Depressive episodes (depressive episodle): depressive episodes are dominated by a depressed state of mind, disproportionate to its situation, and can range from sullenness to grief, or even a wooden stiffness. In severe cases, psychotic symptoms such as hallucinations and delusions may occur. Anxiety and motor agitation are prominent in some cases. The clinical manifestations of a depressive episode consist of 3 parts.

1. Core symptoms Mainly include depressed mood, lack of interest and loss of pleasure.

(1) depressed mood: often manifested as a bad mood, not happy; feel useless (Worthlessness), helpless or despair, think life is worthless; or feel that their own disease can not get better, to the treatment and recovery of the loss of confidence; despair about the future, that they bring only trouble to others, dragged down the family, and even anorexia, unwilling to live, suicidal concepts. They may even become world-weary and unwilling to live, and develop suicidal ideation. The most dangerous pathological intention is suicide attempts and behaviors. Once there is a determination to commit suicide, it is often more resolute than that of young patients, with more hidden behaviors and higher success rates. Elderly depression is often accompanied by anxiety, manifested as chest thumping, fidgety, fearful or wandering in the bucket.

(2) lack of interest: lack of interest in previous hobbies and cultural and sports activities such as chess, playing cards, reading, watching TV, listening to music, etc., or reluctance to meet people, unwilling to speak, and lack of interest in anything, good or bad.

(3) Loss of pleasure: or anhedonia, inability to experience pleasure from family, work or life.

The above 3 core symptoms are interrelated and causal, and can occur simultaneously in a single patient, or only 1 or 2 of them can be manifested. Some patients can participate in some activities alone, or reluctantly with the persuasion of family members or friends, but they are unable to derive any pleasure from them, and the main purpose of engaging in these activities is to kill time. Some patients do not recognize that they are in a bad mood, but they are not interested in the things around them or lose their pleasure.

2. Psychological symptoms mainly include seven aspects such as anxiety, self-guilt and self-blame, delusions or hallucinations.

(1) Anxiety: often co-exist with depression, sometimes often become one of the main manifestations of depression. Patients in anxiety can often be accompanied by somatic symptoms, such as palpitations, chest tightness, sweating, frequent urination, and so on, and even these somatic symptoms can become the patient's main complaint.

(2) Self-guilt and self-blame: often unwarranted guilt, thinking that their own disease has brought burden to their families, sorry for their parents, children, or relatives and friends, and even to the past mistakes or faults of remorse, delusional blame, and in serious cases, will reach the level of delusion.

(3) delusion or hallucination: one is the so-called harmony with the state of mind (mood-congruent) delusion, that is, the content of the delusion is commensurate with the state of depression, such as cerebrovascular disease can not be restored to the delusion, delusion of sin, disaster delusion, delusion of worthlessness, or often hear some of their own, mocking themselves, such as auditory hallucinations. Another type of delusion is called mood-incongruent, that is, the content of the delusion is not commensurate with the depressive state, such as delusions of victimization, delusions of torture, hallucinations without any emotional components. However, all such delusions do not have the characteristics of schizophrenic delusions, such as absurdity, grotesqueness, and originality.

(4) Cognitive symptoms: Cognitive symptoms associated with depression are often reversible, such as memory loss, distraction, etc., and these symptoms are often relieved with improvement in treatment. Some patients may develop cognitive distortions, such as seeing everything around them as gray and making pessimistic and disappointing interpretations of everything.

(5) Suicidal ideology and behavior: patients often have suicidal ideology, the lesser patients feel that there is no point in living, and often think of things related to death; the more serious patients will actively look for ways to commit suicide and put them into practice, and even some patients kill several people before committing suicide, which will lead to extremely serious consequences. Therefore, such patients should be highly vigilant, and actively give intervention treatment, and at the same time should be asked to psychiatry professional doctor consultation, if necessary, to the psychiatric hospital hospitalization.

(6) Self-awareness: The self-awareness of depressed patients is greatly affected by the degree of their impaired consciousness, and patients with severe impaired consciousness lose their self-awareness completely; while a considerable portion of patients who are fully aware of their self-awareness will take the initiative to seek medical treatment and cooperate with the treatment.

(7) psychomotor retardation or agitation: psychomotor retardation (psyehomotor retardation) patients often manifested as slow thinking, slow brain response, memory and attention decline; slow action, slow to do things, the heavy can reach the degree of wooden stiffness. Psychomotor agitation (psychomotor agitation) of the patient is manifested as thinking jump chaotic, the brain is in a state of tension, but its thinking is not organized, purposeless; action is also manifested as nervousness and restlessness, irritability agitation, and even out of control action. Thinking content is poor, slow, can not seem to think of anything, part of the patient often recalls unpleasant events; in the context of depression, the patient underestimates himself, often think that they are useless people. Self-blame and self-guilt, resulting in anorexia. 80% of the patients have memory dysfunction, some may show a decline in writing, calculation, comprehension, judgment, dementia-like performance, domestic and foreign authors named this performance as depressive pseudo-dementia.

3. Physical symptoms mainly include sleep disorders, energy loss, appetite disorders and other six aspects.

(1) Sleep disturbance: often complain of difficulty in falling asleep, dreaming or waking up early at night, and after waking up, unable to fall asleep again, loss of sleep, etc., which is a more common symptom in post-stroke depression, especially early waking up is the most characteristic: however, there are also some patients with the opposite, which manifests itself as increased sleep.

(2) Loss of energy: laziness, fatigue, listlessness, unwillingness to speak or see others, often accompanied by psychomotor retardation.

(3) Appetite disorders: often manifested as a decrease in the amount of food, no appetite, and in the long run, weight loss or even malnutrition. Some patients may show hyperphagia and weight gain.

(4) morning weight and night light: often manifested in the early morning after waking up that began to worry about the day, do not know how to spend, thus worrying, depressed, to the afternoon or evening to reduce. But there are a few patients with the opposite performance.

(5) Hypogonadism: It can range from loss of libido to complete loss of sexual desire, or barely having sex without being able to experience pleasure from it.

(6) non-specific physical symptoms: may complain of a variety of symptoms, such as headache, dizziness, limb pain, body discomfort, panic, shortness of breath, nausea, belching, urinary frequency sweating, etc., often diagnosed as a variety of autonomic dysfunction, etc., and should pay attention to differentiate.