Indian Write-Ups

In India, psychiatry has been the Cinderella among medical specialties, more so with respect to the undergraduate medical curriculum. As a result most practitioners and other medical specialists are not aware of the specific connotations of the terms used routinely by psychiatrists. This article attempts to clarify and throw light on psychiatric terminology.

Any scientific specialty as it grows inevitably develops its own terminology, which facilitates rapid and clear communication among its practitioners, but at the time this ‘’jargon’’ leads to lay persons and other specialists considering the language obscure and mystifying. It is hoped that this column will demystify psychiatric terminology to the medical profession.

Evolution

It must be remembered that psychiatry itself is a relatively young science, though mentally ill people and mental hospitals have been with us since ages. The scientific basis of psychiatry, especially in the fields of neurochemistry, neurotransmitters, brain imaging etc. have made such rapid strides in the last few decades that this itself has resulted in a vast addition to the psychiatric ‘’jargon’’ with which psychiatrists themselves have to take pains to keep themselves abreast and updated.

Culture, language and psychological factors are so relevant in all aspects of psychiatry, that the evolution of a ‘’common psychiatric language’’ for the entire world has been a serious problem to which psychiatrists from different countries have been addressing themselves since quite some time. The International Classification of Diseases (ICD) by the World Health Organization undergoes periodic revisions, keeping in line with advances. This often results in rechristening of a disorder. For example, with respect to ‘’depression’’, the familiar terms ‘’neurotic depression’’ and ‘’endogenous depression ’’ are no longer in use. It is not that these were erroneous or irrelevant, but in the light of new researches and cross-cultural studies, the need was felt to modify the classification system without a prior theoretical assumption about of the illness – i.e. depression.

In this article, we elaborate on two terms commonly used by psychiatrists.

Anhedonia

Anhedonia, a commonly used term in psychiatry, is one of the main characteristics of depressive illness. It literally means a state of being unable to experience pleasure. It is linked to the word ‘’Hedonism’’ (Heathenism) which implies seeking after pleasure. In depression the patient instead of experiencing sadness often experiences this affect – anhedonia.

It is more appropriately expressed as a loss of interest in one’s surroundings and activities e.g. the housewife may complain of being unable to take interest in household work, or a person previously fond of music may lose interest in it, or the breadwinner may complain that he now has to push himself to attend office. Such observations may be ignored or considered as phases, which come, and go, which wax and wane. On the other hand, this inability to enjoy life may be the core expression of depression in many cases, and if missed or ignored can lead to complications of depression including, attempted and successful suicide.

One must be aware that anhedonia is a ‘symptom’ and needs to be followed up by further questioning. How long has this lack of interest been going on? Is it all pervasive? Is there any change during the day? Is it easier to mix and talk with people towards evening, for example? Anhedonia, itself, often leads to feelings of guilt, fear, shame etc. In brief, anhedonia is an important symptom of depression.

Dysthymia

Dysthymia is derived from the Greek word meaning despondency (Euthymia implies normal mind, spirit and courage). Dysthymia is a condition of morbid anxiety and depression. Once upon a time the thymus gland was believed to be related to one’s moods. In the ICD-10 classification ‘’Dysthymia’’ is the term used for depressive neurosis, neurotic depression, depressive personality disorder and persistent anxiety depression.

When the course of the entire life of a dysthymic patient is charted it will be observed that the patient has been depressed and tired most of the time. While he is able to cope with the demands of daily routines and has periods of days and weeks when he feels quite alright, concurrently he is also cribbing, complaining irritable, brooding, sleeping badly as well as feeling inadequate hopeless and helpless. This however is never of severe intensity and never acute enough to disrupt either his routine or that of his family members.

The dysthymic disorder is therefore synonymous with chronic/recurrent and mild/moderate depression often mixed with anxiety. This disorder may start in late teenage or in the early twenties. It can begin as a clear-cut episode of depression and at that point may be associated with severe stress or grief. It usually lasts for years and may sometimes persist indefinitely. In brief it is important to note that dysthymia and depression are synonymous.