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Depression: Clin Psych
Terms in this set (10)
Compare and Contrast Major Depression with Dysthymia
-the most severe form of depression
-Characterized by considerable disability
-High rate of mortality (only partially attributed to suicide)
-aka Chronic depression, milder than major depression
-also associated with significant disability
-DX of Dysthymia: depressed mood + at least 2 other symptoms of depression are present most days during the previous 2 years.
less severe but more chronic form of depressive illness that is also related to significant disability and even M/L to be undiagnosed than major depresseion
-Diagnoised when depressed mood and at least two other symptoms of depression have been present most of the day for more than half of the day during the past 2 years.
Define Adjustment Disorder with Depressed Mood
involves a reaction to an identifiable stressor such as divorce or loss of job.
- Presents with sad or depressed mood, a level of impairment greater than expected for most individuals facing that specific stressor
-diagnosed within the first 6 months after the stressor has occurred.
Mood Disorders due to a general Medical Cond
refers to psychiatric syndromes judged to result from the direct physiologic consequence of a general medical condition (ie. hypothyroidism), substance abuse (cocaine withdrawn), or medication.
AKA Manic Depression: is a common and severe mental illness
Characterized by *mania with or without overt changes in mood, irritability, paranoia and hyperactivity.
-Periods of hyperactivity or maina are often followed by periods of depression and hypoactivity.
Define and Discuss Major Depression
Characterized by considerable disability
Five symptoms from the following but *depressed mood and anhedonia are required. The symptoms must have been present for most of the day nearly everyday for 2 weeks.
1) *Depressed Mood
2) *Anhedonia: lack of interest or pleasure in almost all activities
3) Physical Symptoms
-Fatigue or loss of energy
4) Psychomotor Changes
-psychological symptoms, difficulty concentrating, indecisivness, guilt, suicidal ideas
List and Discuss the barriers to the diagnosis of Depression
Somatic Presentation- some patients present to doctors with vague findings (pain, headache, insomnia, dizziness, GI) and do not mention depression
Stigma-patients do not want to admit depression because of associated social stigma also sometimes doctors do not want to diagnose because of the stigma.
Pandora's Box-physicians often do not want to pursue possible psychiatric or emotional problems for fear of it tking too much time.
Financial Discrimination-some providers avoid diagnosis and tx of mental disorders because insurance providers may not reimburse at all of many reimburse at lower rates than tx for other med conditions.
Differentials To Depression
1) Mental Disorders
2) Anxiety Disorders-commonly present with depression
-depressive disorders ofen come with unexplained body complaints that must be differentiated from somatoform disorders. Depression is HIGHLY treatable while somatoform disorders are more chronic and treatment is focused on improving function.
-ETOH is depressive. Substance buse must be treated concurrently to prevent depression treatment from further enabling the sub abuse.
5) Personality Disorders
-represent enduring character patterns and are generally not alterable.
-demanding and difficult and this may cause clinicians to avoid them and miss a diagnosis of depression.
-Leads to cognitive impairment in to form of decreased concentration, memory difficulties, impaired decsion making abilities and difficulty getting started on tasts.
-These symptoms are also common in depression but *in depression they are considered reversible while in dementia they are nonreversible.
Etiologic Factors in Major Depression
1) Genetic: genetic factors play the strongest role followed by recent negative life events.
-Endocrine Factors: elevated cortisol, blunted response of TSH to TRF
-CNS levels of serotonin and NE may be altered. M/L the NE and 5HTP receptor Numbers are affected
-Sleep Cycles are interrupted causeing early induction of REM sleep and overall increase in REM densirt
None of the biological factors are considered a diagnosis
3) Social and Psychosocial
-Psychosocial Stressors: esp those involving loss ofter trigger depression (loss of SE caused by loss of job)
-Post partum blues (occurs in 50-80% of women)
SPEAK approach to managing the Depressed Patient
framework for patient education and ongoing support and counselling
S: Schedule-have patient mk weekly schedule and follow is which makes the patients activities less mood dependent and more time contingent
P: Pleasurable-activities should be included in order to counteract anhedonia abnd the tendancy of depressed patients to withdraw from pleasurable activities. Have paint make a list of things they like to do and them include in weekly sch.
E: Exercise is a short term mood enhancer and long term prophylaxis against depression
-breaks somatic rigidity and releases endorphins
-Encouraged to exercise several times per week
A: Assertiveness is a prob for depressed patients and should be encouraged to assert their feelings intentions and opinions on others.
K: Kind Thoughts- about oneself. Patients should be aware of the self punishing nature of their thoughts and they should be replaced with positive thoughts 3:1
Speak approach should not replace psychotherapy or medication and can be taught to the patients in 10 minutes and should be reviewed for about 5 min at each session.
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