9 Dec 2014

Clinical features of depression

Depression is a common clinical problem. Many of us at sometime or other experience sadness, fed up or down in dumps. It is called as depressive illness when such symptoms become qualitatively different and interfere with normal functioning. It can vary in severity may be mild, moderate or severe. Symptoms can be transient or persistent. Patients usually experience disturbance of mood , speech, energy and ideas. Some patients describe symptoms in physical terms. Two most common physical symptoms are fatigue and headache. If symptoms  are severe patients require hospitalization.

Many patients describe the world looking grey and they are devoid of pleasure and interest in life (anhedonia). Anxiety and phobic disorders are common in these patients. Symptoms usually last for at least 2 weeks. In severe forms of the disease diurnal variation in mood can be seen. Such people feel worse in the morning after awaking. One of the major risk is suicide, risk is 5%in out patients and 15% in those whose symptoms are severe enough to require hospital admission.

The following changes are noted in depression.
Mood - May be depressed, miserable or irritable.
Talk - Slow, monotonous.
Energy - Low energy and lethargic.
Ideas - Feeling of futility, guilt, self unworthiness, hypochondriacal preoccupation, worrying, suicidal thoughts, delusions of guilt and persecution.
Cognition - There can be impaired learning and pseudodementia in elderly patients .
Behavior - Retardation or agitation ,poverty of movements and expression.
Hallucination - Auditory ,often hostile and critical
Physical - Early waking, poor appetite ,constipation, loss of libido, erectile dysfunction, fatigue, bodily aches and pains.

Other psychiatric disorder associated with depression
1. Misuse of alcohol
2. Amphetamine and derivatives misuse and withdrawal
3. Dementia
4. Delerium
5. Schizophrenia

Other medical illness associated with depression
1. Cushing syndrome
2. Thyroid disorders
3. Increased parathyroid hormone
4. Steroid treatment
5. Brain tumours

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