Psychiatry

Depression

What is Depression?

A depressive disorder is a syndrome that makes one  persistently sad and/or have an irritable mood which exceeds normal sadness or grief.

  • Statistics
  • Types of Depression
  • Signs and Symptoms
  • Causes and Risk Factors
  • Diagnosis
  • Treatment
  • Prognosis
  • Prevention
  • Conclusion

depressiondiagram

Statistics

Depression is a major public health problem as it affects millions of people. Approximately 10% of adults, 18% of teenagers and 2% pre teens are said to be affected by some type of depressive disorder. In the United States alone,  huge amounts of costs are incurred each year for the treatment of depressive disorders.

Types of Depression

The three common types of depression are major depression, dysthymia and bipolar depression. These different types of depression vary in number, timing, severity and persistence of symptoms. In addition, there are differences in how patients express and experience the disorder in adherence to their gender, age and culture.

Major Depression

This type of depression is portrayed by many symptoms which will prevail for a minimum of two weeks which will include sadness and irritability. These symptoms will affect one’s work, sleep, eating habits and other activities. Sleeping and eating disturbances can either be extreme or inadequate.

Dysthymia

Dysthymia is a less severe type of depression and is more long lasting than major depression. One may experience persistent symptoms which will not debilitate the person but rather make it difficult for one to perform tasks to his or her potential. In addition, dysthymia will make a person difficult to feel good about themselves. They may also undergo certain episodes of major depression. Such a combination of two depression is commonly referred to as double-depression

Bipolar disorder (manic depression)

Bipolar disorder comprises of a group of mood disorders. It was, in the past, referred to as manic depression. Bipolar disorder is not as common as the other forms of depression and involves mood changes that consists of at least one incident of mania or hypomania and may include incidents of depression too. The disorder is  long term and recurring which may also be dramatic and instantaneous. However, episodes of bipolar disorder is most often reported to be gradual.

 Symptoms of major or manic depression

  • Constantly sad, angry, worried, bad-tempered or irritable or in an ‘empty mood’.
  • Pessimism or hopelessness
  • Feeling excessive guilt, weakness or uselessness
  • Losing interest in activities and hobbies that an individual used to enjoy
  • Unsociable with family or friends
  • Insomnia, excessive sleep or waking early in the morning
  • Loss of weight, or weight gain, reduced appetite
  • Fatigue, loss of energy
  • Fits of crying
  •  Thoughts of suicide and attempts of suicide
  • Feeling irritable or restless
  • Hard to concentrate and remember
  • Headaches, digestion problems and chronic pain

Signs and Symptoms

Men

Men who are afflicted with this disorder generally have low energy, constantly irritable, episodes of anger, which gets to a point where the individual may want to cause pain or harm to others. They may also experience sleep disturbances, substance abuse and they may also lose interest in activities, work and hobbies which they used to enjoy previously. Additionally, they have the tendency to get into risky practices and work immoderately while undergoing depression. Statistics show that men commit suicide four times as much as women who are in similar condition.

Women

Women, on the other hand, develop this disorder at an early stage. The depressive spells last much longer and recurrence rate is higher in women when compared to men. Women often exhibit a seasonal pattern of the disorder and express symptoms of atypical depression. Individual suffering from atypical depression may display the features listed below:-

  • Excessive eating or sleeping
  • Crave for carbohydrates
  • Gain in weight
  • Heavy feeling in legs and arms
  • Mood changes or mood worsening in the evenings
  • Sleep disturbances where one finds it difficult to fall asleep.

Additionally, women with depressive disorders often experience anxiety and eating problems. Perimenopausal women, which can last for a period of 10 years, are at a higher risk of being afflicted with depressive disorders.

Teenagers

Teenagers who have depression are irritable, disinterested in hobbies and activities they enjoyed prior to depression, undergo weight changes and some may get themselves into substance abuse. Additionally, they may get into high-risk activities, express no concern for their safety and well-fare and are more likely to commit suicide.

Children

Children who have depression may experience the same symptoms that was mentioned above as adults. However, they may experience and exhibit other symptoms along with or without the classical symptoms of depression that was outlined previously:

  • School performance is poor
  • Feels bored frequently
  • Experiences headaches, stomach aches and other physical health related problems often.
  • Displays changes in sleeping and eating patterns.

 Causes and Risk Factors

Some types of depression have been found to be hereditary. This genetic susceptibility is mostly seen to be prevalent with  bipolar disorder. When families with bipolar disorder were studied it was found that those with the disorder have a fairly dissimilar genetic composition than those who are not affected. But it must also be kept in mind that not every person with this genetic composition that causes susceptibility to bipolar disorder will be affected by it. External factors like stress can trigger the illness. Major depression too is hereditary, but in a lower scale when compared with bipolar I or II. Major depression can also occur in individuals who have no family history of the illness.

Stressful or traumatic events in one’s life instigate depression. Financial problems, health related problems, loss of a loved one, relationship problems and other factors that bring about a drastic change in one’s life can initiate depression. Frequently, an amalgamation of genetic, psychological and environmental aspects trigger depression in an individual. Stressful factors that lead to depression occasionally have an effect on some individuals more than others. Minority groups affected by discrimination, individuals with poor socioeconomic status and immigrants are some of the groups of people who are in risk of developing depression

Women are twice as prone to the illness as men, and the reason for this phenomena still remains unknown. Psychological factors play a major role in depressive disorders. The rate of recurrence and severity of depression can be enhanced by many reasons like constant denial of childhood, abuse, be it sexual or physical, individual’s behavioural pattern, and poor coping strategies. 

Diagnosis

If you are thinking about talking to your health care professional about the risk of depression and if you are suffering from it or not, you may want to think about taking a self test or quiz on depression, which will focus on asking you about questions related to the symptoms of depression. Additionally, you may want assess your symptoms and find out if the sadness you feel lasts for a period of two weeks or more. Moreover, you can also examine if this persistent feeling affects other activities, work, school, social life and your relationship with the ones around you.

It is important to understand that only a sound diagnosis by your medical doctor will allow you to obtain the best treatment available that will be appropriate to your condition. Thus, diagnosis will require a complete physical examination and psychological inspection in order to find out if the patient has a depressive disorder and the type he or she suffers from. As episodes of depression can be brought about by certain medications (side effects) and some health related problems; the doctor will work towards ruling out these possibilities through laboratory tests, thorough physical examination and an interview.

The medical doctor will evaluate the symptoms by asking  several questions regarding the duration of the symptoms, the severity of the symptoms and  when the symptoms first commenced. Additionally, if  the patient have had these symptoms before, the doctor will question him or her about the treatment they received. Other questions which are generally asked will be about substance abuse and if the patient have had thoughts of suicide and death. The doctor may inquire about the patient’s family history and whether other close relatives of the patient had suffered from depression and the treatment they had taken, if effective.

Treatment

Depressive disorders that are considered to be severe in its form and are recurrently occurring require antidepressant medications as well as psychotherapy to treat the disorder successfully. Statistics show that when an individual undergoes a depressive episode, the person has a 75% chance of undergoing a second episode in the future. Additionally, if this individual has already undergone such episodes, his or her chance of experiencing a third episode increases up to 80%. Similarly, the chances of having a fourth episode will increase up to about 90%-95%. Consequently, after the patient has experienced his or her first episode, the patient has to come off the prescribed medication gradually, not abruptly. Having mentioned that, after the patient experiences the second or third episode, medical doctors will have the patient on medication for a longer period of time, or permanently in some cases.

During the treatment of depression, patience is essential as treatment will take time. Medical doctors may prescribe a number of medications or antidepressants before finding the combination of medication that is most suitable and appropriate for the patient’s condition. Also, the dosage of the medication has to be increased in some cases in order bring about the desired effect in the patient.

Certain criteria needs to be taken into account before prescribing antidepressants. This includes one’s age, other medical conditions and side effects of certain medications the patient may have. It is important to understand that antidepressant medications for children and adolescents have the tendency of aggravating the disorder rather than treating it. Thus, doctors will exercise some caution before prescribing such medications to minors.  Additionally, the depressed individual should inform doctors of the medications they are under, if they are taking medications for any other medical conditions.

Prognosis


Clinical depression takes place in episodes, when one experiences such an episode, he or she will in due course experience another. These episodes that follow eventually are easily activated compared to the first one. Nevertheless, most patients suffering from these episodes recover from it. Studies have proven that patients who have the mild form of the depressive disorder tend to recover with drugs and sugar pills (placebo effect) equally, without any significant difference. However, those individuals who suffer from a severe form of the depressive disorder are not likely to recover from sugar pills, that is the placebo effect, as mentioned before. Thus, they will require antidepressant medications. Research has also reported that patients, be it teenagers or adults, who have not gotten better when treated with a medication, their condition may improve when they take another medication along with psychotherapy.

Prevention

Cognitive therapy, which involves mental health care professionals teaching their patients thinking skills, have been proven to be effective in preventing depressive disorders. Postpartum depression can be prevented by assisting new mothers adjust and decrease to certain aspects that may lead to depression. These aspects could be poor adaptation to their marriage, little social support or other domestic reasons.

Conclusion

depressive disorder is a syndrome that makes one  persistently sad and/or have an irritable mood which exceeds normal sadness or grief. Depression is a major public health problem as it affects millions of people. Approximately 10% of adults, 18% of teenagers and 2% pre teens are said to be affected by some type of depressive disorder. The three common types of depression are major depression, dysthymia and bipolar depression. Stressful or traumatic events in one’s life instigate depression. Financial problems, health related problems, loss of a loved one, relationship problems and other factors that bring about a drastic change in one’s life can initiate depression. is important to understand that only a sound diagnosis by your medical doctor will allow you to obtain the best treatment available that will be appropriate to your condition. Thus, diagnosis will require a complete physical examination and psychological inspection in order to find out if the patient has a depressive disorder and the type he or she suffers from. Depressive disorders that are considered to be severe in its form and are recurrently occurring require antidepressant medications as well as psychotherapy to treat the disorder successfully.Cognitive therapy, which involves mental health care professionals teaching their patients thinking skills, have been proven to be effective in preventing depressive disorders.

We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

 

 

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The Team Manager Web Diseases

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Obsessive Compulsive Disorder (OCD)

 

What is Obsessive Compulsive Disorder (OCD)?

OCD and its Symptoms

Obsessive Compulsive Disorder (OCD) is a disorder related to anxiety which is portrayed by the inability of the person who suffers from OCD to act accordingly in a social, work-related or educational convention, as a result of his or her recurrent obsessive and compulsive behaviour which in turn affects many aspects of their life.

Their behaviour pattern may be a result of the amount of time exhausted due to the symptoms or due to an underlying phobia or anguish felt by the sufferer. Four types of OCD are said to prevail. One type of OCD relate to aggressive behaviour which also involves both sexual and religious thoughts; moreover checking compulsions also play a part. Another type of OCD pertain to the line of symmetry that is sufferers of this type of OCD tend to almost always arrange things and repeat certain compulsions. Another type of compulsion is that associated with constant cleaning as patients feel that surfaces of various structures are contaminated. Stocking up or hoarding compulsive behaviours are another type.

Obsessive behaviours are described as having repeated thoughts, urges or a persistent image that result in anxiety which is almost always severe. To an OCD patient, these thoughts seem to be enticing even though he or she is usually aware that the thoughts are baseless. There are many examples related to OCD some of them being the constant fretting over bacteria, being clean, may also be about safety and security as well as order. A compulsion, on the other hand, is a type of behaviour which pertain to the OCD patient getting himself or herself into a particular habit; which may be a result of their obsessions or the result of following inflexible rules and regulations. Examples of this type of obsessions include the constant and uncontrolled washing of hands, constant checking of locks, arranging items or stuff around all the time and in some cases picking of skin. In addition, habits are behaviours which result from the absence of thought before action; they are performed in adherence to a particular routine. These habitual behaviours do not take a lot of a person’s limited time, not a result of an obsession and most importantly does not cause anxiety or stress. Cracking knuckles and keeping car keys in a particular place are some examples of habits.

Diagnosing OCD, a complex matter, has been explained and discussed for a long time; approximately for the past 100 years. 1%-2% of the population in the United States are said to suffer from OCD which roughly comes up to about 2-3 million people. Rate of incidence of OCD and the symptoms it manifest itself in are similar irrespective of one’s culture or geographical background. Studies also show that the average age of the commencement of the condition is 19 years. The condition itself may start during early childhood years or during the teenage years but becomes apparent by the age of 30. OCD prevails more in male than females.

OCD in children is a complicated situation as their obsessions or compulsive behaviour may not seem unreasonable or unacceptable. Throwing tantrums or a fit of temper may result when someone stops them from finishing one of their routinely performed tasks or rituals. Fatigue, headaches and indigestion persist in children and teenagers who suffer from this condition.

The affliction also starts many other conditions. One of the most likely conditions they may develop is trichotillomania known as chronic hair pulling or other disorders like anorexia or bulimia which are common eating disorders. OCD patients are also inclined to instigate mood problems like depression, anxiety disorders or panic disorders. In addition, some OCD sufferers have also shown unreasonable concerns over their health. Hypochondriasis is a type of disorder where the sufferer worries too much about having an illness. Bipolar disorder, known as manic depression, can also show up in an OCD patient.

Obsessive Compulsive Personality Disorder (OCPD) is almost always confused with OCD. This disorder is characterised by the sufferer being a stickler for perfection as well as having high expectation of himself/herself or of others to carry out a certain set of rules and regulations. There is a fine line between OCD and OCPD; OCPD sufferers do not have compulsive or ritual behaviours. Nevertheless, OCPD has a tendency of occurring in patients suffering from OCD than non-OCD people. Consequently, OCPD is reckoned to be a risk factor of OCD.

Causes of OCD

No specific causes for OCD is known although family medical history and chemical imbalance in the brain are associated with the progression of the condition. People with relatives who had or are suffering from OCD have a risk of attaining the disorder. Having said that, most OCD patients do not have any relatives suffering from the anxiety disorder. Researchers say that a specific modification of a gene/chromosome is associated with the condition. The modification or variation is linked to doubling the chances of acquiring the disorder. An imbalance of a chemical in the brain called ‘serotonin’ is also thought to increase the risk of attaining the condition. Other occurrences which can be risk factors for OCD may include a stressful event. For example, a child who underwent sexual abuse is considered a “life stressor” which can increase the risk of developing OCD.

Diagnosing OCD

Diagnosing OCD can be a tricky business. Patients who are suspected of suffering from OCD can be self-tested by asking a variety of questions. Medical practitioners will also assess the patient for symptoms related to any obsessions and compulsive behaviour. This usually takes place as a form of mental-status examination. In addition, practitioners will then evaluate the symptoms; check if the symptoms are linked to other emotional disorders in addition to diagnosing OCD. Diagnosing OCD may also involve a physical examination and other relevant tests to ensure that the sign and symptoms are due to OCD and not other medical conditions which may also cause similar signs and symptoms.


Available Treatments for OCD.

Video of  OCD

Patients who suffer from the disorder usually have symptoms of OCD that they suffer from endlessly. Symptoms persist in such a way that there are ‘ups’ and ‘down’; times of improvement which occur in turn with times of difficulty. Milder form of OCD sufferers who have less persistent symptoms and no other related problems or illnesses prior to OCD are said to have a better prognosis.

Cognitive Behavioural psychopathy, behavioural therapies and some medications are usually the treatments administered to the patient. In the case of behavioural therapies for OCD, generally includes an exposure therapy as well as ritual prevention. In an exposure therapy the patient are made to come in contact with their problems “head-on”. Therefore, the individual is exposed to a situation which will increase the individual’s impulse to get themselves into their routine compulsions. The practitioner then helps the patient to oppose that impulse. In a ritual prevention therapy, the mental-health care professional will help the patient to experience and tolerate prolonged periods of exposure to a situation. The situation once again is something that encourages them to “go back” to their compulsive behaviours. Consequently, behavioural therapy is a form of behaviour modification where therapists engage to alter one’s pessimistic way of thinking and behaving that pertain to OCD.

SSRIs (Selective serotonin re-uptake inhibitors) is a medication that is commonly prescribed to OCD patients. The levels of serotonin, a neuro-chemical in the brain, are said to be low in the case of OCD. Thus, a serotonin re-uptake inhibitor will consequently increase the levels of serotonin in the brain. It achieves this state by inhibiting or blocking selectively, the re-uptake of serotonin in the brain at the synaptic junction (a gap) between two neurones (brain cells). Thus, serotonin is a neurotransmitter, a chemical that carries signals or messages from one neurone to another across the synapses. As a result, the SSRIs maintain high levels of serotonin in the synapses by blocking the re-uptake of serotonin back into the brain cell or neurone which function to transmit or pass on the signals or messages it receives. If the serotonin is taken up from the synapse into the neurone then the manufacturing of new serotonin by the cell is stopped. By having high levels of serotonin the messages to manufacture more serotonin keeps coming and more and more serotonin made. This phenomenon is thought to help in activating cells which have been deactivated as a result of OCD which once again will relieve the symptoms of the sufferer.

In addition, the SSRIs are said to have fewer side effects in comparison to clomipramine. Clomipramine is an older medication which is said to be more successful in treating the disorder. Unfortunately, clomipramine cause orthostatic hypotension which is the abrupt drop in one’s blood pressure while siting or standing and disruptions in the rhythm of the heart. These are not seen in SSRIs, making it more ideal and are considered to be first-line treatment for the disorder. Prozac (fluoxetine), Zoloft (sertraline), Celexa (citalopram), Paxil (paroxetine), Luvox (fluvoxamine) are all examples of used SSRIs. After prescribing an SSRI and if the patient does not show a successful outcome, which the mental-health care professional anticipated, then an additional neuroleptic medication may be prescribed. Examples of this medication include Risperdal (risperidone), Zyprexa (olanzapine), Abilify (aripiprazole); which are said to be helpful to the patient.

SSRIs and its relative tolerance rate are usually satisfactory. Side effects are not severe and may include nausea, agitation, insomnia, headache as well as diarrhoea. The side effects are said to clear off after the first month of using the medication. In some patients the side effects go beyond the above mentioned ones. Sexual side effects are known to persist in some and may include decreased libido. A characteristic tremor is one of the side effects often experienced with SSRIs. A syndrome, commonly known as serotonergic syndrome is a potentially fatal neurologic condition generated due to the consumption of SSRIs. This syndrome is depicted by seizures, high fevers and heart-rhythm disturbances. On an important note, this condition is very rare and uncommon. It only has been reported to happen in very sick psychiatric patients who are under many psychiatric drugs.

Newer neuroleptic medications, often referred to as atypical, like the ones afore mentioned cause fewer side effects than the older medications which were used in this class. Most common side effects which occur during the course of atypical neuroleptics include dizziness, drying of mouth, gaining weight and sleepiness. Certain patients show signs of being overly sensitive to the rays of the sun while taking these prescribed drugs. Hence, the patient should apply sunblock in order to be protected from the sun. Other less common side effects of atypical neuroleptics which persist may take the form of painless movement of muscles like tremors or stiffness. Another rare condition called tardive dyskinesia may occur. This condition shows up as permanent muscles twitches or spasms in patients.

Carbamazepine (Tegretol), divalproex sodium (Depakote), lamotrigine (Lamictal) are drugs that are prescribed to OCD patients as mood stabilisers. These may be given to patients who suffer from bipolar disorder in addition to OCD. Side effects vary depending on the drug used. Thus, mental-health care professionals will look for side effects according to the prescribed drug. They usually look out for mild side effects like sleepiness or indigestion when Tegretol or Depakote is prescribed. At the same time they are very vigilant about other side effects. For example, a severe side effect of Tegretol is the drop or decrease in white blood cell count. Another example of a severe side effect associated with Depakote or Lamictal are the autoimmune reactions occurring in the body like Steven Johnson’s syndrome.

Research and studies which have looked into the effectiveness of treatment of OCD in adults have variable results. Some studies testify that medications, response prevention and cognitive behavioural therapy in the effectiveness of treating the disorder range from mild to moderate values. Cognitive Behavioural Group therapy is also another therapy program which have said to be beneficial to the patient.

Research and studies that have looked in depth into treating OCD in children and teenagers say that medications are effective in treating OCD but the improvement of the disorder as a result of medication is poor or mild. Nevertheless, Clomipramine is said to bring about more beneficial results than SSRIs. At the same time individual SSRIs are tend to be equally effective too. Individuals under 18 years show significant improvement when a treatment plan coupling both medications and cognitive behavioural therapy are administered. Deep brain stimulation or DBS has also proven to be effective. Thus, patients suffering from a dreadful case of OCD who do not show any improvement to treatments can undergo DBS.

Complications of OCD when not treated.

The symptoms of OCD will advance into a state where the patient’s life will be completely devoured if appropriate treatment is not given. The sufferer may not be able to attend school, be employed and most importantly his/her relationships with family or friends may be estranged. Sufferers of OCD quite often contemplate on committing suicide and statistics show that 1% of the sufferers have committed suicide.

It is unlikely that the symptoms of OCD will progress to affect one’s physical abilities. Nonetheless, compulsive behaviours like washing of hands may result in dryness of skin. Trichotillomania or chronic hair pulling may lead to ghastly scabs and patches in the scalp.

Prognosis for OCD

In approximately 40% of the patients diagnosed with OCD, the symptoms seem to persist to an unspecified amount time to some degree. If a proper treatment plan is ascribed, the patients will only be mildly or moderately affected by the symptoms. Patients who have been living with the symptoms for a long period of time before being diagnosed to be treated will be at a higher risk of attaining other illnesses related to mental health and will acquire a severe form of OCD.

Prevention of OCD

There is one course of action to prevent OCD; that is by recognising and treating the symptoms early. A good place to start will be the early recognition of symptoms of OCD related to one’s child. Parents should read the signs of their child who is at risk of attaining the condition. For instance, excessive objections or complaints by a child about certain food or clothes being insufferable will be an early indication. Other examples may be in the form of a child who occupies herself/himself with certain inflexible behavioural patterns.

CONCLUSION

Obsessive Compulsive Disorder or OCD is an anxiety disorder which affects many aspects of one’s life. It relates to certain obsessions as well as compulsive behaviour. There are no specific causes of OCD but family history and chemical imbalance in the brain are linked with the development of the disorder. Diagnosing OCD can be quite complex but is usually achieved by being self-tested with a variety of questions, a mental-status examination and a physical examination. Cognitive Behavioural psychopathy, behavioural therapies and some medications like the SSRIs ( Selective serotonin re-uptake inhibitors) are prescribed to the patient. The consequences of not adequately treating an OCD patient at the right time will render detrimental results. Thus, a proper treatment plan should be administered in order to decrease the suffering of the patient. Treatment will make his or her life better as he or she will only be mildly or moderately affected by the symptoms. A good way to go about this disorder is to detect it early. Thus, parents play a key role in recognising the “warning signs” which relate to OCD in one’s child.

We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

Click here for PDF

We welcome your comments at the end of the article.

The Team Manager Web Diseases

 

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