DEPRESSIVE EPISODE - PowerPoint Presentation

Slide1

DEPRESSIVE EPISODESlide2

Definition

Depression, also known as depressive disorders or

unipolar

depression, is a mental illness characterized by a profound and persistent feeling of sadness or despair and/or a loss of interest in things that once were pleasurable. Disturbance in sleep, appetite, and mental processes are a common accompaniment.Slide3

According to the National Institute of

Mental Health

, symptoms of depression may include the following

:

difficulty concentrating, remembering details, and making decisions

fatigue and decreased energy

feelings of guilt, worthlessness, and/or helplessness

feelings of hopelessness and/or pessimism

insomnia, early-morning wakefulness, or excessive sleeping

irritability, restlessness

loss of interest in activities or hobbies once pleasurable, including sex

overeating or appetite loss

persistent aches or pains,

headaches

, cramps, or digestive problems that do not ease even with treatment

persistent sad, anxious, or "empty" feelings

thoughts of suicide, suicide attemptsSlide4

Warning signs of suicide with depression include

:

a sudden switch from being very sad to being very calm or appearing to be happy

always talking or thinking about death

clinical depression (deep sadness, loss of interest, trouble sleeping and eating) that gets worse

having a "death wish," tempting fate by taking risks that could lead to death, like driving through red lights

losing interest in things one used to care aboutSlide5

making comments about being hopeless, helpless, or worthless

saying things like "It would be better if I wasn't here" or "I want out"

talking about suicide (killing one's self)

visiting or calling people one cares about

Remember, if you or someone you know is demonstrating any of the above warning signs of suicide with depression, either call your local suicide hot line, contact a mental health professional right away, or go to the emergency room for immediate treatment.Slide6

SOMATIC SYNDROME IN DEPRESSION

A)Significant decrease in appetite or weight.

B)Early morning awakening, at least 2

(or more) hours before the usual time of awaking.

C)Diurnal variation with depression being worst in the morning.

D)Pervasive loss of

interst

and loss of reactivity to pleasurable stimuli.

E)Psychomotor agitation or retardation.Slide7

There are two main categories of depression: 1)major depressive disorder and

2)

Dysthymic

disorder

O

thers

-

atypical

depresssion

-postpartum depression

-Bipolar depression

-seasonal depression

-Psychotic depression Slide8

Major depressive disorder

To distinguish your condition as major depression, one of your symptoms must be either depressed mood or loss of interest. Also, the symptoms must be present for most of the day every day or nearly every day for at least two weeks.Slide9

Other symptoms include-

1)Fatigue or loss of energy almost every day

2) Feelings of worthlessness or guilt almost every day

3)Impaired concentration, indecisiveness

4)insomnia or

hypersomnia

(excessive sleeping) almost every day

5) Markedly diminished interest or pleasure in almost all activities nearly every day (called

anhedonia

, this symptom can be indicated by reports from significant others.)Slide10

6)Psychomotor agitation or retardation (restlessness or being slowed down)

7) Recurring thoughts of death or

suicide

(not just fearing death)

8)Significant

weight loss

or gain (a change of more than 5% of body

weight

in a month)Slide11

Major Depressive Disorder - Epidemiology

Lifetime prevalence

-women:10 - 25%

-men: 5 - 12 %

-pre-pubertal children: boys>girls

-puberty to 50 yrs: women 2x men

-after 50 yrs: women=menSlide12

Dysthymia

depression

Dysthymia

, sometimes referred to as chronic depression, is a less severe form of depression. With

dysthymia

, the depression symptoms can linger for a long period of time, perhaps two years or longer. Those who suffer from

dysthymia

are usually able to function adequately but might seem consistently unhappy.Slide13

symptoms

The symptoms of

dysthymia

are the same as those of major depression but not as intense and include the following:

Persistent sad or empty feeling

Difficulty sleeping (sleeping too much or too little)

Insomnia (early morning awakening)

Feelings of helplessness, hopelessness, and worthlessness

Feeling of guilt

Loss of interest or the ability to enjoy oneselfSlide14

Loss of energy or fatigue

Difficulty concentrating, thinking or making decisions

Changes in appetite (overeating or loss of appetite)

Observable mental and physical sluggishness

Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment

Thoughts of death or suicideSlide15

Organic Illnesses Associated with Depression

Rheumatologic -

rheumatoid

arthritis,SLE

Cardiac -

myocardial infarction, hypertension

Endocrine -

hyperthyroidism, hypothyroidism, diabetes mellitus, postpartum state

Gastrointestinal -

cirrhosis,

inflammmatory

bowel disease, pancreatitis,

Hematologic -

sickle cell anemia

Nutritional deficiencies

- B12,

Folate

, iron, thiamine, niacin

Infectious -

encephalitis, hepatitis, tuberculosis

Renal

- renal transplant, uremia

Neoplastic

- Leukemia,

Neurologic

- subdural hematoma, multiple sclerosis, CVA, Parkinson’s,

Miscellaneous

- psoriasis,

sarcoidosisSlide16

Depression in Children & Adolescents

Presenting symptoms may include:

-sad or irritable mood

-loss of interest/pleasure in usual activities

-school difficulties

-school-refusal

-somatic complaints

-aggressive/antisocial behavior patterns

-weight change or sleep pattern disruptionSlide17

III)BIPOLAR MOOD(AFFECTIVE)DISORDER

Bipolar disorder is a complex genetic disorder. The mood swings associated with it alternate from major, or clinical, depression to mania or extreme elation. The mood swings can range from very mild to extreme, and they can happen gradually or suddenly within a timeframe of minutes to hours. When mood swings happen frequently, the process is called rapid cycling.Slide18

The clinical

depression symptoms

seen with bipolar disorder include:-

Decreased appetite and/or

weight loss

, or overeating and

weight

gain

Difficulty concentrating, remembering, and making decisions

Fatigue, decreased energy, being "slowed down"

Feelings of guilt, worthlessness, helplessness

Feelings of hopelessness, pessimism

Insomnia, early-morning awakening, or oversleeping

Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex

Persistent physical symptoms that do not respond to treatment, such as

headaches

,

digestive disorders

, and chronic pain

Persistently sad, anxious, or "empty" moods

Restlessness, irritability

Thoughts of death or suicide, suicide attemptsSlide19

The signs of mania with bipolar disorder include:-

Disconnected and racing thoughts

Grandiose notions

Inappropriate elation

Inappropriate irritability

Inappropriate social behavior

Increased sexual desire

Increased talking speed and/or volume

Markedly increased energy

Poor judgment

Severe insomniaSlide20

SUBTYPE OF BIPOLAR DISORDER

1)Bipolar I:-

Characterized by episodes of severe mania and severe depression.

2)Bipolar II:-

Characterized by episodes of hypomania(not requiring hospitalization)and severe depression.

Slide21

Signs of hypomania with bipolar II disorder include:-

Decreased need for sleep

Extreme focus on projects at work or at home

Exuberant and elated mood

Increased confidence

Increased creativity and productivity

Increased energy and libido

Reckless behaviors

Risk-taking behaviorsSlide22

IV)RECURRENT DEPRESSIVE DISORDER

This disorder is characterized by recurrent(at least two)depressive episodes(

unipolar

depression).

V)PERSISTENT MOOD DISORDER

-These disorders are characterized by persistent mood symptoms which last for more than 2years(1year in children and adolescents)but are not severe enough to

labelled

aseven

hypomaniac

or mild depression.Slide23

Prognostic factors in mood disorders

Good:-

acute onset,

typical c/f,

severe depression,

good

premorbid

personality,

good response to Rx.Slide24

Poor:-

co-morbid medical disorders,

double depression,

stress,

hypochondriacal

features,

poor drug complianceSlide25

ETIOLOGY

The etiology of mood disorders is currently unknown.

However several theories have

have

been propounded;

These include:-

1)Biological theories:-

The following finding and theories point toward a biological basis of mood disorders.

A)Genetic hypothesis:-

The life time risk for the 1

st

degree Slide26

relative of Bipolar mood disorder patient is 25%,and

Of recurrent depressive disorder patient is 20%.

-The life time risk for the children of one patient with mood disorder is 27% and of both parents with mood disorder is 74%.

-The concordance rate in bipolar disorders for monozygotic twins is 65% and for

dizygotic

twins is 20%.

-The concordance rate in

unipolar

depression for monozygotic twins is 46% and for

dizygotic

twin is 20%. Slide27

B)BIOCHEMICAL THEORIES

-The

mmonoamine

hypothesis suggests abnormality in monoamine(catecholamine(

norepinephrine

and dopamine) and serotonin) system in the central nervous system at one or more sites.

C)NEUROENDOCRINE THEORIES

Mood symptoms are prominently present in many endocrine

disorders,like

hypothyroidism,Cushing’s

disease, Addison’s disease.

-Endocrine function is often disturbed in depression with

cortisol

hypersecretion,non

suppresion

with

dexamethasone

challenge,Decreased

TSH level,Slide28

Decrease growth hormone production.

D)BRAIN IMAGING

CT

Scan,MRI

Scan,PET

scan, can be done.

-These have yielded inconsistent ,yet suggestive findings are:-

Ventricular

dilatation,changes

in blood flow and metabolism in several parts of

brain,like

prefrontal

cortex,anterior

cingulate

cortex,and

caudate)Slide29

2)psychosocial theories

a)psychoanalytic theories

b)increased stress

c)cognitive and behavioral theories.Slide30

MANAGEMENT

Antidepressants

Tricyclic

Antidepressants (TCAs)

Monoamine

Oxidase

Inhibitors (MAOIs)

Selective Serotonin Reuptake Inhibitors

1)

Tricyclic

antidepressants:-

-

Imipramine,AmitriptylineSlide31

2)MAOIs

-

Moclobemide,clorgyline

3)

SSRIs

Fluoxetine,Fluvoxamine,paroxetine,sertraline,citalopram,Escitalopram

There are 3 phases of treatment:-

1.Acute treatment(till remission occurs)

2.Continuation

tretment

(from remission till end of treatment)

3.Maintenance treatment(to prevent further recurrences)Slide32

Maintenance treatment may be indicated in the following patient.

-partial response to acute treatment.

-poor symptom control during the continuation treatment.

-more than 3 episodes(90% chances of recurrence)

-More than 2 episodes with early age

of

onset,or

recurrence within 2 years of stopping

antidepressants,or

severe and \or life threatening

depression,or

family history of mood disorder.

-chronic depression(>2 years) or double depression.Slide33

About 20-35%of depressed patients are refractory to antidepressant

medication.These

patient may require one of the following treatment.

-A change of antidepressant.

-combination of 2 types of antidepressants.

-Augmentation with lithium

-ECT

One type of depression namely Delusional depression is usually refractory to antidepressant

alone.The

treatment of choice are:-

-Antidepressants with ECT

-Antidepressants with antipsychotics

-Antidepressants with lithiumSlide34

2)ECT(Electroconvulsive therapy)

The indication of ECT in depression are:-

a)Severe depression with suicidal risk

b)Severe depression with

stupor,severe

psychomotor

retardation,or

somatic syndromeSlide35

C)Severe treatment refractory depression

d)Delusional depression

e) Presence of significant antidepressant side-effects or intolerance to drugs.

The response is rapid, resulting in marked

improvement.usually

6-8 ECTs are

needed,given

three times a week.

ECT can also be used for acute maniac excitement if it is not responding to antipsychotics and lithium.Slide36

ANTIPSYCHOTIC DRUGS

The commonly used drugs are

risperidone,haloperidol,olanzapine,chlorpromazine

.

ANTIMANIAC(MOOD STABILIZING) DRUGS

lithium

-acute phase of mania

-prevention of further episodes in bipolar mood disorder.Slide37

SODIUM VALPROATE

-For acute treatment in mania and prevention of bipolar mood disorder.

-particularly useful in those patient who are refractory to lithium.

CARBAMAZEPINE AND OXCARBAZEPINE

-For acute treatment of mania and prevention of bipolar mood disorder.

-particularly in those patient who are refractory to lithium and

valproate

.

LAMOTRIGINE

-Bipolar disorderSlide38

BENZODIAZEPINES

-

clonazepam,lorazepam

3)PSYCHOSOCIAL TREATMENT

-

A)COGNITIVE BEHAVOUR THERAPY

-Aims at correcting the depressive negative ideations

e.g.hopelessness,worthlessness,helplessness

, and pessimistic ideas and replacing them by new cognitive and behavioral responses.

B)INTERPERSONAL THERAPY

IPT attempts to recognize and explore interpersonal stressors, social isolation, or social skill deficits which act as precipitants for depression.Slide39

C)BEHAVOUR THERAPY

- This includes various short-term modalities like social skills

training,problem

solving techniques,

Activity

scheduling,and

decision making techniques.

D)GROUP THERAPY

E)FAMILY

THERAPY