Transcript Document
Common Psychiatric Problems in Family Practice Depression Saudi Diploma in Family Medicine Center of Post Graduate Studies in Family Medicine Dr. Zekeriya Aktürk [email protected] www.aile.net 1 / 12 • You elect to administer an initial 2-question screen for depression to all patients in your practice. The 2 questions would include: A. “During the past month, have you been often bothered by little interest or pleasure in doing things?” B. “During the past 2 weeks, have you had any disturbance in your sleep?” C. “Over the past 2 weeks, have you felt sad, down or depressed?” D. “Do you frequently experience low self-esteem?” E. “How frequently do you have crying spells?” 2 / 12 • How long should the depressive patient continue his/her drug? 3 / 12 What is Depression? • Serious, persistent illness caused by a number of factors • Interferes with person’s ability to function: – Socially / Personally – Academically / Occupationally • It can be chronic or intermittent 4 / 12 Common Symptoms of Depression • • • • • • • • • Sad mood Feeling worthless or guilty Fatigue / lack of energy Low motivation / difficulty starting activities Loss of interest or pleasure in activities Problems in concentrating and thinking Increased or decreased appetite & weight Changes in pattern of sleep Suicidal thoughts or plans 5 / 12 “Normal” and “Real” Depression “Normal Depression” Mood • Normal reaction to life events (e.g. death of loved one, major changes) • Mood described as “blue” • Few symptoms • Short duration • Little, if any, impairment in functioning Clinical Depression • Mood described as “black” • Many symptoms • Longer duration (weeks – months) • Significant impairment in functioning (can be debilitating) 6 / 12 Case • Ahmet has been feeling down since his parents seperated last week. Although he’s gone out with friends, he hasn’t enjoyed activities like he normally would and his appetite has decreased. He has been in classes during this time, but finds it difficult to stay focused on the material being discussed. • Is Ahmet depressed? 7 / 12 Case • Now four weeks after the breakup, Ahmet remains extremely sad. His grades have begun to fall because he finds it difficult to get out of bed. He has been telling friends that he doesn’t deserve to be loved anyway. • Is Ahmet depressed? 8 / 12 Causes of Depression • Environmental Factors – Stressful life events • Death, Move, New Job, Relationship • Psychological Factors – Negative belief systems • About self, world, future • Biological Factors – Genetic predisposition (i.e. familial link) – Neurotransmitter abnormalities 9 / 12 Treatments for Depression • Psychotherapy – A confidential way to talk through and express your emotions in a safe, supportive environment – Fosters coping skills to help manage stressors – Enhances insight about reason(s) for beliefs and behaviors 10 / 12 Treatments for Depression • Medication – Several different types of medication that are commonly prescribed • All are equally effective overall, but each person will react a bit differently to each medication. • Some are more frequently given because they have fewer side effects • It takes some time to see the full benefits of the medications 11 / 12 Treatments for Depression • Treatment is effective: 80% of those with depression show improvement – Medications are most effective over the short term – Screening tools might be used for follow up • BDI, BDI-PC • Hamilton • Zung… – Therapy is most beneficial over a longer period of time: • 6 months to lifetime 12 / 12