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11. Mental/psychical disorders in adults
Depression
D e p r e s s ion is c ha r a c te r is e d by a s e t of s ym p tom s la s ting a t le a s t tw o
w e e ks a nd c a us ing
a c ha nge fr om the p a tie nt‟s p r e v ious func tioning.
T he c la s s ic d ia gnos tic c r ite r ia for a m a jor d e p r e s s iv e e p is od e a r e :
– P e r v a s iv e s a d ne s s a nd / or a la c k of inte r e s t or p le a s ur e in a c tiv itie s
nor m a lly found
p le a s ur a ble
A nd
– A t le a s t four of the follow ing s ign s :
•Signific a nt los s of a p p e tite or w e ight
•Ins om nia , e s p e c ia lly e a r ly w a king (or , m or e r a r e ly, hyp e r s om nia )
•P s yc hom otor a gita tion or r e ta r d a tion
•Signific a nt fa tigue , m a king it d iffic ult to c a r r y out d a ily ta s ks
•D im inis he d a bility to m a ke d e c is ions or c onc e ntr a te
•F e e ling of guilt or w or thle s s ne s s , los s of s e lf-c onfid e nc e or s e lf-e s te e m
T ••hTFeehfoeeulaginhtgtusor feodfsdeoesf adp taeh,iprsr ueics isdioanl icd ae na tvioan royr, ah totewmepvte r , fr om on e c ult ur e t o a n ot h e r
1
e xa m p le , th e d e p r e s s e d p a tie nt m a y e xp r e s s m ultip le s om a tic c om p la ints
r a the r th a n
p s yc h ologic a l d is t r e s s . D e p r e s s ion m a y a ls o m a n ife s t it s e lf a s a n a c ut e
p s yc h ot ic
d is or d e r in a giv e n c ultur a l c onte xt.
Management
W he n fa c e d w ith s ym p tom s of d e p r e s s ion, c ons id e r a n und e r lying or ga nic
c a us e (e .g.,
h yp oth yr oid is m or P a r kin s on ‟s d is e a s e ) or a d v e r s e e ffe c ts fr om m e d ic a l
trea tm ent
(c or tic os te r oid s , c yc los e r ine , e fa v ir e nz, le v od op a , e tc .). L ook for a tr igge r ing
e v e nt (e .g.
r a p e , r e c e nt c hild bir th a nd p os t-p a r tum d e p r e s s ion).
D e p r e s s iv e s ym p tom s a r e the m os t c om m on p s yc hic a l d is or d e r s in
p a tie nts w ith s e v e r e
scs sehyhmyorvcouepnlhdrtiocoelnomigonoitsrcfeblaoecnl tgnio-eluasgsl1edti1cnisgteepdar o,sbeelessmp sesuccwiahlilaythasssiHgnthiIfeiVcyaihnnafteivmcetpioaan cotrotnubdeariclyulliofes,isor. Tif he s e
ps ne ga tiv e im p a c t on
a d he r e n c e to
tr e a tm e nt.
Sym p tom s of d e p r e s s ion a r e us ua l r ight a fte r a m a jor los s (be r e a v e m e nt,
e xile , e tc .).
T h e y gr a d ua lly s ubs id e , in m os t c a s e s , w ith s up p or t fr om r e la t iv e s .
P s yc h ologic a l
s up p or t m a y be us e ful.
P ha r m a c ologic a l tr e a tm e nt is jus tifie d if th e r e is a r is k of s uic id e or in th e
e v e n t of
Depression
D e p r e s s ion is c ha r a c te r is e d by a s e t of s ym p tom s la s ting a t le a s t tw o
w e e ks a nd c a us ing
a c ha nge fr om the p a tie nt‟s p r e v ious func tioning.
T he c la s s ic d ia gnos tic c r ite r ia for a m a jor d e p r e s s iv e e p is od e a r e :
– P e r v a s iv e s a d ne s s a nd / or a la c k of inte r e s t or p le a s ur e in a c tiv itie s
nor m a lly found
p le a s ur a ble
A nd
– A t le a s t four of the follow ing s ign s :
•Signific a nt los s of a p p e tite or w e ight
•Ins om nia , e s p e c ia lly e a r ly w a king (or , m or e r a r e ly, hyp e r s om nia )
•P s yc hom otor a gita tion or r e ta r d a tion
•Signific a nt fa tigue , m a king it d iffic ult to c a r r y out d a ily ta s ks
•D im inis he d a bility to m a ke d e c is ions or c onc e ntr a te
•F e e ling of guilt or w or thle s s ne s s , los s of s e lf-c onfid e nc e or s e lf-e s te e m
T ••hTFeehfoeeulaginhtgtusor feodfsdeoesf adp taeh,iprsr ueics isdioanl icd ae na tvioan royr, ah totewmepvte r , fr om on e c ult ur e t o a n ot h e r
1
e xa m p le , th e d e p r e s s e d p a tie nt m a y e xp r e s s m ultip le s om a tic c om p la ints
r a the r th a n
p s yc h ologic a l d is t r e s s . D e p r e s s ion m a y a ls o m a n ife s t it s e lf a s a n a c ut e
p s yc h ot ic
d is or d e r in a giv e n c ultur a l c onte xt.
Management
W he n fa c e d w ith s ym p tom s of d e p r e s s ion, c ons id e r a n und e r lying or ga nic
c a us e (e .g.,
h yp oth yr oid is m or P a r kin s on ‟s d is e a s e ) or a d v e r s e e ffe c ts fr om m e d ic a l
trea tm ent
(c or tic os te r oid s , c yc los e r ine , e fa v ir e nz, le v od op a , e tc .). L ook for a tr igge r ing
e v e nt (e .g.
r a p e , r e c e nt c hild bir th a nd p os t-p a r tum d e p r e s s ion).
D e p r e s s iv e s ym p tom s a r e the m os t c om m on p s yc hic a l d is or d e r s in
p a tie nts w ith s e v e r e
scs sehyhmyorvcouepnlhdrtiocoelnomigonoitsrcfeblaoecnl tgnio-eluasgsl1edti1cnisgteepdar o,sbeelessmp sesuccwiahlilaythasssiHgnthiIfeiVcyaihnnafteivmcetpioaan cotrotnubdeariclyulliofes,isor. Tif he s e
ps ne ga tiv e im p a c t on
a d he r e n c e to
tr e a tm e nt.
Sym p tom s of d e p r e s s ion a r e us ua l r ight a fte r a m a jor los s (be r e a v e m e nt,
e xile , e tc .).
T h e y gr a d ua lly s ubs id e , in m os t c a s e s , w ith s up p or t fr om r e la t iv e s .
P s yc h ologic a l
s up p or t m a y be us e ful.
P ha r m a c ologic a l tr e a tm e nt is jus tifie d if th e r e is a r is k of s uic id e or in th e
e v e n t of
