Psychiatry (Depressive Disorder)

1-biological (neurochemical - neuroendocrine(Hypothyroidism may mimic depression, and hyperthyroidism may mimic mania)- genetic )

2-psycho-social (loss of self esteem or loved person and cognitive theory - learned helplessness)

The lifetime prevalence of developing major depressive disorder is about 17% overall; the prevalence in women is roughly twice the prevalence in men.

mean age of onset is about 40 years old.

Approximately 50% after one episode, 70% after 2 episodes.

1-psychosocial

2-physiological

3-other features like (Impaired social and occupational functioning-cognitive and motor symptoms -behavioral symptoms)

Depressed mood and sadness

Loss of interest and lack of enjoyment.

Psychotic symptoms may be found in severe cases as:

 Delusions: of guilt, nihilism, poverty,

hypochondriasis,

 Hallucinations: auditory, visual etc. (All delusions or hallucination are mood congruent)

(sometimes there is diurnal variation, which means that the symptoms are more severe in the morning).

-loss of apetite

-loss of libido

-disturbnace sleep

-pain

(Sometimes-atypical symptoms occur e.g. (increased appetite, hypersomnia).

Sometimes disturbed sleep and appetite

Slow thinking

 Depressed mood

 Loss of interest

 Decrease energy

-Low self esteem

-Idea of guilt

-Recurrent thoughts about death

-Decrease concentration

-Indecisiveness

-Change psychomotor

activity(retardation or agitation)

-Change appetite

-Sleep disturbance

2 weeks of:

 For severe depression need all criteria of category A and 5 of category B to be (8)

 For moderate depression 2 of category A and 4 of B to complete (6)

 For mild depression 2 of A and 2 of B to form (4)

Chronic sub-threshold depression these symptoms remain for at least 2 years.

 Patients present with a depressed mood for most of the day (at least 2 years in duration for adults and 1 year for children and adolescents)

increase or decrease in appetite or sleep

low energy,

low self-esteem

poor concentration

poor decision-making ability, hopelessness.

Comorbid depression with dythymia called double depression.

-Dysthmia

-Bereavement and Greif Adjustment Disorder with depressed mood

-Depression 2ry to medical illness

-Drug Induced depression

-Psychotic depression

-Depression with somatic syndrome

Mild to moderate symptoms of depression occurred and disappeared within 6 months of significant stressor

Steroids, Contraceptive pills, some antihypertensive

DM, MI, CVS

diurnal variation of symptoms, early morning awakening, retardation or agitation, weight loss and loss of libido.

(Hamilton or Beck depression scale)

Management starts with risk assessment, in terms of self-neglect and suicide.

-Hospitalisation

-Pharmacotherapy (TCA-selective sertonin reuptake inhibitor-selective norephinephrine reuptake inhibitor-antipsychotic (quitapin200-600mg))

-Electroconvulsive therapy

-Psychosocial therapy

 Suicidal risk, refusal of food or medication.

 Severe agitation or retardation, psychotic symptoms, severe depression.

-About 70% with moderate to severe illness respond to treatment within 6 weeks.

-Depression is a recurrent disorder in about 50% of cases.