Depression And Medical Illness 2

Question 1

What two questions are vitally importaint to ask for depression diagnosis

Answer 1

1) Feeling depressed/down?
2) loss of interest in activities and life?
* at least one of these symptoms lasting 2 weeks or greater*

after these 2, then you can go through DIGSSPACE

Question 2

What approach must you use when giving a psychiatric patient interview?

Answer 2

Bippsychosocial model

• bio = medical issues/medications
• pscyho = psychological issues
• social = social issues

Question 3

Epidemiology of MDD

Answer 3

30-50% of patients with CAD/cerebrovascular disease, diabetes, obesity, cancer and HIV experience MDD

depression in patients with CAD is an independent risk factor for increased cardiac mortality

Can be seen in males or females and really at any age

Risk factors:

• on multiple meds (especially antidepressant and corticosteroids)
• elderly
• pre-existing brain changes
• absence of social support
• coping style
• simultaneous stressful life events

Question 4

Pain and depression

Answer 4

Pain
- somatic/visceral/neuroleptic/psychogenic

Anxiety and depression is known to lower the pain threshold
-85% of patients with chronic pain have MDD also

Chronic pain and depression = Major increase in suicide risk
- may request assisted suicide

Must address pain with mutual respect and dignity
- dont say you understand unless you really do and try to actually understand the pain

Pain management = deliberate and targets approach to each specific type of pain.

Question 5

Grief vs depression

Answer 5

Grief: starts off strong, but decreases

• adaptive response and universal
• highly personal to a specific loss at the time
• maintains self-worth
• guilt is over specific events
• sadness and dysphoria
• has interests with mild decline during grief periods
• doesn’t necessarily want to die, just wishes for speedy death.

Depression: starts off strong and usually doesnt go away

• maladaptive response and not universal
• personalized in all aspects of life
• symptoms are constant
• protracted and flat affect mood
• has no interests or pleasure in all activities
• has constant and excessive hopelessness and guilt
• no self-worth
• preoccupied with desire to die