Differential diagnosis of stress related disorders with endogenic depression

Abstract

Background: The 10th edition of the International Classification of Diseases contains a category of mental disorders. In psychiatry, two types of diagnoses are made: syndromic and nosological. One syndrome may appear in many diseases according to the classification of diseases and syndromes. In the diagnosis of mental disorders, therapists use observation, physical examination, anamnesis collection, and pathopsychological analysis. Stress-related disorders, such as sleep disturbances, anxiety, unexplained body aches, and depression, are common according to the World Health Organization (WHO). The National Epidemiological Study on Mental Diseases in Mongolia (2013) reported a 4.4% prevalence of depression and 11.7 cases of unexplained somatic complaints per 1000 individuals. In 2022, the National Center for Mental Health reported 383 hospitalizations for Affective Disorder and 1,921 hospitalizations for stress-related disorders. Individuals exposed to emotional stress may develop post-traumatic stress disorder, which is a form of adjustment disorder that can last for over six months or even years. Aim: A clinical discussion was held to determine the correct diagnosis, establish work incapacity, and decide on further treatment. Materials and Methods: Clinical cases were examined using qualitative and retrospective research methods, as well as clinical interviews. Informed consent was obtained and signed by the patient. Results: Currently, the patient has pains here and there in the body, it is not known what exactly is causing the pain, she went to the hospital and underwent an early detection examination, but no physical disease was diagnosed. In the CT scan of the head: There is an old nucleated fracture in the inner and lower wall of the recess of the right eye. The nasal septum is deviated to the right and there is an old fracture in the nasal bone. There is an old fracture in the front and outer wall of the right maxillary sinus. According to information obtained from the therapist’s sister and herself, her husband commits psychological and physical abuse. He was beaten in the face and underwent facial surgery. The death of the mother, father, and child was a psychological trauma. In the last 5 years, I have been admitted to a psychiatric hospital 10 times due to the pain of poor sleep, depression, feeling like I want to die, body aches here and there, and I don’t know what is causing the pain. I take medicine at home, but my condition does not improve. It is said that as soon as I am admitted to the hospital, my body becomes fine and calms down. He is so tired that he can’t do his job, he has repeated illnesses and he has been admitted to the hospital many times, so he wants to be diagnosed with incapacity for work. Conclusion: The patient’s disease is a psychological disorder induced by childbirth, caused by repeated stress in life, and emotional and physical abuse by the family. It is believed that the progression of the disease was caused by long-term stress, not being fully involved in psychotherapy, and not being able to use simple ways to relieve stress as an individual. Physicians do not need to establish disability and further address domestic violence issues with psychotropic medication and psychotherapy depending on the patient’s mental state at the time.