Pemicu 8

Dessy
405120170
Depression
Major depressive disorder occurs without a
history of a manic, mixed, or hypomanic episode agitation
Women 2x>, mean age 40 yo; increasing in <20
yo, person without close interpersonal
relationships/those who are divorced/separated •decreased rate and volume of speech
Etiology:
Biological factors (biogenic amines)
Norepinephrine, serotonin, dopamine
Other Neurotransmitter Disturbances
Abnormal levels of choline, reductions of
GABA, glutamate
Alterations of Hormonal Regulation
Thyroid axis activity, growth hormone
Alterations of Sleep Neurophysiology
Immunological Disturbance
Structural and Functional Brain Imaging
Neuroanatomical Considerations
Genetic factors
Psychosocial Factors
Life events and environmental stress,
personality fctors, psychodynamic factors in
depression
Mental status examination:
•General= psychomotor retardation and
•social withdrawal and generally decreased
activity
•respond to questions with single words and
exhibit delayed responses to questions
•have negative views
•overemphasize their symptoms, their
disorder, and their life problems
•statements may be false, and they require
confirmation from another source
Treatment:
Hospitalization
Pyschosocial therapy
Sleep deprivation
Pharmacotherapy: NE reuptake inhibitors, 5
HT reuptake inhibitors, pre and post synaptic
active agents, dopamine reuptake inhibitors,
mixed action agents
Longitudinal course specifiers (with and without interepisode recovery)
With seasonal pattern
 Mental status examination:
Mania •General description= excited, talkative,
Manic  abnormally and persistently
sometimes amusing, and frequently
elevated, expansive, or irritable mood lasting
hyperactive
for at least 1 week, or less if a patient must be
•euphoric, but they can also be irritable,
hospitalized
especially when mania has been present for
Hypomanic  ~manic; lasts at least 4 days;
some time
not sufficiently severe to cause impairment in
•low frustration tolerance  anger & hostility
social or occupational functioning; no
•cannot be interrupted while they are
psychotic features are present
speaking, and they are often intrusive
More common in men
nuisances to those around them
Treatment: •Delusions occur in 75 percent of all manic
Hospitalization patients
Pyschosocial therapy •themes of self-confidence and self-
Sleep deprivation aggrandizement
Pharmacotherapy •unrestrained and accelerated flow of ideas
•orientation and memory are intact
•unreliable in their information
•Impulse Control: assaultive or threatening,
attempt suicide and homicide
 Bipolar
• Epidemiology
– childhood (as early as age 5 or 6) to 50 years or
even older (rare);
– mean age 30 yo
– divorced and single persons than among married
persons
– upper socioeconomic groups; did not graduate
from college
– lifetime history of substance use disorders, panic
disorder