depression lecture

7/29/2019 depression lecture

1/22

8:30-8:55 Genetics in the Mentally Ill8:55-9:00 Break9:00-9:25 Sleep

9:25-9:30 Break9:30-9:55 Psychological Assessment9:55-10:00 Break10:00-10:50 Major DepressionAfternoon Blackboard Video Exercise #4


2/22

Lecture Schedule Changes

Old Schedule

Oct 25th

Psychological Assessment,9:30-9:55, Dr. Trede

November 1st

Death & Dying, 8:30-9:10,Dr. Hankins

Trauma Survivor Interview,9:20-10:00

Final Exam Review, 10:10-11:00, Dr. Hughes

New Schedule

Oct 25th

Psychological Assessment,9:30-9:55, Dr. Shu

November 1st

Final Exam Review, 8:30-9:10, Dr. Hughes

Trauma Survivor Interview,9:20-10:00

Death & Dying, 10:10-11:00, Dr. Verma


3/22

8:30-8:55 Genetics in the Mentally Ill8:55-9:00 Break9:00-9:25 Sleep

9:25-9:30 Break9:30-9:55 Psychological Assessment9:55-10:00 Break10:00-10:50 Major DepressionAfternoon Blackboard Video Exercise #4


4/22

ICM SAC: 9/20 &10/25

Lonnie [email protected]

Lauren [email protected]

Ben [email protected]

Michael [email protected]
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


5/22

Major Depression

Doug Hughes, MDProfessor of Psychiatry

Boston University


6/22

Major Depression Lifetime prevalence of 5% to 10%

Higher prevalence in certain groups likethe medical ill

Average age of onset is 40

Twice as common in females

At greater risk of death from all causes

No ethnic or socioeconomic differences

Certain professions have significantlyhigher rates of depression and anxietydisorders


7/22

Empathic Concern

Empathic concern is how much one caresabout others

Those who score high in these areas aremore likely to return incorrect change to acashier when they believe no one iswatching, give money to a homelessperson, volunteer and not put it on theirresume, help an animal or friend out, etc


8/22

Screening Questions for DiagnosingColumbia University Study Journal of Pediatrics, July, 2006

Have you lost interest and pleasure in

doing things (anhedonia)?

Do you feel down or depressed, Childrenand males may report empty feelings).


9/22

DSM-IV: 5 or more of the symptoms &one or both of the top 2 symptoms

A. At least 5 symptoms forat least 2 weeks

B. Symptoms cause

significant distressand/or impairment

C. Symptoms not due todrugs, alcohol, or

medical illness.D. If bereavement, usually

symptoms must persistfor at least 2 months

SYMPTOMS

Depressed mood *

Anhedonia *

Weight loss, >5%

Sleep problems

Psychomotor < or >

Chronic fatigue

Worthlessness

Poor concentration

Suicide thoughts

* Must have one or both


10/22

S uicide recurrent thoughts with or without a plan

I nterestmarkedly diminished interest or pleasure, others may note it

G uilt excessive or inappropriate, feeling of worthlessness, may be delusional

E nergy fatigue or loss of energy nearly every day

C oncentratediminished ability to think/decide or as observed by others

A ppetite 5% body weight loss in a month, or decreased or increase in appetitenearly every day. Note: In children, consider failure to make expected weight gains.

P sychomotor agitation or retardation every day, observable by others

S leep, insomnia or early morning wakening nearly every night, Hypersomniapresent in atypical depression or bipolar depression


11/22

Depression and Suicide

15 % of people with major depression eventuallycommit suicide

Mood disorders account for 50-70 % of allsuicides

Suicide is more common in men than in women Suicide is more common in the elderly but may

be increasing in adolescents

Risk of suicide is highest in untreated depressionand in the early treatment phase withantidepressants

If a patient mentions suicide, follow up with an

open-ended question to get more information


12/22

Assisted Suicide

Not always clear what is a suicide v an accident

Physicians may asked by their dying or suffering

patients to assist in their death. This is called euthanasia and is illegal in all

States except Oregon, Washington, & Montana

Death is defined as irreversible cessation of allfunctions of the entire brain, including thebrainstem, often certified by a flatelectroencephalogram (EEG)


13/22

Diagnostic Challenges


14/22

Normal v Abnormal/Pathological Grief

Normal

Minor weight loss


15/22

Masked Depression Possibly 50% of depressed patients are

unaware or deny symptoms of depression, aresaid to have masked depression

Patients often visit their primary care physicians

and complain of vague physical symptoms. These symptoms can be misdiagnosed as

hypochondrias or anxiety

Atypical DepressionA variant of major depression where patients

gain weight rather than lose, and are morelikely to show excessive somnolence


16/22

Medical Differential

Drug abuse, alcohol and illicit drugs,particularly freebase cocaine (shortesttime to onset and shortest duration of

action) Cancer, particularly pancreatic and other

gastrointestinal tumors

Viral illness such as pneumonia, HIV/AIDS(most STDs are usually not associatedwith depression)

Endocrine abnormalities, such as

hypothyroidism


17/22

Patients with Cancer

Many illnesses, particularly cancer, results in lossof energy, decrease appetite, weight loss,trouble sleeping all of which are also symptomsof depression

Also hospitalized patients because of thestressful environment have trouble sleeping,may not like the food, not able to access theirhobbies, etc all of which make diagnosingdepression more difficult

Concentration and excessive guilt may be thebest indicators of depression


18/22

Treatment


19/22

Major Depression Treatment Antidepressants; the SSRIs as first line agents

(paxil, prosaz, zoloft), effectiveness is not clear Be careful with SSRIs with the new FDA, Black Box

warning about greater suicide risk for adolescents,probably the case for adults.

Tricylics are just as effective but have moreanticholinergic side effect; tachycardia, conductiondisturbances. Avoid in cardiac patients

Lithium is both a good augmenting agent for

antidepressant medications Lithium may also be used by itself initially in

treating the depressed and suicidal patient as itdecrease impulsivity (found to decrease suiciderates, one of only two medication that do this)


20/22

Cycle of Despair

Major Depression

Atypical DepressionDsthymia

Alcohol AbuseAlcohol Dependence

Drug Abuse

Suicide

Homicide

Child Abuse

Substance AbuseDepression

Violence


21/22

Video

This video interview of a patient has manysymptoms see if you can make a diagnosis

After the video we will have Turning Pointquestions so dont talk during video withyour neighbor

11 minutes


22/22

DSM-IV: 5 or more of the symptoms &one or both of the top 2 symptoms

A. At least 5 symptoms forat least 2 weeks

B. Symptoms cause

significant distressand/or impairment

C. Symptoms not due todrugs, alcohol, or

medical illness.D. If bereavement, usually

symptoms must persistfor at least 2 months

SYMPTOMS

Depressed mood *

Anhedonia *

Weight loss, >5%

Sleep problems

Psychomotor < or >

Chronic fatigue

Worthlessness

Poor concentration

Suicide thoughts

* Must have one or both

depression lecture

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