Common Psychiatric Problems

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Common Psychiatric Problems in Family Practice
Depression
Saudi Diploma in Family Medicine Center of Post
Graduate Studies in Family Medicine
Dr. Zekeriya Aktürk zekeriya.akturk_at_gmail.com www.
aile.net
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• You elect to administer an initial 2-question
  screen for depression to all patients in your
  practice. The 2 questions would include
• A. During the past month, have you been often
  bothered by little interest or pleasure in doing
  things?
• B. During the past 2 weeks, have you had any
  disturbance in your sleep?
• C. Over the past 2 weeks, have you felt sad,
  down or depressed?
• D. Do you frequently experience low
  self-esteem?
• E. How frequently do you have crying spells?

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• How long should the depressive patient continue
  his/her drug?

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What is Depression?

• Serious, persistent illness caused by a number of
  factors
• Interferes with persons ability to function
• Socially / Personally
• Academically / Occupationally
• It can be chronic or intermittent

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Common Symptoms of Depression

• Sad mood
• Feeling worthless or guilty
• Fatigue / lack of energy
• Low motivation / difficulty starting activities
• Loss of interest or pleasure in activities
• Problems in concentrating and thinking
• Increased or decreased appetite weight
• Changes in pattern of sleep
• Suicidal thoughts or plans

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Normal and Real Depression
Mood

• Normal Depression
• Normal reaction to life events (e.g. death of
  loved one, major changes)
• Mood described as blue
• Few symptoms
• Short duration
• Little, if any, impairment in functioning

• Clinical Depression
• Mood described as black
• Many symptoms
• Longer duration (weeks months)
• Significant impairment in functioning (can be
  debilitating)

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Case

• Ahmet has been feeling down since his parents
  seperated last week. Although hes gone out with
  friends, he hasnt enjoyed activities like he
  normally would and his appetite has decreased.
  He has been in classes during this time, but
  finds it difficult to stay focused on the
  material being discussed.
• Is Ahmet depressed?

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Case

• Now four weeks after the breakup, Ahmet remains
  extremely sad. His grades have begun to fall
  because he finds it difficult to get out of bed.
  He has been telling friends that he doesnt
  deserve to be loved anyway.
• Is Ahmet depressed?

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Causes of Depression

• Environmental Factors
• Stressful life events
• Death, Move, New Job, Relationship
• Psychological Factors
• Negative belief systems
• About self, world, future
• Biological Factors
• Genetic predisposition (i.e. familial link)
• Neurotransmitter abnormalities

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Treatments for Depression

• Psychotherapy
• A confidential way to talk through and express
  your emotions in a safe, supportive environment
• Fosters coping skills to help manage stressors
• Enhances insight about reason(s) for beliefs and
  behaviors

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Treatments for Depression

• Medication
• Several different types of medication that are
  commonly prescribed
• All are equally effective overall, but each
  person will react a bit differently to each
  medication.
• Some are more frequently given because they have
  fewer side effects
• It takes some time to see the full benefits of
  the medications

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Treatments for Depression

• Treatment is effective 80 of those with
  depression show improvement
• Medications are most effective over the short
  term
• Screening tools might be used for follow up
• BDI, BDI-PC
• Hamilton
• Zung
• Therapy is most beneficial over a longer period
  of time
• 6 months to lifetime