MARY YVETTE ALLAIN TINA RALPH SHERYL BART HEINRICH PIPOY KC JAM CECILLE DENESSE VINCE HOOPS CES

XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC PENG KARLA

Class 2010 SUBJECT PSYCHIATRY (July 10,

2008)
TOPIC Depression
LECTURER Dr. Besa
ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MACKY VIKI JOAN PREI KATE BAM AMS MEMAY PAU RACHE ESTHER JOEL GLENN TONI

DEPRESSION  Lived lives for someone else

o Heinz Kohut
Epidemiology
 Loss of self esteem that
- 17% lifetime prevalence
presents as depression
- most common in females
o effects of childbirth
Diagnosis (DSM-IV)
o different psychosocial stressors
A. 5 or more symptoms during same 2-week
- mean age of onset: 40 (20-50 years old) period and represent a change in previous
- marital status: without close interpersonal functioning: at least one of the symptoms is:
relationship 1) depressed mood or
2) loss of interest or pleasure
Comorbidity
- alcohol abuse or dependence 1. depressed mood
- panic disorder 2. decreased interest or pleasure
- OCD 3. weight loss/gain
- Social anxiety disorder 4. insomnia, hypersomnia
5. psychomotor agitation, retardation
Etiology 6. loss of energy
- Biological factors 7. worthlessness or guilt
o depletion of serotonin 8. diminished ability to concentrate or decide
o reduced dopamine activity 9. suicidal ideation
o decreased Norepinephrine
- Genetic factors * if only 4 symptoms were met, Minor Depressive
o one parent with mood disorder: 10- Disorder
25%
- Psychosocial factors D – epressed
o stressful life event precedes first E – nergy
episodechanges in brain biology P – leasure
(loss of neurons and reduction in R – etardation
synaptic contacts) E – ating
 losing a parent at age of 11 S – leep
 loss of spouse S – elf-esteem/worthlessness
 unemployment E – concentration
- Personality Factor D – eath
o OCD, histrionic, borderline
- Stressors reflect negatively on one’s self B. Do not meet criteria for mixed episode (bipolar)
esteem C. Significant impairment in social, occupational
- Psychodynamic Factors functioning
o Sigmund Freud D. Not due to direct physiological effects of
 disturbances in infant-mother substance or general medical condition
relationship during oral phase E. Symptoms not accounted for by bereavement
 object loss
Criteria for Severity
 introjection of departed
- Mild
object
o result in minor impairment in
 anger directed towards
occupational, social functioning
inward at self
- Moderate
o Melanie Klein
- Severe without Psychotic Features
 agression toward love ones
o markedly interfere with occupational
o Edward Bibring
social functioning
 Discrepancy between high
ideals and inability to meet - Severe with PF
goals o with delusions or hallucinations
o Silvano Arieti  Mood congruent

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PLM-College of Medicine
Psychiatry
Class 2010 III-B
Depression

 Mood incongruent Differential Diagnosis

Diagnosis - Medical Disorder
- Major Depressive Disorder (MDD) Single - Mental Disorder
episode
- MDD Recurrent

Course and Prognosis

- Specifiers describing most recent episode:
Course
o With PF (mood incongruent)
o With melancholic features - Untreated 6-13 months
 Severe anhedonia, early AM - Treated about 3 months
awakening, weight loss, guilt
o With atypical features Prognosis
 Overeating, oversleeping - Mild episodes
(reverse vegetative - Absence of psychotic symptoms
symptom) - Short hospital stay
o With catatonic features - Psychosocial indicators: solid friendship,
stable family, functioning, sound social
 Postpartum onset
functioning
- Absence of comorbid psychiatric disorder
Clinical Features
- feel blue, hopeless, worthless
Treatment
- 2/3: contemplate suicide; 10-15%: commit
Hospitalization
suicide
- risk of suicide or homicide
- 97% complain about reduced energy, impaired
- reduced ability to get food or shelter
at school work, less motivation
- diagnostic procedures
- 80% have trouble sleeping
- progressing symptoms
- Children and adolescent: school phobia,
- poor patient social support
excessive clinging, poor academic
performance, substance abuse, antisocial
Psychosocial Therapy
behavior
- Cognitive Therapy
- Older people: somatic complaints
o identify negative cognitions and
develop alternative and positive
MSE Quiz ways of thinking and rehearse new
1. General Appearance and Behavior cognitive and behavioral therapy
o stooped posture, untidy, no
eye contact - Interpersonal Therapy
2. Mood and Affect (2 points) o interpersonal problems for early
o mood congruent dysfunctional relationships
o depressed
- Behavioral Therapy
o appropriate affect
o Maladaptive behavioral patterns
3. Speech
result from rejection of society
o poverty of speech, speak
slowly
Pharmacotherapy
4. Perception
- SSRI
o none
o Fluoxetine
o or with PF: hallucination
o Sertraline
5. Thoughts
o Citalopram
o suicidal
o Escitalopram
o negative thought
o Fluvoxamine
6. Orientation
o Paroxetine
o oriented
7. Memory
o memory intact - SNRI
8. Judgment o Venlafaxine
o impaired judgment o Duloxetine
9. Insight Page 2 of 3
o poor insight?
PLM-College of Medicine
Psychiatry
Class 2010 III-B
Depression

 SE: Decrease sexual libido

 Taken for 6 months – 1 year

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