These are broad terms that cover a continuum of emotional states. It is not always possible on the basis of a single interview to distinguish self limiting distress, which forms a natural part of the adjustment process, from the psychiatric syndromes of depressive illness and anxiety state, which need specific treatment. Borderline cases are common, and both the somatic and psychological symptoms of depression and anxiety can make diagnosis difficult.
Somatic symptoms—Depression may manifest itself as intractable pain, while anxiety can manifest itself as nausea or dyspnoea. Such symptoms may seem disproportionate to the medical pathology and respond poorly to medical treatments.
Psychological symptoms—Although these might seem understandable, they differ in severity, duration, and quality from "normal" distress. Depressed patients seem to loathe themselves, over and above loathing their disease. A useful analogy is that the patient who is sad blames the illness for how they feel, whereas a patient who is depressed blames themselves for their illness. This expresses itself through guilt about being ill and a burden to others, pervasive loss of interest and pleasure, and hopelessness about the future. Attempted suicide or requests for euthanasia, however rational they might seem, invariably indicate clinical depression. It is important that such thoughts are elicited—for example, by asking "have you ever felt so bad that you wanted to harm or kill yourself?"
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