Depression

Depression is a psychological state of mind. It is a major problem faced by most of the people especially the youths. all the reasons why depression is caused what are it's symptoms signs how must the person be treated is explained in this slide

1. Depression

2. INTRODUCTION Widespread mental health problem affecting many people. It is one of the leading cause of disability across the world. It is often associated with variety of medical condition. Highest incidence occurs in individuals without close interpersonal relationships and in person who are divorced or separated.

3. DEFINITION Depression is defined as a common mental disorder that presents with depressed/low mood , loss of interest or pleasure , decreased energy , feelings of guilt or low self worth , disturbed sleep or appetite & poor concentration.(WHO) More over depression often comes with symptoms of anxiety. At its worst depression can lead to suicide.

4. Anatomy and Physiology Thalamus- speech , behavioural reactions , movement , learning , thinking. Hippocampus- processing long term memory and recollection. Amygdala- anger, pleasure , sorrow , fear & sexual arousal. Prefrontal cortex- making decisions and forming memories.

5. EPIDEMOLOGY Common mental disorder. 1/5 th of adults experiences major depressive disorder during their lifetime. More than 300 million people of all ages suffer from depression women>men 4 th leading cause of disability. By 2020, depression will Be the 2 nd leading cause of disability.(WHO) According to DSM 5 criteria life time prevalance—28.2% for MDD. Suicide is the 2 nd leading cause of death in 15-29 yr olds.

6. Classification F 32—Depressive episode F 32.0—Mild depressive episode F32.00- without somatic syndrome F32.01-with somatic syndrome F 32.1—Moderate depressive episode F32.10- with out somatic syndrome F32.11-with somatic syndrome F 32.2– severe depressive episode without psychotic symptoms F32.3—severe depression episode with psychotic symptoms F32.8—Other depressive episode- Atypical depression F32.9—Depressive episode, unspecified

7. F33.0 Recurrent Depressive Disorder, current mild episode F33.2 Recurrent Depressive Disorder, current episode moderate F33.3 Recurrent Depressive Disorder, current episode severe with psychotic symptoms F33.4 Recurrent Depressive Disorder, currently in remission F33.8 Other Recurrent Depressive Disorder F33.9 Recurrent Depressive Disorder- unspecified

8. ETIOLOGY BIOLOGICAL THEORIES Neurochemical Genetic theory Endocrine theories Circadian rhythm theories Change in brain anatomy

9. PSYCHOSOCIAL THEORIES Psychoanalytic theory Behavioural theory Cognitive theory Sociological theory Transactional model of stress

10. PSYCHOPATHOLOGY In depression, patient’s sadness deepens to a morbid depression and the difficulty in concentration becomes retardation of all thoughts and actions .Depressive patient may show a complete failure of all insight, deny that they are ill and hold steadfastly to their ideas of guilt and punishment.

11. CLINICAL FEATURES Depressive mood- sadness, loss of interest in activities Depressive cognitions- hopelessness, helplessness , worthlessness , unreasonable guilt , self blame Suicidal thoughts Psychomotor activity- slowness in thinking, walking & act, restlessness, feeling of uneasiness Psychotic features- Delusions & hallucinations, nihilistic delusions

12. SOMATIC SYMPTOMS Loss of appetite and weight loss Early morning awakening at least 2 or more hours before usual time of waking up Diurnal variation ,depression being worst during morning Lack of interest or lack of reactivity to pleasurable stimuli Psychomotor retardation

13. BOOK PICTURE PATIENT PICTURE Sadness of mood, loss of pleasure or interest in activities Sadness of mood, loss of pleasure in almost all activities Hopelessness, helplessness, worthlessness, guilt Hopelessness, worthlessness Self blame over trivial matters in the past Suicidal thoughts Suicidal thoughts Thinks, Walks, acts slowly Thinks, walks, acts slowly restlessness Loss of appetite hallucination Loss of weight Loss of appetite Loss of weight

14. PSYCHOLOGICAL TESTS- BECK DEPRESSION INVENTORY A 21 question multiple choice self report that measure the severity of depression symptoms and feeling ZUNG SELF—RATING DEPRESSION SCALE A short survey that measures the level of depression ranging from normal to severely depressed .The scale consist of 20 item self report questionnaire. HAMILTON RATING SCALE FOR DEPRESSION DEXAMETHASONE SUPPRESSION TEST ICD—10 CRITERIA SERUM ELECTROLYTES,LFT,RFT HEMATOLOGICAL INVESTIGATIONS DIAGNOSIS

15. BOOK PICTURE PATIENT PICTURE HAMILTON RATING SCALE FOR DEPRESSION HAMILTON RATING SCALE FOR DEPRESSION BECK’S SUICIDE INTENT SCALE BECK’S SUICIDE INTENT SCALE BECK’S DEPRESSION INVENTORY ICD—10 CRITERIA ZUNG SELF RATING DEPRESSION SCALE SERUM ELECTROLYTE,LFT,RFT ICD—10 CRITERIA HEMATOLOGICAL INVESTIGATION SERUM ELECTROLYTE,LFT,RFT HEMATOLOGICAL INVESTIGATION

16. TREATMENT

17. Psychopharmacology

18. INDIVIDUAL PSYCHOTHERAPY Phase 1 Client is assessed to determine the extent of the illness. Complete information is given to individual regarding nature of depression Phase 2 Focus on helping the client resolve complicated grief reactions-----establishment of new relationships Phase 3 Clarification of emotional states, improvement of interpersonal communication, testing of perceptions

19. GROUP THERAPY- Sharing of feelings in groups. FAMILY THERAPY COGNITIVE THERAPY- The individual is taught to control thought distortions that are considered to be a factor in the development and maintenance of depressive disorder. ELECTROCONVULSIVE THERAPY- It is induction of generalized grandmal seizure through application of electric current to the brain . TRANSCRANIAL MAGNETIC STIMULATION- Use very short pulses of magnetic energy to stimulate nerve cells in the brain, Similar to ECT.

20. COMPLICATION Alcohol or drug misuse Anxiety , panic disorder , social phobic Family conflicts, relationship difficulties Social isolation Suicidal feelings Self mutilation Premature death from medical condition

21. Altered communication process related to depressive cognitions as evidenced by being unable to interact with others, withdrawn, expressing fear of failure or rejection .

22. Altered sleep and rest related to depressed mood and depressive cognitions as evidenced by waking up around 3 am and difficulty falling asleep after that.

23. Self esteem disturbance related to impaired cognitions as evidenced by expression of worthlessness, negative and pessimistic outlook

24. Conclusion Depression is a state of low mood, anhedonia , decreased energy. It is caused by various biological and psychosocial factors. Diagnosis is done by various psychological and hematological tests. Treatment includes various psychopharmacological treatments along with psychotherapy.

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