[Clinico-psychopathological features and dynamic aspects of long-standing and chronic endogenous depressions]

Long-sanding depressions are defined as protracted depressive conditions lasting at least 2 years with subsequent spontaneous or therapeutic high-quality remission (intermission) and fully reversed depressive disorders, recovery of the premorbid psychic functions, personality traits and quality of life. Two variants of long-standing depressions, simple and polymorphic, are distinguished based on peculiarities of the psychopathological structure. The practicability of classification of long-standing depressions and their dynamics by phase states is discussed. Chronic depressive states are distinctive for well-apparent polymorphism of disorders and gradual aggravation of depressive symptoms up to neurosis-like and delusional register without a tendency toward spontaneous normalization and with only low-quality therapeutic remission with residual productive symptomatology. Four types of chronic depressions are distinguished: melancholic, apathoadynamic, depressive-hypochondriac, and depressive-depersonalizing. Three variants of dynamics of chronic depressions are described: dynamic-inert, dynamic-labile, and dynamic with continuous aggravation of the disorder. The appropriateness of discussion of chronic depressions in terms of protracted progressive attacks and conservation of their psychopathological basis throughout the period of the disease is considered. The principles of therapy of long-standing and chronic endogenous depressions are briefly outlined.