Depression PowerPoint Presentation PDF

What is Health? WHO defines health as: “"A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity "  Depressive Disorders According to the American Psychiatric Association (APA) Depression is  A common and serious medical illness that neg...

What is Health? WHO defines health as: “"A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity "  Depressive Disorders According to the American Psychiatric Association (APA) Depression is  A common and serious medical illness that negatively affects feelings, thoughts and actions  Can cause feeling of sadness, a loss of interest in enjoyable activities and can lead to a variety of emotional and physical difficulties affecting one’s ability at work at home  Can cause feeling of sadness, a loss of interest in enjoyable activities and can lead to a variety of emotional and physical difficulties affecting one’s ability at work at home  Strong familial association - 1.5 to 3 times more likely in first degree relatives  In some cases reduced levels of norepinephrine Association with low & dopamine are levels of serotonin implicated in symptoms Pathophysiology Dysregulation of stress Increased blood flow in response function in amygdala hypothalamus-pituitary- region/dysfunction in adrenal axis: increased limbic prefrontal cortex cortisol levels with slow communication recovery from stimuli   Patients suffering at least one major depressive episode lasting at least two weeks  Usually present with five or more of the nine symptoms: Major   Depressed mood Loss of interest or pleasure in most or all activities Depressive  Insomnia or hypersomnia Disorder   Change in appetite or weight Psychomotor retardation or agitation (MDD)  Low energy  Poor concentration  Thoughts of worthlessness or guilt  Recurrent thoughts about death/suicide   Patients with depressed mood for at least two years accompanied by at Persistent least two of the following symptoms: Depressive  Decreased or increased appetite Disorder  Insomnia or hypersomnia (combination of  Low energy Dysthymic Disorder  Poor and Chronic Major self-esteem Depressive Disorder)  Poor concentration  Hopelessness Epidemiology The WHO has estimated by 2020, depression will be the leading cause of overall disease burden across the globe in all genders and age groups ADULTS:  An estimated 16.2 million (6.7%) adults in the United States had at least one major depressive episode  Prevalence is higher among adult females (8.5%) compared to males (4.8%)  Prevalence is highest among individuals aged 18-25 (10.9%)  Prevalence is highest among adults reporting two or races (10.5%) ADOLESCENTS:  An estimated 3.1 million (12.8%) adolescents aged 12 to 17 in the United States had at least one major depressive episode  Prevalence is higher among adolescent females (19.4%) compared to males (6.4%).  Prevalence is highest among adolescents reporting two or more races (13.8%).  Risk Factors  Personal or Family history of depression  Major life changes  Trauma  Stress  Illness  Bereavement  Perceived social support  Personality disorders  Loneliness   Initial treatment s often sought at PCP and not be identified as depression  Vague somatic concerns rather than identifying or sharing emotions Clinical  such as sadness or hopelessness Irritability is likely identified in children; depressed mood and Presentatio hopelessness are more apparent in adults; and somatic concerns are common older adults’  Loss of interest or pleasure in previously enjoyable events and social n  withdrawal are almost always present Decreased appetite and insomnia are often present but may be missed in patient report.  Preoccupations with perceived personal deficits along with an exaggerated sense of guilt or worthlessness are also common  Impaired concentration, difficulty with decision-making, and mild memory impairment are possible  Thoughts of death vary from “the world would be better off without me” to engaging in dangerous behaviors without concern for personal safety and to having specific plans for suicide  No specific PE Physical Careful Interview to assess for stressors, Exam/ sleep patterns, nutrition, physical activity Diagnostics Tools to diagnose depression: Primary Care Hamilton PHQ-9 Patient Behavioral Risk Geriatric Evaluation of Depression Scale & Health Factor Surveillance Depression Scale Mental Disorders Beck Depression Questionnaire System (BRFSS) (PRIME-MD) Inventory  Pharmacological Treatments Anti-depressants classes include:  Selective serotonin reuptake inhibitors (SSRIs)  Serotonin-norepinephrine reuptake inhibitors (SNRIs)  Atypical anti-depressants  Serotonin modulators  Tricyclic antidepressants  Monoamine oxidase inhibitors (MAOIs)  REMEMBER: Full therapeutic of meds may take 12 weeks ***PT MUST BE ASSESSED FOR SUICIDAL RISK AFTER STARTING MEDICATION -----Suicidal Threshold**** Supportive Treatments RELAXATION, PSYCHOTHERAPY CONVULSIVE PATIENT EXERCISE THERAPY EDUCATIO (ECT, TMS) N Referral / Follow-up ASAP/ EMERGENT URGENT Routine (ER) High risk of harm Concern of other Not responding to to self or other psychiatric treatment disorders Complications with treatment Explore other treatment options