psychiatric disorders
Depressive Disorders
Symptoms and Signs of Depressive Disorders
Depression causes cognitive, psychomotor, and other types of dysfunction (eg, poor concentration, fatigue, loss of sexual desire, loss of interest or pleasure in nearly all activities that were previously enjoyed, sleep disturbances), as well as a depressed mood. People with a depressive disorder frequently have thoughts of Suicidal Behavior and may attempt suicide. Other mental symptoms or disorders (eg, Patients with all forms of depression are more likely to abuse alcohol or illicit drugs in an attempt to self-treat sleep disturbances or anxiety symptoms; however, depression is a less common cause of alcoholic use disorder and other substance use disorders than was once thought. Patients are also more likely to become heavy smokers and to neglect their health, increasing the risk of development or progression of other disorders (eg, Chronic Obstructive Pulmonary Disease (COPD) [COPD]). Depression may reduce protective immune responses. Depression increases risk of cardiovascular disorders, Acute Myocardial Infarction (MI) (MIs), and Patients may appear miserable, with tearful eyes, furrowed brows, down-turned corners of the mouth, slumped posture, poor eye contact, lack of facial expression, little body movement, and speech changes (eg, soft voice, lack of prosody, use of monosyllabic words). Appearance may be confused with Parkinson Disease . In some patients, depressed mood is so deep that tears dry up; they report that they are unable to experience usual emotions and feel that the world has become colorless and lifeless. Nutrition may be severely impaired, requiring immediate intervention. Some depressed patients neglect personal hygiene or even their children, other loved ones, or pets. 5 ( Symptoms and signs references ) of the following must have been present nearly every day during the same 2-week period, and one of them must be depressed mood or loss of interest or pleasure: Depressed mood most of the day Markedly diminished interest or pleasure in all or almost all activities for most of the day Significant (>5%) weight gain or loss or decreased or increased appetite Insomnia (often sleep-maintenance insomnia) or hypersomnia Psychomotor agitation or retardation observed by others (not self-reported) Fatigue or loss of energy Feelings of worthlessness or excessive or inappropriate guilt Diminished ability to think or concentrate or indecisiveness Recurrent thoughts of death or suicide, a suicide attempt, or a specific plan for committing suicide Depressive symptoms that persist for≥2 years without remission are classified as persistent depressive disorder (PDD), a category that consolidates disorders formerly termed chronic major depressive disorder and dysthymic disorder. Symptoms typically begin insidiously during adolescence and may persist for many years or decades. The number of symptoms often fluctuates above and below the threshold for major depressive episode. Affected patients may be habitually gloomy, pessimistic, humorless, passive, lethargic, introverted, hypercritical of self and others, and complaining. Patients with PDD are also more likely to have underlying Overview of Anxiety Disorders , of persistent depressive disorder ( Symptoms and signs references ), patients must have had a depressed mood for most of the day for more days than not for Poor appetite or overeating Insomnia or hypersomnia Low energy or fatigue Low self-esteem Poor concentration or difficulty making decisions Feelings of hopelessness Premenstrual dysphoric disorder involves mood and anxiety symptoms that are clearly related to the menstrual cycle, with onset during the premenstrual phase and a symptom-free interval after menstruation. Symptoms must be present during most menstrual cycles during the past year. Manifestations are similar to those of Premenstrual Syndrome (PMS) but are more severe, causing clinically significant distress and/or marked impairment of social or occupational functioning. The disorder may begin any time after menarche; it may worsen as menopause approaches but ceases after menopause. Prevalence is estimated at 3 to 8% of menstruating women ( of premenstrual dysphoric disorder ( Symptoms and signs references ), patients must have Marked mood swings (eg, suddenly feeling sad or tearful) Marked irritability or anger or increased interpersonal conflicts Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts Marked anxiety, tension, or an on-edge feeling In addition,≥1 of the following must be present: Decreased interest in usual activities Difficulty concentrating Low energy or fatigue Marked change in appetite, overeating, or specific food cravings Hypersomnia or insomnia Feeling overwhelmed or out of control Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a feeling of being bloated, and weight gain Prolonged grief is persistent sadness following the loss of a loved one. It is distinct from depression in that the sadness relates to the specific loss rather than the more general feelings of failure associated with depression. In contrast to normal grief, this condition may be highly disabling and require therapy specifically designed for prolonged grief disorder. of prolonged grief, the grief response (typified by persistent longing or yearning for and/or preoccupation with the deceased) lasts a year or longer and is persistent, pervasive, and exceeding cultural norms ( Symptoms and signs references ). It also must be accompanied by Feeling of identity disruption (eg, feeling as though part of oneself has died) Marked disbelief about the death Avoidance of reminders of the loss Intense emotional pain (eg, sorrow) related to the death Difficulty engaging in ongoing life Emotional numbness Feelings of meaninglessness Intense loneliness Some useful screening tools include theInventory of Complicated Griefand theBrief Grief Questionnaire. Clusters of symptoms with characteristics of a depressive disorder that do not meet the full criteria for other depressive disorders but that cause clinically significant distress or impairment of functioning are classified as other depressive (specified or unspecified) disorder. Included are recurrent periods of dysphoria with≥4 other depressive symptoms that last<2 weeks in people who have never met criteria for another mood disorder (eg, recurrent brief depression) and depressive periods that last longer but that include insufficient symptoms for diagnosis of another depressive disorder. Major depressive disorder and persistent depressive disorder may include one or more specifiers that describe additional manifestations during a depressive episode: Anxious distress:Patients feel tense and unusually restless; they have difficulty concentrating because they worry or fear that something awful may happen, or they feel that they may lose control of themselves. 3 manic or hypomanic symptoms (eg, elevated mood, grandiosity, greater talkativeness than usual, flight of ideas, decreased sleep). Patients who have this type of depression are at increased risk of developing Bipolar Disorders . Melancholic:Patients have lost pleasure in nearly all activities or do not respond to usually pleasurable stimuli. They may be despondent and despairing, feel excessive or inappropriate guilt, or have early morning awakenings, marked psychomotor retardation or agitation, and significant anorexia or weight loss. Atypical:Patients' mood temporarily brightens in response to positive events (eg, a visit from children). They also have≥2 of the following: overreaction to perceived criticism or rejection, feelings of leaden paralysis (a heavy or weighted-down feeling, usually in the extremities), weight gain or increased appetite, and hypersomnia. Psychotic:Patients have delusions and/or hallucinations. Delusions often involve having committed unpardonable sins or crimes, harboring incurable or shameful disorders, or being persecuted. Hallucinations may be auditory (eg, hearing accusatory or condemning voices) or visual. If only voices are described, careful consideration should be given to whether the voices represent true hallucinations. Catatonic:Patients have severe psychomotor retardation, engage in excessive purposeless activity, and/or withdraw; some patients grimace and mimic speech (echolalia) or movement (echopraxia). Peripartum onset:Onset is during pregnancy or in the 4 weeks after delivery. Psychotic features may be present; infanticide is often associated with psychotic episodes involving command hallucinations to kill the infant or delusions that the infant is possessed. Seasonal pattern:Episodes occur at a particular time of year, most often fall or winter. 1.Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision (DSM-5-TR). American Psychiatric Association Publishing, Washington, DC, pp 184-193. 2.Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision (DSM-5-TR). American Psychiatric Association Publishing, Washington, DC, pp 194-198. 3.Halbreich U, Borenstein J, Pearlstein T, et al: The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD).Psychoneuroendocrinology28 Suppl 3:1-23, 2003. doi: 10.1016/s0306-4530(03)00098-2. PMID: 12892987 4.Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision (DSM-5-TR). American Psychiatric Association Publishing, Washington, DC, pp 198-201. 5.Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision (DSM-5-TR). American Psychiatric Association Publishing, Washington, DC, pp 323-328. 