Depression DSM IVAbdullatif Sami Al RashedFamily and Community Medicine Block 5.2College of Medicine, King Faisal UniversityAl Ahsa, Saudi Arabia

Introduction

• Depression is defined as a mental illness that causes a steady low mood. People who suffer from depression tend to be distressed and have a sense of disappearing.

• Depression is common in primary care patients, with an incidence from 10 % to 14 % among patients who present to a physician's office for any reason.

Introduction

• Today, depression is estimated to affect 350 million people.

• According to the World Health Organization (WHO), by the year of 2020, depression will be the second-leading cause of world disability, and by 2030; it is expected to be the largest contributor to disease burden.

Clinical Manifestations

• Classically, patients with depression present with psychological symptoms of:

1. Depressed mood, 2. Loss of interest in activities,3. Impaired concentration,4. Feelings of worthlessness or guilt, and 5. Suicidal ideation.

However, some patients may instead report nonspecific symptoms!

Risk Factors

Screening

• The U.S. Preventive Services Task Force (USPSTF) has published more recent reviews on depression screening.

• Ultrashort screening instruments, such as the Patient Health Questionnaire (PHQ)-2 may rule out, but not definitively diagnose, depression.

Screening

• The PHQ-2, which asks two simple questions about mood and anhedonia, and has been found to be up to 97% sensitive and 67% specific in adults, with a 38% positive predictive value and 93% negative predictive value.

• A PHQ-2 score ranges from 0-6. A score of 3 or greater is positive and patient should be evaluated more by prompt administration of the full PHQ-9  

Screening

• The PHQ-9 is one of the most common instruments used for depression screening, diagnosis and monitor treatment.

• It is increasingly administered for confirmation of a positive PHQ-2 result.

Screening

• The PHQ-9 is valid, takes two to five minutes to complete, and has demonstrated 61% sensitivity and 94% specificity for mood disorders in adults.

Diagnosis of Major Depressive Disorder (MDD)

• The criteria of diagnosing MDD according to DSM-IV is:1. Five (or more) of the PHQ-9 symptoms have been present -More

than half the days- or -Nearly every day- during the same 2-week period.

2. At least one of the symptoms either 1) depressed mood or 2) loss of interest or pleasure marked More than half the days or Nearly every day.

Diagnosis of Major Depressive Disorder (MDD)

• The criteria of diagnosing MDD according to DSM-IV is:

3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

4. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

3. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Treatment(Pharmacological)

Treatment(Non-Pharmacological)

Treatment(Non-Pharmacological)

Reference