STUDY - Technical - New Dacian's Medicine
Depression
(Classical / Allopathic Medicine)
Depression is a
mental state of depressed mood, characterized by feelings of
sadness, despair, and loss of interest or pleasure in
activities. These feelings may be accompanied by somatic
complaints, such as changes in appetite, sleep disturbances,
restlessness or lethargy, and decreased concentration.
Thoughts of death or suicide may also occur.
Clinical
depression must be distinguished from “the blues,” periodic
bouts of dysphoria that are less persistent and severe than
the clinical disorder. The criterion for major depression is
one or more episodes of depressed mood, or decreased interest,
or the ability to take pleasure in all or most activities,
lasting at least 2 weeks.
Major depression
strikes 10% to 15% of adults and affects all racial, ethnic,
age, and socioeconomic groups. It's twice as common in women
as in men and is especially prevalent among adolescents.
Depression has numerous causes, including genetic and family
history, medical and psychiatric disorders, and the use of
certain drugs. A complete psychiatric and physical assessment
should be conducted to exclude possible medical causes.
HISTORY:
Ask the patient what's bothering him. Find out how his current mood differs from his usual mood.
Review the patient's medical history for chronic illness.
Ask the patient to describe the way he feels about himself. What are his plans and dreams? How realistic are they? Is he generally satisfied with what he has accomplished in his work, relationships, and other interests?
Ask the patient about changes in his social interactions, sleep patterns, normal activities, or ability to make decisions and concentrate.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Listen for clues that the patient may be suicidal. Find out if he has an adequate support network to help him cope with his depression.
Ask the patient about his family - its patterns of interaction and characteristic responses to success and failure. What part does he feel he plays in his family life? Ask if other family members have been depressed and whether anyone important to the patient has been sick or has died in the past year.
Ask the patient about his environment. Has his lifestyle changed in the past month? Six months? Year? When he's feeling blue, where does he go and what does he do to feel better? Find out how he feels about his role in the community and the resources that are available to him.
Ask the patient what's bothering him. Find out how his current mood differs from his usual mood.
Review the patient's medical history for chronic illness.
Ask the patient to describe the way he feels about himself. What are his plans and dreams? How realistic are they? Is he generally satisfied with what he has accomplished in his work, relationships, and other interests?
Ask the patient about changes in his social interactions, sleep patterns, normal activities, or ability to make decisions and concentrate.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Listen for clues that the patient may be suicidal. Find out if he has an adequate support network to help him cope with his depression.
Ask the patient about his family - its patterns of interaction and characteristic responses to success and failure. What part does he feel he plays in his family life? Ask if other family members have been depressed and whether anyone important to the patient has been sick or has died in the past year.
Ask the patient about his environment. Has his lifestyle changed in the past month? Six months? Year? When he's feeling blue, where does he go and what does he do to feel better? Find out how he feels about his role in the community and the resources that are available to him.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs.
Evaluate physical complaints that the patient may have to help rule out a medical cause for depression.
If the patient has a history of a chronic illness, focus your initial assessment on systems affected by that illness.
Take the patient's vital signs.
Evaluate physical complaints that the patient may have to help rule out a medical cause for depression.
If the patient has a history of a chronic illness, focus your initial assessment on systems affected by that illness.
SPECIAL
CONSIDERATIONS:
Help the patient set realistic goals; encourage him to promote feelings of self-worth by asserting his opinions and making decisions. Try to determine his suicide potential, and take steps to help ensure his safety. The patient may require close surveillance to prevent a suicide attempt.
Help the patient set realistic goals; encourage him to promote feelings of self-worth by asserting his opinions and making decisions. Try to determine his suicide potential, and take steps to help ensure his safety. The patient may require close surveillance to prevent a suicide attempt.
PEDIATRIC
POINTERS:
Because emotional lability is normal in adolescence, depression can be difficult to assess and diagnose in teenagers. Clues to underlying depression may include somatic complaints, sexual promiscuity, poor grades, and abuse of alcohol or drugs.
The use of a family-systems model can help determine the cause of depression in adolescents. When family roles are determined, family therapy or group therapy with peers may help the patient overcome his depression.
Because emotional lability is normal in adolescence, depression can be difficult to assess and diagnose in teenagers. Clues to underlying depression may include somatic complaints, sexual promiscuity, poor grades, and abuse of alcohol or drugs.
The use of a family-systems model can help determine the cause of depression in adolescents. When family roles are determined, family therapy or group therapy with peers may help the patient overcome his depression.
AGING ISSUES:
Depressed older adults at the highest risk for suicide are those who are age 85 or older, have high self-esteem, and need to be in control.
Depressed older adults at the highest risk for suicide are those who are age 85 or older, have high self-esteem, and need to be in control.
PATIENT
COUNSELING:
Because anger typically underlies depression, help the patient acknowledge this emotion and express it safely. Help foster feelings of competence by focusing on past and present experiences in which the patient was successful. Educate the patient about available treatment for depression. Arrange for follow-up counseling, or contact a mental health professional for a referral.
Because anger typically underlies depression, help the patient acknowledge this emotion and express it safely. Help foster feelings of competence by focusing on past and present experiences in which the patient was successful. Educate the patient about available treatment for depression. Arrange for follow-up counseling, or contact a mental health professional for a referral.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)