Depression.pdf

Depression Professor Chantal Simon 2.3 million people suffer from depression in UK at any time. Women are twice as likely to suffer from depression as men Around 30-50% of cases are not detected - although most are mild cases, more likely to resolve spontaneously. What is depression? https://www.you...

Depression Professor Chantal Simon 2.3 million people suffer from depression in UK at any time. Women are twice as likely to suffer from depression as men Around 30-50% of cases are not detected - although most are mild cases, more likely to resolve spontaneously. What is depression? https://www.youtube.com/watch?v=OJ7cf-AgLTQ https://www.youtube.com/watch?v=coSbBsTGs_A Screening questions for depression During the last month, have you often been bothered by feeling down depressed or hopeless? During the last month, have you often been bothered by having little interest or pleasure in doing things? If +ve response to either question, investigate further e.g with PHQ-9 Causes and co-morbidity Associated with: Psychiatric disorders e.g. anxiety, alcohol abuse, substance abuse, eating disorders Physical disorders e.g. PD, MS, dementia, thyroid disorders, Addison’s disease, hypercalcaemia, RA, SLE, cancer, HIV and other chronic infections, cardio- and cerebrovascular disease, learning disability. Drugs causing symptoms of depression: beta-blockers, anticonvulsants, Ca2+ channel blockers, corticosteroids, oral contraceptives, anantipsychotic drugs, drugs used for Parkinson’s disease (e.g. levodopa). What are the symptoms of depression? History Onset including precipitating events Nature of symptoms, severity and affect on life Past history of similar symptoms, mood elevation (may be bipolar disorder) or other mental health problems; previous response to treatment Current life events - stressors at home and at work Family and social history including quality of interpersonal relation-ships, living conditions and social isolation Co-existent medical conditions Current medication - prescribed and non-prescribed. ALWAYS ask about suicidal intent Sleep disturbance and fatigue have high predictive value for depression and should prompt enquiry about other symptoms. Symptoms Present >50% of the time in the past 2 weeks. 2 key features: Depressed mood and/or Reduced interest or pleasure, which must be disabling to the patient. Other symptoms Change in appetite/weight Insomnia or hypersomnia Fatigue or loss of energy Poor concentration Poor appetite or overeating Low energy or fatigue Low self-esteem Sense of worthlessness or guilt Recurrent thoughts of death/suicide Psychomotor agitation/retardation Feelings of hopelessness Poor concentration or difficulty making decisions Examination General appearance self-neglect, smell of alcohol, weight los or weight gain Assessment of mood - looks depressed and/or tired, speech monotone or monosyllabic, avoids eye contact, tearful, anxious or jumpy/fidgety, feeling of distance, poor concentration etc. Psychotic symptoms - hallucinations, delusions etc. Mental ill-health = Lack of mental wellbeing Unhappiness Stress Bacteria Depression/anxiety Psychosis Assessing severity Can be done using a depression symptom count or patient selfcomplete measure, such as the PHQ-9. Subthreshold depression