Overview of Depressive disorder
Presented by Dr. Al Tarique
IMO, Medicine Department
In old Testament, King Saul described Depressive syndrome, as the story of Ajax’s suicide in Homer’s Iliad.
• About 400 BCE, Hippocrates used Mania & Melancholia (Depression).
• In 30 AD, the Roman physician Celsus described Melancholia as Depression caused by black bile.
Genesis
• In 1854, Falret described folie circulaire means alternating Depression and Mania.
• In 1882, German psychiatrist Kahlbaum, used cyclothymia, means Mania & Depression as same illness.
• In 1899, Kraepelin described Manic Depressive Psychosis , now called Bipolar Mood disorder .
DSM - IV
American Psychiatric association mentioned in Diagnostic & Statistical manual of Mental disorders (DSM – IV) as :
Bipolar I disorder: Mania + Depression Bipolar II disorder: Hypomania + Depression
What is Depression?
• Depression means ‘morbid sadness’.• It is defined as combination of both misery &
malaise.• Depression is a major cause of disability &
suicide.• Depression may come as experience, as
symptom of other disease & separate syndrome.
• Mild, Moderate, Severe.• Unipolar: Major Depressive disorder.• Bipolar: Manic Depressive Psychosis.• Recurrent Depression• Atypical Depression • Dysthymic Disorder
Types of Depressive disorder
Terminology1.Major Depression/ Unipolar Depression:
Birth 20 Yrs
Birth 30 Yrs
Depression
Mania
2.Recurrent depression:
3.Bipolar I disorder:
5. Dysthymia
6. Cyclothymia
Hypomania
Depression
4. Bipolar II disorder
Epidemiology:
Prevalence:• F - 6 to 8% (Bangladesh: F- 11.6%)• M - 3 to 5 % ( Bangladesh : M -2.9 %)• Gender: M: F=1:2• Age: Range :6-50 yrs. Mean : 30 yrs. 50% between 20-50 age.
UnemployedDivorcedSeparation
Higher Rate
Causative factors:
Biological:Genetic: Polygenic inheritance. Biochemical:• Decreased 3 monoamine neurotransmitters:
such as - Serotonin (5 HT)
Noradrenaline (NE) CatecholaminesDopamine (DA)
• Change in brain volume:– Enlarged Lateral ventricles– Decreased Hippocampal & Basal ganglia volumes
• Secondary depression :– Cushing’s syndrome.– Addison’s disease.– Hypothyroidism.– Hyper parathyroidism.– Pre menstruation.– Puerperium.– Menopause.
Psychological
• Pre morbid personality: Cyclothymic personality (Repeated & sustained mood swings).
• Stressful life events.• Bereavement
Social
• Relationship with parents.– Deprivation of maternal affection.– Family discord.– Disruption of Parent-Child relationship.– Overprotective parenting.
• Poor social support.• Empty nest syndrome: • Husband abroad syndrome
Presenting features
A. Biological features : (Vegetative/ Somatic)• Sleep disturbance (Early morning awakening).• Diurnal variation of mood (morning ↓, evening ↑).• Anorexia.• Weight loss: In few cases weight may be increased.• Constipation.• Loss of libido.• Amenorrhea.
B. Central features:
• Negative thoughts (Depressive cognition):o Guilty feeling about past.o Worthlessness about present.o Pessimistic thoughts about future.o Suicidal plan
• Anhedonia: Lack of interest & enjoyment.• Reduced energy / Psychomotor
retardation: • Crying Spell
C. Others
Delusions:• Hypochondriacal delusion: Patient
convinces that he has cancer or venereal diseases.
• Persecutory (Paranoid) delusion: Patient believes that other people harm him.
• Nihilistic delusion: Patient believes that he is moneyless/ his family are dead.• Delusion of guilt: Dishonest act will be
punished severely.
Auditory hallucination: Hearing of one 2nd person derogatory & commanding voice.
Features can be described as Mnemonic of Depression • D- Depressed mood, Drug used• E- Energy lack /Eating disturbance• P- Pessimistic thought • R- Retarded movement• E- Emotional disturbance• S- Sexual disturbance/ Speech problems• S- Suicidality• I - Insomnia • O- Obsessional rumination• N- Nihilism
Atypical Depression
Depressive symptoms with :• Increased Appetite• Weight gain• Excessive sleep
Childhood Depression
Depressed mood with :• School Phobia• Excessive clinging to parents
Depression in Adolescent
Depressed mood with :• Poor academic performance • Truancy• Anti- Social Behavior • Substance abuse • Running away• Sexual promiscuity
Depression in older age
Depressive symptoms with loss of memory, known as depressive pseudo dementia
Some Famous people suffered from Depression
• Abraham Lincoln (1809 -1865) , 16th President of USA
• Georgia O’Keeffe (1887-1986) , American artist.
• Jim Carrey (born January 17, 1962) Canadian American actor, comedian, impressionist, screenwriter, and producer.
• J. K. Rowling (born 31 July 1965), British novelist, screenwriter and film producer.
• Dilip Kumar (born on 11 December 1922) , Indian film actor.
• William James (1842 – 1910), American philosopher and psychologist.
• Vincent van Gogh (1853 –1890) ,Dutch painter.
• Agatha Christie (1890 –1976), English crime novelist and short story writer.
• Franz Kafka (1883-1924), German-language writer of novels and short stories.
• Terry Bradshaw ((born September 2, 1948), former American football quarterback.
• Sigmund Freud (1856-1939), Austrian neurologist founder of Clinical psychology.
• Buzz Aldrin (born January 20, 1930) , American engineer and former astronaut.
Source: Internet(Wikipedia)
Thank You All
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