-IBIS-1.5.0-
tx
mental/emotional
depression
diagnoses
definition and etiology
definition: This is diagnosed when the patient fulfills the categorized signs and symptoms of a major depressive episode.
etiology: Depression is classified as the uniform expression of the major affective disorders. Depression is seen twice as often in women than in men, and the usual age of onset is between ages 35-45. There is a familial tendency. Depression is classified as primary when it is the first mental disorder to appear in the patient, or secondary when it appears with another psychiatric or medical condition. In the elderly, the clinician should be aware of "masked" depression: the patient complains of physical illness, and may even frequently smile, when the cause of their illness is a consciously blocked depression.
signs and symptoms
Diagnostic criteria for a major depressive episode: (Taken from DSM-III).
Dysphoric mood or loss of interest or pleasure in all or most of usual activities and pastimes. Symptoms include: depression, sadness, hopelessness, irritability.
At least four of the following symptoms have each been present nearly every day for at least 2 weeks.
» Decreased appetite or weight loss or increased appetite or weight gain.
» Insomnia or hypersomnia.
» Psychomotor agitation or retardation.
» Loss of interest or pleasure in usual activities or decrease in libido.
» Loss of energy; fatigue.
» Feelings of worthlessness, self-reproach, or excessive or inappropriate guilt.
» Decreased subjective ability or actual evidence of decreased ability to think or concentrate; slow thinking; indecisiveness.
» Repeated thoughts of death, suicidal thoughts, desire to die, or actual suicide attempt.
physical findings: Excessive painful trigger points and areas of tenderness over the entire body upon palpation.
lab findings:
Psychological analysis is (+) for depression.
May have absence of diurnal variation in cortisol levels
course and prognosis
Most patients (50-80%) who experience one depressive event will have recurrent attacks: the average is 2-3 episodes during their lives.
Untreated depression tends to last from 5-13 months, with an average of 8-9 months. Between 10-15% of patients will develop a manic form of affective disorder. Conventional treatment consists of drug therapy (MAOI or tricyclic antidepressants), hospitalization (if suicidal), and electroconvulsive therapy.
differential diagnosis
Bipolar disorder.
Somatic reasons for depression:
» Pharmacologic: BCP, reserpine, alcohol, alpha-methyldopa, sedatives/hypnotics, amphetamine withdrawal.
» Infectious: Flu, viral hepatitis, mononucleosis, TB, tertiary syphilis.
» Endocrine: Hypothyroidism, Cushing's disease, Addison's disease.
» Collagen: SLE, RA.
» Neurologic: MS, Parkinson's disease, sleep apnea, brain tumors, early dementias.
» Neoplastic: Malignancy of the head of the pancreas; malignancies in general.
footnotes