eye, the corresponding wrinkles, a mournful look, constraint of movements; symptoms of a mania – a smile, , the raised tone of mimic muscles.
- Psychophysiological tests. Their orientations and qualities are made for assessment of mental and physiological tension, expressiveness and stability of emotions. The color test of the relations of A. M. Etkind, a method of semantic differential of I. G. Bespalko and coauthors, a technique of the interfaced motor actions of A. R. Luriya is used. Tests confirm psychoemotional violations through system of extramental elections – adoption of color, the verbal field, associations. The result is interpreted individually.
- Projective techniques. These technicians are directed to a research of emotions through a prism of extramental personal qualities, traits of character, the social relations. The Thematic apperceptive test, the frustratsionny test of Rosenzweig, Rorsharkh's test, the Drawing of the Person test, "Drawing of the Person in the Rain" is applied. Results allow to define existence of a depression, mania, uneasiness, tendency to aggression, impulsiveness, asociality, the frustrated requirements which became the reason of an emotional deviation.
- Questionnaires. Techniques are based on the self-report – ability of the patient to estimate the emotions, traits of character, the state of health, features of the interpersonal relations. Use of narrowly targeted tests for diagnosis of a depression and alarm (Beck's questionnaire, a questionnaire of symptoms of a depression), complex emotional and personal techniques is widespread (Derogatis, MMPI (SMIL), Ayzenk's test).
Treatment of affective frustration
The scheme of therapy at emotional frustration is defined by the doctor individually, depends on an etiology, clinical manifestations, character of a course of disease. The general scheme of treatment assumes knocking over of sharp symptoms, elimination of the reason (if it is possible), the psychotherapeutic and social work directed to increase in adaptation abilities. An integrated approach includes the following N of an apravleniye:
- Drug treatment. Reception of antidepressants – the drugs increasing mood and working capacity is shown to patients with a depression. Symptoms of alarm are stopped by means of anksiolitik. Medicines of this group remove stress, promote relaxation, reduce concern and fear. Mood stabilizers have anti-maniacal properties, considerably soften expressiveness of the next affective phase, prevent its beginning. Antipsychotic drugs eliminate mental and motor excitement, psychotic symptoms (nonsense, hallucinations). In parallel with psychopharmacotherapy treatment of the accompanying endocrine and neurologic diseases is carried out.
- Psychotherapy. The direction of the psychotherapeutic help is defined by features of frustration. At a heavy depressive component individual sessions of cognitive and cognitive and behavioral therapy, gradual inclusion in group occupations (gestalt therapy, the psychodrama) are shown. Patients with the increased uneasiness need development the technician of self-control and a relaxation, work with the wrong installations interfering undervoltage.
- Social rehabilitation. An important role in recovery of the patient is played by the attitude towards him and to his disease of close relatives. The psychologist and the psychotherapist hold family meetings on which they discuss need of maintenance of the rational mode, physical activity, good nutrition, gradual involvement of the patient in household affairs, joint walks, sports activities. Sometimes there are pathological interpersonal relations with members of household supporting frustration. In such cases the psychotherapeutic sessions aimed at the solution of problems are necessary.
Forecast and prevention
The result of affective frustration is rather favorable at psychogenic and symptomatic forms, timely and complex treatment promotes the return development of a disease. Hereditarily the caused violations of affect tend to a chronic current therefore patients need periodic courses of therapy for maintenance of normal health and the prevention of a recurrence. Prevention includes refusal of addictions, maintenance of the close confidential relations with relatives, observance of the correct day regimen with a full-fledged dream, alternation of work and rest, allocation of time for a hobby, hobbies. At a hereditary otyagoshchennost and other risk factors regular passing of preventive diagnostics at the psychiatrist is necessary.