Giovanna Spantigati

As disease progresses, fatigue becomes continuous and it is so strong that it hinders the performance of each activity.

The slowdown of the higher mental functions can be so strong to cause attention, concentration and memory disorder. The slowdown causes uncertainty and indecision, and in some cases the inability to take any decision, even the most simple, creates a significant hardship, which sometimes blocks all action. The sense of time changes and its flow slows to a halt. The person who is depressed feels that the day is endless, that night will never come, all is still, stagnant, with no possibility to change. In some cases there is psychomotor distress which shows up with restlessness, inability to sit still, need to move, to walk, to twist hands and fingers.

The impairment of intellectual performance, the awareness of emotional aridity and inefficiency, lead the person to worthlessness, self-contempt, the conviction of inadequacy, sometimes also to ruminate on his mistakes and sins. The future is hopeless and the past empty and useless, assessed as full of mistakes. The patient feels guilty and makes predictions of doom and misery. Sometimes he believes himself responsible for his problems and for the inability to heal: being convinced that he could feel better if he made an effort, he judges himself unworthy because of his conduct, his laziness, his own selfishness.

The idea of suicide is present in 2 / 3 of patients. It grows slowly in the early stages of the depressive disorder. The patient believes that life is a burden and therefore not worth the trouble of being lived. Then he wishes to fall asleep and never wake up, or that he might die accidentally or wishes to be killed in a car accident. In worst cases, the self-destructive plan is programmed with detailed plans and the patient commits suicide. The belief that there is no chance of finding help and the loss of hope lead the person to think of suicide as the only liberation from suffering, or as a just expiation of his sins. In some cases there is the so-called extended suicide: the patient, before committing suicide, kills the persons he loves, usually children, in order to preserve them from the sufferings of life, the tragedy of existence. The risk of suicide should always be taken into consideration and the patient might therefore need drug therapy or hospitalization. In Italy there are about 4,000 people each year who commit suicide and many more who attempt suicide. (Dr. Salvatore Di Salvo) End of Part Three.

Giovanna Spantigati