Published on March 11, 2014
MOOD DISORDERS DEPRESSIVE EPISODE
Introduction: In these disorders, which include depressive episodes, bipolar mood disorder and persistent mood disorder, there is a disturbance of mood that is not secondary to organic causes, psychoactive substance use or another psychia- Tric disorder such as schizophrenia or schizoaffective disorder.
DEFINITION: This model shown in mental disorder after sepe Cific accident example : 1.delivery. 2.Surgical operation . It become appearance suddenly . sometime slide gradual from depression into acute depression or psychotic depression.
CLINICAL FEATURES: Characteristic features of a depressive episode include depression of mood , anhedonia, reduced attention and concentration ,ideas of guilt and worthlessness, lowered self-esteem and reduced energy, which in turn causes tiredness and reduced activity. In turn ,these can lead to hopelessness and a belief that life is not worth living , which can cause suicidal thoughts .biological symptoms occur frequently. The type of sleep disturbance that may occur in depressive episodes are shown diagrammatically.
MENTAL STATE EXAMINATION 1.Appearance: Depressive facies include down turned eyes sagging of the corners of the mouth and a vertical furrow between the eyebrows . There is typically poor eye contact . There may be direct evidence of weight loss, with the patient appearing emaciated and dehydrated .indirect evidence of recent weight loss may be indicated by the clothing appearing to be too large. Evidence of poor self-care and general neglect may include an unkempt appearance ,poor personal hygiene and dirty clothing.
CONT. 2.Behaviour: psychomotor retardation typically occurs. 3.Speech : the patient's speech is typically slow, with long delays before questions are answered. 4.Mood : it is low and sad , with feeling of hopelessness. The future seems bleak. Anxiety, irritability and agitation may also occur. The patient may complain of reduced energy and drive, and an inability to feel enjoyment (anhedonia). There is a loss of interest in normal activities and hobbies.
CONT. 5.Thought content: Pessimistic thoughts occur concerning the past ,present and future. Suicidal and homicidal thoughts may occur and should be checked for. Obsessions may occur secondary to depression 6. Abnormal beliefs and interpretation of events: Ideas or delusions of a hypochondriacally or nihilistic nature may be present .
CONT. 7. Abnormal experiences: In severe depressive episodes auditory hallucination may occur which are typically in the second person and derogatory in content. 8. Cognition : Concentration is characteristically poor.
DSM-IV CRITERIA FOR MAJOR DEPRSSIVE EPISODE A-at least five of the following symptoms have been present during the same 2-week period represent a symptoms is either (1) or (2): 1-depressive mood most of the day ,nearly every day, as indicated by either subjective report (e.g. feels sad or empty) or observation by others (e.g. appears tearful) . In children and adolescents this can be irritable mood. 2- markedly diminished interest or pleasure in all
CONT. Or almost all, activities most of the day , nearly every day. 3-significant weight loss when not dieting or weight gain (e.g. a change of>5% body weight in a month), or a decrease or increase in appetite nearly every day . In children consider failure to make expected weight gain . 4-Insomnia or hypersomnia nearly every day . 5-Psychomotor agitation or retardation
CONT. (observable by others) nearly every day . 6-fatigue or loss energy nearly every day. 7-feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) Nearly every day. 8-diminished ability to think or concentrate ,or indecisiveness, nearly every day . 9-recurrent thoughts of death (not just fear of
CONT. Dying), recurrent suicidal ideation without a specific plan , or a suicide attempt or a specific plan for committing suicide. B-Exclude a mixed episode (in which a manic episode also occurs). C-The symptoms cause clinically significant distress or impairment in social ,occupational Or other important areas of functioning.
CONT. D-The symptoms are not caused either by a direct physiological action of a substance (e.g. Drug of abuse ,or medication), or by general medical condition (e.g. hypothyroidism) . E-The symptoms are not better accounted for by bereavement.
DIFFERENTIATION FROM BEREAVEMENT 1- Guilt about things other than action taken or not taken by the survive at the time of death. 2-Thoughts of death other than the survive feeling that he or she would be better off dead ,or should have died with the deceased . 3-Morbid preoccupation with worthlessness. 4-Marked psychomotor retardation .
ATYPICAL TYPES OF DEPRESSION DEPRESSIVE STUPOR: This is rare these days because of effective treatment. MASKED DEPRESSION: Depressive patients may present with somatic or other complain instead of a depressed mood. SEASONAL AFFECTIVE DISORDER(SAD)
CONT. The onset depressive episodes is related to a particular time or season . AGITATED DEPRESSION: This occur in the elderly . INVESTIGATION: The physical examination should include a careful inspection for any evidence of self- harm, such as scars on the wrists.
TYPE OF DEPRESSION SEVERE DEPRESSION. MODERATE DEPERSSION. MILD DEPRESSION. TRANSIENT DEPRESSION Major depressive disorder. Dysthymic disorder. Normal grief response. Life's everyday disappointme nts.
EPIDEMIOLOGY INCIDENCE: In males ,80-200 new cases per 100000 popul- Ation per year . In females ,250-7800 new cases per 100000 population per year. POINT PREVALENCE: In the west ,1.8-3.2%of males ,and 2.0-9.3% of females . The point prevalence of depressive symptom in western population is up to 20%.
CONT. LIFETIME RISK: In the general population of western countries 5-12% in males and 9-26% in females . AGE OF ONSET: On average , around the late 30s. However ,it can start any where from childhood to old age. SEX RATIO:
CONT. Commoner in females . MARRIAGE: Higher incidence in those who are not married , including the divorced and separated. SOCIAL CLASS: 1)Have three or more children under the age of 14 to look after.
CONT. 2)Do not work outside the home. 3)Do not have somebody to confide in, that is , There is a lack of intimacy. 4)Lost their own mother before the age of11, through death or separation. AETIOLOGY: #Women may be more likely to admit to feeling depressed.
CONT. #Depression may be underdiagnosed in man , who may be more likely to engage in excessive alcohol consumption and therefore be diagnosed rather than depression. MANAGEMENT: 1)HOSPITALIZATION: Less severe episodes can be treated by GPs in the community or by psychiatrists in out clinics.
CONT. 2)DRUG TREATMENT: Antidepressant medication is the mainstay of treatment for moderate and severe depressive episodes . Mild depressive symptoms can also benefit from such treatment. 3)ELECTROCONVULSIVE THERAPY (ECT): This may used as a first line of treatment in the following relatively rare condition:
CONT. *Very low fluid intake ,resulting in oliguria. *Depressive stupor. *A dangerously high risk of suicide. PSYCHOSURGERY: This is considered only extremely rarely ,when all other treatment for severe chronic handicapping depression have failed. PHOTOTHERAPY:
CONT. SAD with an autumn or winter onset can be treated with high- intensity light. PSYCHOTHERAPIES: @Cognitive therapy. @Group therapy. @Psychoanalytic Psychotherapy. @Family therapy. @Marital therapy.
SOCIAL MILIEU: Increased activity and social contact should be encouraged. The development of confiding relationships has a protective function in preventing relapse. PROGNOSIS: The outcome in general is better the greater the length of follow-up. The risk of relapse is reduced if antidepressant medication is continued for 6 months after the end of the depressive episode .over all, the suicide rate is around 9%.
REFERENCE PSYCHIATRY FOR: Basant k.puri. Name of student: SAMIAH AL-JHANY. SAMIAH AL-HARBY.
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