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DEPRESSIVE ILLNESS

DEPRESSIVE ILLNESS. By DR. MUHAMMAD ASIF ANWAR. DEPRESSION. DEFINITION: Persistent low mood for 04 weeks noticeable to others and interfering with normal occupational activities. . DEPRESSIVE ILLNESS . Mild Moderate Severe . DEPRESSIVE ILLNESS. Unipolar Bipolar. CLINICAL FEATURES:

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DEPRESSIVE ILLNESS

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  1. DEPRESSIVE ILLNESS By DR. MUHAMMAD ASIF ANWAR

  2. DEPRESSION DEFINITION: Persistent low mood for 04 weeks noticeable to others and interfering with normal occupational activities.

  3. DEPRESSIVE ILLNESS • Mild • Moderate • Severe

  4. DEPRESSIVE ILLNESS • Unipolar • Bipolar

  5. CLINICAL FEATURES: • Persistent low mood / Irritability • Pessimistic (Negative) Thinking • Lack of interest in life • Hopelessness / helplessness / haplessness • Loss of sleep / increased sleep • Loss of appetite / hyperphagia • Early morning awaking / diurnal variation • Psychomotor agitation / retardation • Suicidal thoughts • Guilt feeling

  6. DIAGNOSIS: • History • Mental State Examination DIFFERENTIAL DIAGNOSIS: • Medical conditions e.g. thyroid dysfunction, organic brain disease, diabetes and hepatitis, cardiovascular diseases. • Bipolar affective disorder • Substance induced disorder • Schizophrenia

  7. CASE VIGNETTE: Mr. ABC 24 years of age, single educated uptomatric, worker in a garment factory, R/O KotLakhpat Lahore, presented in OPD at PIMH with following presenting complaints: - • Persistent low mood / sad • Loss of sleep & appetite ----- 6 years • Feelings of un-fresh in the morning • Hopelessness • Lack of enjoyment • Irritability • Lack of confidence • Social Isolation • Lack of interest in routine activities • Pessimistic thoughts

  8. Social stress (Failure in love) • Insomnia +ve (Initial, Late) • Suicidal thoughts • Family History: - Father : bipolar affective disorder

  9. Pre-morbid Personality: - Dysthymic General Physical Examination: - NAD Systemic Examination: NAD Mental State Examination: A young man uncombed, unshaven, sitting in chair rubbing his hands continuously. Eye contact made and maintained. Behaviour was cooperative.

  10. Talk: Relevant and coherent. Mood: Subjectively and objectively low. Thought Disorder: • No paranoid thoughts. • Hopelessness +ve. • Pessimistic thoughts +ve. • Guilt feelings +ve. • Thoughts of worthlessness +ve. • Thoughts of death +ve. • Suicidal thoughts and plans +ve. Perceptual Disorder: Vague auditory hallucination +ve. No 3rd person hallucinations present.

  11. Cognitive FunctionsINTACT Abstract Thinking INTACT Insight PRESENT

  12. CONCLUSION Major depressive illness (Unipolar type)

  13. INVESTIGATIONS • CBC / Urine C/E / ECG / LFT’s / S / T3, T4, TSH / S / Electrolytes. • Psychosocial History

  14. TREATMENT Pharmacological • SSRI e.g. Fluoxetin, Es-citalopram, Paroxetin, Sertraline. • SNRIs e.g. Venlafexine • Trycyclics / Serotonine modulators • Benzodiazepine e.g. alprazolam, bromazepam • Hybnotic for e.g. temazepam. • ECT

  15. Psychological • Counseling • Cognitive Behavioural Therapy • Family Therapy Regular Follow-ups

  16. DURATION OF TREATMENT • Minimum 6 months after stabilization of symptoms.

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