Depression and Therapy 1a
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Transcript of Depression and Therapy 1a
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Jayson B Bascos MD
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Pathological mood Sustained emotional state
Affective disorder
Expression of a transient emotional state
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Symptoms sustained over weeks to months
Departure from a persons normal functioningwith a tendency for recurrence
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And there is a subjective feeling of greatdistress
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Decreased energy Decreased interest
Feelings of guilt Difficulty concentrating Loss of appetite Thoughts of death or suicide
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Activity levelCognitive abilities
SpeechVegetative functionssleep, sex and other biological rythms
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Impaired interpersonal, social andoccupational functioning.
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King saul
Saul's initial conflict with Samuel occurred after Saul offered asacrifice to God, thereby assuming Samuel's office. Samuelrebuked Saul and proclaimed that Saul's dynasty would not becontinued on the throne of Israel. Their second disagreement tookplace after Saul retained the war booty of the defeatedAmalekites, Israel's traditional enemy, and spared the life of theirking, Agag. Samuel publicly pronounced Saul's deposition fromthe throne. Saul fell into a state ofmelancholia that developedinto an emotional disorder.
Saul's fits of depression and his moody, suspicious temperamentcaused him to attack the lad David, who had been brought into hishousehold to soothe him by playing music. Jealous of David, Saulpersecuted him, attacked him, sent him on perilous expeditions,and finally made him into an outlaw.
http://www.answers.com/topic/bootyhttp://www.answers.com/topic/bootyhttp://www.answers.com/topic/agaghttp://www.answers.com/topic/agaghttp://www.answers.com/topic/melancholia-1http://www.answers.com/topic/temperamenthttp://www.answers.com/topic/soothehttp://www.answers.com/topic/soothehttp://www.answers.com/topic/periloushttp://www.answers.com/topic/periloushttp://www.answers.com/topic/periloushttp://www.answers.com/topic/soothehttp://www.answers.com/topic/temperamenthttp://www.answers.com/topic/melancholia-1http://www.answers.com/topic/agaghttp://www.answers.com/topic/booty -
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Suicide of Ajax:
When Achilles was killed, his armor was to be
awarded to the next greatest Greek hero. Ajaxthought it should go to him. Ajax went mad andtried to kill his comrades when the armor wasawarded to Odysseus, instead. Athenaintervened by making Ajax think cattle were hisformer allies. When Ajax realized he hadslaughtered the herd, he committed suicide ashis only honorable end. Ajax used the swordHector had given him to kill himself.
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Seen in more females than males
Hormonal differences
Effects of childbirth
Differing psychosocial stressors for men andwomen
Behavioral models of learned helplessness
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Mean of 40 yrs old50% seen between 20 to 50 years old
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Increased in:
Persons without close interpersonal relations
Divorced
Separated
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Biological factors
Biogenic amines
Norepinephrine Downregulation of beta adrenergic receptors
Clinical antidepressant response
Indicates a direct role for the noradrenergic system indepression
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Serotonin
Biogenic amine neurotransmitter most associated
with depression SSRIs and serotonergic antidepressants are
effective in depression therapy
Depletion may precipitate suicide in pxs
Low csf concentrations of serotonin metabolites
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Chances for mood disorder decreases asdegree of relationships widens
2nd
degree vs 1st
degree relatives
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Life events and environmental stressors
Stressful life events precedes mood disorders
Alter functional states of various neurotransmitter andintraneuronal signaling systems, changes that may eveninclude the loss of neurons and an excessive reduction insynaptic contacts.
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Personality factors
No single personality trait or type predisposes a
person towards depression All humans of whatever pattern can and will
become depressed under the appropriate
conditions
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1. Disturbances in the infant-motherrelationship in the oral phase (10-18months)
2. Depression can be linked to real orimagined object loss
3. Introjection of the departed object is adefense mechanism invoked to deal with the
distress connected with the objects loss 4. lost object is regarded with a mixture of
love and hate, feelings of anger are directedinward and to the self
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Depressogenic schemata
Self
negative self precept Environment experiences it as hostile and
demanding Future suffering and failure
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Cognitive triad self, environment and future
Schemas
ways of organizing andinterpreting experiences
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Specific abstraction focus on single detail Arbitrary inference concludes without
evidence Magnification/ minimization over or
undervaluing event Personalization self reference external
events without basis Absolutist thinking all or none
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A. five or more of the following symptomshave been present during the same 2 week
period and represents a change fromprevious functioning. At least one of thesymptoms is either
1. depressed mood 2. loss of interest or pleasure
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1) depressed mood most of the day, nearlyeveryday as indicated by either subjective
report or observation by others
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2) markedly diminished interest or pleasure inall or almost all activities most of the day,
nearly everyday
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3) significant weight loss when not dieting orweight gain; decrease or increase in appetite
nearly everyday
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4) insomnia or hypersomnia nearly everyday
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5) psychomotor agitation or retardationnearly everyday
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6) fatigue or loss of energy nearly everyday
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7) feelings of worthlessness or excessiveinappropriate guilt
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8) diminished inability to think orconcentrate, or indecisiveness, nearly
everyday
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9) recurrent thoughts of death
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B. the symptoms do not meet criteria formixed episode
C. symptoms cause clinically significantimpairment in social/ occupationalfunctioning
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D. Symptoms are not due to direct physiologiceffects of a substance or a general medical
condition
E. Symptoms are not better accounted for bybereavement
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Zung self-rating depression scale
20 item report scale
Normal score is 34 or less Depressed score is 50 or more
Provides a global index of severity of a patients
depression
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Hamilton depression rating scale
Widely used scale of 24 items
Rated as 0-4 or 0-2 per item Total score of 0-76
Guilt, suicide, sleep habits and other symptoms of
depression
Based on clinicians assessment/ interview
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1. Guarantee patients safety
2. Complete diagnostic evaluation must becarried out
3. Treatment plan must address immediate
symptoms and patients prospective wellbeing
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Cognitive therapy
Alleviate depressive episodes and prevent
recurrence Identify and test negative cognitions
Develop alternative, flexible and positive ways of
thinking
Rehearse and develop new cognitive responses
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Interpersonal therapy
Current interpersonal conflicts are likely to have
roots from early disfunctional relationships
Current interpersonal conflicts are involved inprecipitating or promoting depressive symptoms
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Behavior therapy
Maladaptive behavioral patterns result from a
persons receiving little positive feedback and
perhaps outright rejection from society
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Individual patients may respond to oneantidepressant and not to another
Most antidepressants interact withserotonergic or noradrenergicneurotransmission or with both
Antidepressants doubles the chance thatdepression will resolve within 1 month
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All currently available antidepressants maytake 3-4 weeks to exert significant
therapeutic effect Fluoxetine, sertraline, mirtazapine and
venlafaxine are safer and have bettertolerance profiles than previously used drugs
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The principal indication for antidepressants isa major depressive episode
First symptom to improve are often poorsleep and appetite patterns Agitation anxiety depressive episodes and
hopelessness are the next symptoms to
improve
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