Desymbolisierung in der schweren depression und das problem der hemmung: Ein neuropsychoanalytisches modell der störung des emotionalen selbstbezugs depressiver

Inhibition in severe depression is a problematic concept in the context of an established psychoanalytical theory of depression. A neuro-psychoanalytical model for defence and coping mechanisms in depression has been developed based on the results of empirical studies on emotional-cognitive interaction in healthy and depressed subjects. It was hypothesized that certain principles of neuronal integration are related to specific defence mechanisms. The neuropsychological and neurophysiological correlates of these regressive processes in depression are presented. Somatization processes in depression are related to an abnormal functional balance between top-down and bottom-up modulation in medial, cortical and subcortical regions. Defence mechanisms of introjection often observed in depressed patients may be associated with abnormal reciprocal modulation and neuronal activity attenuation in medial and lateral prefrontal cortex during emotional-cognitive interaction. It is hypothesized that sensori-motor regression could be related to abnormal modulation by functional unit across medial prefrontal cortical regions. This neuro-psychoanalytical model could provide a starting point for future empirical studies on the psychophysiological mechanisms underlying defence and coping mechanisms in depression. It could also be of value in understanding the partial decoupling of the psychic process from current psychopathology, which is not without significance for the psychoanalytical psychotherapy of depression.