Depression and management Guidelines. Prof. Dr. Momtaz AbdEl Wahab Prof. of psychiatry Cairo University. Face the Facts. Depression is a Prevalent Disorder. Epidemiology. Epidemiology.
Prof. Dr. Momtaz AbdEl WahabProf. of psychiatry Cairo University
Depression is a Prevalent Disorder
121 Million People Suffer From Depression
ATLAS (WHO 2001)
The Prevalence of Depression is Rising?!
Lack of support
Depression is a Burden
2000 is the world
2020 will be the
4th greatest health problem
2nd greatest health problem causing disability
Depression in an Expensive Disorder
- family member
Their relationships frequently being shattered
- increased drinking
- initiation drug abuse
-suicidal risk is high 15%-19%
- wasted training
Depression is a Recurrent Disorder
Keller et al., (1992) & Scot & Dicky (2003), B. J. Psychiat.
(preoccupied with organicity ).
Depressive symptoms Background
Somatic symptoms Foreground
Depression is recorded in up to 30% of patients seen by other specialties
(Widmer & Cadoret, 1978)
Depressed patients seen in primary care practice
Why there is a Tendency for depression to manifest itself in the somatization sphere
Only about ½ of patients with MD are explicitly recognized as being depressed.
Only about ½ of all depressed patients receive some form of therapy for their illness (Lepine et al 1997)
Only about ¼ of depressed patient receive an adequate dose and duration of AD treatment (Katon et al 1992)
Khalia M (2005): Metabolism Clinical & experimental
54 Suppl(1).; 24-27
Malhi GS, et al., (2005): Acta Psychiatr. Scand.; 111:94-105
Sex & appetite Aggression
Modified from Healy & McMonagle. J Psychopharmacol 1997; 11 (suppl 4): S25-S31.
Pattern of Symptoms:
1) Common Presentations
Usually the patient presents either of the following symptoms:
1- Multiple Somatic complaints.
2- Lack of Concentration and/or forgetfullness.
3- Increased fatigability.
The patient has multiple and excessive complaints, involving more than one system in the body.
2) Signs suggesting a depressive disorder:
C) The symptoms lead to significant distress or impairment in social, occupational or other important functional areas.
1-vegetative symptoms of reserved polarity as:-
2-marked mood reactivity.
3-sensitivity to emotional rejection.
In extreme cases,individuals might be unavailable to function socially, occupationally, un-able to feed and clothe themselves, or to maintain minimal personal hygiene.
Characterized by at least two of the following:
1- Loss of pleasure in all, or almost all activities.
2-Lack of reactivity to pleasurable stimuli (anhedonia).
3- Distinct quality of depressed mood.
4- Diurnal variation (depression regularly worse in the morning).
5-Early morning awakening.
6- Marked psychomotor retardation or agitation.
7- Significant anorexia or weight loss.
8- Excessive or inappropriate guilt.
1-Depression due to general medical condition
2-Depression secondary to other nonpsycho-active drugs (steroids, & reserpine).
In Different Patient Populations*
*There is a range of percentages depending on the study.
The Myth & The Reality
Depression is obvious and easily recognized and expressed by the patient
Depression disorders are overlapping, hardly expressed by the patient and constitute a major problem in symptom exaggeration
The Myth & The Reality
Depression is Secondary to GMD activity
Treatment of the medical disorder will relief Depression.
DEPRESSION REQUIRES TREATMENT intervention and do not remit with relieve of symptoms
MINI INTERNATIONAL NEUROPSYCHIATRIC INTERVIEW
3. عندما شعرت أنك مكتئب أو مهموم أو حزين خلال الأسبوعين الماضيين:
اذا حصلت على 5 اجابات أو أكثر ”بنعم“ على الأسئلة من 3.أ الى 3.ز
اذا فالمريض يعانى من
نوبة اكتئاب حالية
Current Depressive Episode
4. (أ) خلال سنوات حياتك الماضية هل مررت بفترات أخرى (مدتها أسبوعين أو أكثر) أحسست خلالها بالاكتئاب أو أنك غير مهتم بمعظم الأشياء أو عانيت خلالها بنفس الأعراض السالف ذكرها؟
4.(ب) هل مرت عليك مدة لا تقل عن شهرين بدون اكتئاب أو احساس بعدم الاهتمام فى فترة ما بين نوبتين للاكتئاب؟
نوبة اكتئاب متكررة
1- The DSM-IV classification of mood disorders encompasses all of the following except
3- Which of the following statements isn’t true of bipolar disorders?
4- The concept of uncomplicated bereavement includes all of the following except
6- an individual whose symptomatology fulfills the criteria for dysthymic disorder , but who have intermittent periods of normal mood which last more than a few months is BEST classified as having