True about “Major Depression” include the following EXCEPT
Correct Answer: Two times more common in men than women
Description: Ans. a (Two times more common in men than women) (Ref. Harrison 18th/ p 2259)Mood disorder subtypesTypesCharacteristicsDysthymia# Depressed mood# Loss of interest or pleasure# Chronic (at least 2 years)Cyclothmia(nonspecific bipolar)# Alternating states# Chronic# Often not recognized by affected personSeasonal affective disorder (SAD)# Depressive symptoms during winter months (shortest days, so least amount of light)# Caused by abnormal melatonin metabolism# Treat with bright light therapyUnipolar depression(major depression)# Symptoms for at least 2 weeks# Must be a change from previous functioning# May be associated with anhedonia, no motivation, feelings of worthlessness, decreased concentration, weight loss or gain, depressed mood, recurrent thoughts, insomia or hypersomia, psychomotor agitation or retardation, somatic complaints, delusions or hallucinations (mood congruent), loss of sex drive# Diurnal improvement as day progresses# Suicide: 60% of depressed patients have suicidal ideation: 15% die by suicide# Neurochemistry: "biogenic amine theory of depression" - caused by decreased NE/5HT# Sleep:- | REM in first half of sleep, |REM latency, stage 4 sleep, | REM time overall, early morning wakeningBipolar disorder (manic-depression)# Symptoms of major depression and symptoms of mania (period of abnormal and persistent elevated, expansive, or irritable mood)# Subtypes:- Bipolar I: mania more prominent- Bipolar II: recurrent depressive episodes, plus hypomanic episodes- "Rapidly cycling bipolar disorder": It alternates within 48-72 hours# Manic symptoms:- | self-esteem or grandiosity, low frustation tolerance, need for sleep, flight of ideas, excessive involvement in activities,weight loss and anorexia, erratic and uninhibited behaviour, libidoCriteria for Major Depressive EpisodeA. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.# Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful)# Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)# Significant weight loss when not dieting or weight gain (e.g., a change of >5% of body weight in a month), or decrease or increase in appetite nearly every day# Diagnosis requires exposure to neuroleptics for at least 3 months, but often take longer Insomnia or hypersomnia nearly every day# Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)# Fatigue or loss of energy nearly every day# Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely selfreproach or guilt about being sick)# Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)# Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.B. The symptoms do not meet criteria for a mixed episodeC. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioningD. The symptoms are not due to the direct physiologic effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism)E. The symptoms are not better accounted for by bereavement; i.e., after the loss of a loved one, the symptoms persist for 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.Major or Severe endogenous/ melancholic depressionIs characterized by early morning awakening, marked weight loss, psychomotor retardation and/or agitation, diurnal variation, and lack of reactivity. ECT is at least as effective as TCA in the short-term treatment of these severe endogenous/melancholic depressions. ECT appears to be more effective than MAOI in the treatment of severe depressions.Involutional melancholiaIs a syndrome of severe depression and mania which occurs in involutional period (old age). It is characterized by marked agitation, multiple somatic symptoms (somatization), hypochondriacal delusions, and psychotic features like delusions of persecution, tactile and auditory hallucination.
Category:
Psychiatry
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