Difficulties in the diagnosis of depression in somatic and neurological practice: clinical observation

Depression often develops on a background of somatic and neurological conditions, but the relationship and mutual influence of these disorders can be different. Depression can be exogenous-organic in the context of somatic and neurological diseases; it can be a nosogenic reaction to the disease. In somatic and neurological patients, endogenous depression can be observed as a comorbid depressive episode of a recurrent depressive disorder or a bipolar affective disorder. However, patients' somatic complaints often mask the psychopathological picture of the depression and make its diagnosis more difficult. Conversely, depression can trigger or aggravate somatic condition via psychosomatic mechanisms, which is of great importance for the care providers of these patients. To illustrate the above, we present a clinical observation in which a patient with a history of two traumatic brain injuries with subsequent hospitalizations, long-term alcohol abuse, hepatitis B and C, accompanied by antiviral therapy, was diagnosed with recurrent depressive disorder (current episode – depressive hypochondriacal). Difficulties in the diagnosis of depression, aetiopathogenetic and therapeutic aspects are discussed.