# 04 - Pain symptoms

# Pain symptoms:

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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