04 - Pain symptoms

Pain symptoms:

© SPMM Course Mixed states: It is long appreciated that between the extremes of mania and depression various mixed states exist. In fact, mixed states are commoner than pure mania or depression, according to the recent literature. s. no Type Mood Will Thought Manic stupor High Low Low Mania with poverty of thought High High Low Inhibited mania High Low High Depressive mania Low High High Excited depression Low High Low Depression with flight of ideas Low Low High Over the years, the six Kraepelinian mixed states have dwindled into just two varieties: 1. Dysphoric Mania (when predominant mania is present with some depressive symptoms) and 2. Depressive Mixed State (when full depression is present with some manic symptoms). Other terms such as agitated depression (full depression with psychomotor agitation), anxious depression (depression with marked anxiety), irritable depression (depression with marked irritability), and mixed hypomania (hypomania with some depressive symptoms) are used in this context but are better avoided. Pain symptoms: Pain is frequently associated with mood disturbances. It is difficult to distinguish organic and non-organic pain as often there are mixed elements of both in a pain syndrome. Nevertheless certain differences exist as listed below. Psychiatric vs. Organic pain: Organic pain Non-organic pain Less diffuse More diffuse More anatomical confinement Less anatomical Often fluctuant and remits during intervals Often constant and unremitting Usually characteristic quality Difficult to describe the quality Progression, if occurs, will have tissue boundaries Progresses without tissue confinement generally Anywhere in the body Head and neck, back are the most common Can wake patients from sleep Rarely wakes one from sleep Tenderness may be present Tenderness very rare May have typical postural changes e.g. intracranial pathology Usually no postural variation