I would like to thank the leadership of the Department of General Medicine of the 1st Medical Faculty of Charles University in Prague, especially MUDr. Norbert Král, for inviting me to the annual meeting, where I had the opportunity to witness the blossoming of the department in which I worked for a quarter of a century. Their scientific work confirms psychiatrists’ warning about the prevalence of depression in the population. We all received a beautiful gift, a book, What Feelings Do, by Tiny Oziewiczová and Aleksandra Zajacová. Through it, we can move further in the text.
Let us love and welcome spring. For most of us, spring is a beautiful time of year: nature awakens, everything blooms, days get longer, and the most beautiful months of the year lie ahead.
I would like to point out that for people with a depressive disposition it is exactly the opposite: April is the month with the highest suicidality in the year. For emotionally labile individuals, the shift from short days to long days is a critical time when internal clocks fall apart and life is at its most painful. We should keep in mind that three people out of ten have a tendency toward depression.
I do not mean to bypass current diagnostic procedures; I only want to point out three empirical domains of depression that Professor Vondráček instilled in us: disturbances of foria, hedonie and dynamogenie, which I see as quite practical and useful.
Foria is an elevated term for mood, which can be depressive, depressive-anxious with varying degrees of both components and possible (rarely) panic attacks, sorrowful, or a rather melancholy state with self-aggressive self-reproach outbursts, or a state that we might describe as “no mood.”
Hedonie is the ability to take pleasure, and anhedonie is a deficit of it, even its absence. It is then a central symptom of depression, often combined with a feeling of total loneliness. We have two simple questions to detect it: What do you look forward to today? What do you still look forward to at all? If we receive negative answers to both questions, that is, “to nothing,” we are dealing with severe depression, even if the mood does not indicate it and may appear more positive.
Dynamogenie concerns overall psychomotor tempo—the readiness of both body and mind to respond appropriately to internal impulses and external stimuli. One of my first patients introduced me to worsening in this area already during my studies when he told me: In the morning, it is a problem for me to tie my shoelaces.
Empirical evidence confirms that treatment does not affect all three components of depression uniformly, and the most risky stages appear to be the onset of depression and the period when recovery begins. In that phase, hedonie may still be in total suppression while psychomotor tempo is already fully active. The outlook for the future is then clearly poor, while the patient already has enough strength to drive in the nail on which they can hang themselves. In spring, in April, this happens most often.
It is therefore the duty of every doctor, male or female, to actively look for signs of depression; two questions focused on hedonie do not hold anything back; rather, they help improve the therapeutic relationship. Where we detect anhedonie, a question about suicidal intent is necessary, which can be done as follows: And don’t you feel like putting all this together and ending it? If the answer is positive or ambiguous, contacting a psychiatrist is appropriate, at least through a request for advice on how to proceed.
MUDr. Radkin Honzák psychiatrist Source, author’s blog: https://blog.aktualne.cz/blogy/radkin-honzak.php?itemid=45293