A CASE STUDY ON DEPRESSION .presentation.pptx

A CASE STUDY ON DEPRESSION

1. A CASE STUDY ON DEPRESSION UNDER THE GUIDANCE OF SUBMITTED BY : MR. P. RANA KISHORE K.GOWRI PRIYA 19AB1T0011 VIGNAN PHARMAY COLLEGE 1

2. DEPRESSION DEFINITION: It is a common mental disorder that is characterized by depressed mood, loss of interest or pleasure, feeling of guilt or low self worth, disturbed sleep or appetite, low energy or poor concentration. CAUSES : Genetics, family history Environmental & biochemical factors Endocrine factors & hormonal imbalance Mental health, lack of support , loneliness Physical illness Drug abuse & alcohol Drug induced ( anticonvulsants, antipsychotics) VIGNAN PHARMACY COLLEGE 2

3. DEPRESSION PATHOPHYSIOLOGY: There are 6 types of hypothesis involved in Depression. BIOGENIC AMINE HYPOTHESIS: Deficiency of monoamines i.e., noradrenaline, serotonin. RECEPTOR SENSITIVY HYPOTHESIS : Alteration of receptor sites SEROTONIN ONLY HYPOTHESIS: Low levels of serotonin PERMISSIVE HYPOTHESIS; Imbalance between noradrenaline & serotonin ELECTROLYTE MEMBRANE HYPOTHESIS: Hypercalcemia in depression NEUROENDOCRINE HYPOTHESIS: Altered endocrine function These 6 hypotheses results in loss of emotional behaviours & leads to Depression VIGNAN PHARMACY COLLEGE 3

4. DEPRESSION SYMPTOMS: Emotions : sadness, anxiety, guilt, anger, mood swings Thoughts: self criticism, confusion, suicidal thoughts Actions: social withdrawl, decreased acti vity level , poor self care Physical state: chronic fatigue, lack of energy, increased sleeping. Behaviour: changes in personal appearance, & neglecting responsibilities DIAGNOSIS: History collection Mental state examination ( via depression Rating scales) Blood tests, LFT, TFT ICD – 10 & DSM – IV criteria VIGNAN PHARMACY COLLEGE 4

5. DEPRESSION TREATMENT : NON PHARMACOLOGICAL THERAPY: Psychotherapy, ECT PHARMACOLOGICAL THERAPY: Monoamine uptake inhibitors: Tricyclic inhibitors (IMIPIRAMINE) SSRIs (FLUOXETIN) SNRIs ( VENLOFAXINE) . MAO inhibitors: SELEGILINE, PHENELAZINE. MAO receptor antagonists : MIRTAZEPINE, TRAZADONE. Others: MIANSERIN, AGOMELATIN, AMINOKETONE VIGNAN PHARMACY COLLEGE 5

6. SOAP NOTES PATIENT DETAILS : NAME : XXX AGE : 48 YEARS GENDER : FEMALE SUBJECTIVE DATA : C/o: lack of sleep, lack of food intake, silly fighting, crying from about one month, lack of self care, lack of day to day activities from about one year. VIGNAN PHARMACY COLLEGE 6

7. OBJECTIVE DATA : PAST SUPAST MEDICAL HISTORY : Patient had 1 st episode 17 years ago; 2 nd episode 8 years ago. RGICAL HISTORY: NIL PAST MEDICATION HISTORY : NIL FAMILY HISTORY: NIL SOCIAL HISTORY: NIL ALLERGIES: NIL VIGNAN PHARMACY COLLEGE 7

8. OBJECTIVE DATA : VITALS & PHYSICAL EXAMINATION: -Blood Pressure: 110/80 mmHg - Respiratory rate: 18 cycles/min - Temperature: 98.6 °F - Pulse rate: 82/min - CVS: S1, S2 Present - CNS: NFND - Respiratory system: NVBS+ - GU & GI: Soft VIGNAN PHARMACY COLLEGE 8

9. OBJECTIVE DATA : COMPLETE BLOOD COUNT : VIGNAN PHARMACY COLLEGE 9 PARAMETER RESULT NORMAL RANGE Hemoglobin 7.6 gm/dl 12-16 gm/dl Total WBC count 5400 cells/ mm³ 4000-11000 cells/ mm³ Total RBC count 4.0 million cells/ mm³ 3.8-4.8 mill/ mm³ Total platelets 3.02 lakh/ mm³ 1.5-4 lakhs/ mm³ Packed cell volume 25.7 % 35-46 % DC P-17, L-20.2, E-2.7, M-6.0,B-0.1 P: 40-70, L: 20-40, E: 1-6, M :2-10, B: <1

10. OBJECTIVE DATA : R ENAL FUNCTION TESTS: VIGNAN PHARMACY COLLEGE 10 PARAMETER RESULT NORMAL RANGE Blood urea nitrogen 7mg/dl 7-17 mg/dl creatinine 0.7 mg/dl 0.8-1.5 mg/dl BLOOD SUGAR PROFILE: PARAMETER RESULT NORMAL RANGE RBS 100 mg/dl 80-140 mg/dl FBS 97 mg/dl 70- 140 mg/dl

11. OBJECTIVE DATA : LIVER FUNCTION TESTS: PARAMETER RESULT NORMAL RANGE Total protein 7.0 g/ dl 6.3-8.2 g/ dl Albumin 3.7 g/dl 3.5-5 g/ dl Globulin 2.9 g/dl 1.5-3 g/ dl Total bilirubin 0.3 mg/dl 0.2-1.3 mg/ dl Direct bilirubin 0.1 mg/dl 0.0-0.2 mg/ dl SGOT 28 IU/L 14-36 IU/L SGPT 39 IUL 9-52 IU/L ALP 182 IU/L 38-126 IU/L VIGNAN PHARMACY COLLEGE

12. OBJECTIVE DATA : PARAMETER RESULT NORMAL RANGE Sodium 140 mmol/L 134 - 144 mmol/L potassium 3.8 mmol/L 3.5 – 5.1 mmol/L chloride 103 mmol/L 98 – 106 mmol/L Bicarbonates 21 mmol/L 21 – 28 mmol/L VIGNAN PHARMACY COLLEGE ASSESSMENT: The tests and other symptoms confirms the diagnosis as Depression

13. PLAN: VIGNAN PHARMACY COLLEGE 13 SL no. NAME OF DRUG GENERIC NAME DOSE ROUTE OF ADMINISTRATION FREQUENCY DAYS 1. CAP.PRODEP FLUOXETINE 20 mg ORAL HS 4 DAYS 2. TAB.IMIPRAMINE IMIPRAMINE 25 mg ORAL HS 4 DAYS 3. TAB.TRINICALM PLUS TRIFLUOPERAZINE 5 mg ORAL TID 4 DAYS 4. TAB.NITROSUN NITRAZEPAM 5 mg ORAL HS 4 DAYS

14. FARM NOTES FINDING: FLUOXETINE + IMIPRAMINE ASSESSMENT: Concurrent use of both drugs may cause sedation, dry mouth, blurred vision, constipation, urinary retention & may also leads to serotonin syndrome risk. RESOLUTION: Avoid concurrent use of both drugs MONITORING: Monitor patient’s symptoms carefully. VIGNAN PHARMACY COLLEGE 14