00:01
Let's talk a little bit now about the
symptoms of depression and how you actually
go about diagnosing it.
00:06
Very important again, because as we just
learned, many people will be diagnosed with
depression. So let's consider the following
example.
00:15
When you're talking about the diagnosis of
depression, patient must
meet at least five of these criteria five or
more.
00:24
And of note one of the criteria must be
depressed mood almost every
day for about two weeks.
00:31
Also anhedonia.
00:33
That's decreased interest or pleasure in
activities that someone once found
enjoyable. So you might encounter a patient
who used to play basketball or
soccer, and all of a sudden they're not
interested anymore.
00:44
That would be an example of anhedonia.
00:48
Someone might experience appetite or weight
changes.
00:51
This can be either eating too much or too
little.
00:55
Also sleep disturbance, which can be
hypersomnolence
sleeping for hours over seven, eight, ten,
12, 14
hours in a day or even more, or decreased
sleep where
somebody is barely getting any rest.
01:12
Another key factor is to ask people what
time of day they wake up,
often very early awakening.
01:19
So waking up early in the morning before the
sun comes up can be a sign associated with
depression. Psychomotor agitation or
retardation are
other symptoms of depression.
01:30
So this would look like a patient who's very
anxious and fidgety, moving around a lot,
or having retarded psychomotor function
where they barely move.
01:40
Maybe they describe to you that they just
can't get out of bed, that their body feels
like lead and they just can't move even
though they're wide awake.
01:48
Loss of energy is another symptom, as is
feeling
worthless or excessively guilty about
something out of their control.
01:57
Also trouble concentrating.
02:00
So patient might describe to you that all of
a sudden their work colleagues are telling
them that their work isn't quite as good
anymore, or they're not keeping up with tasks
like they once did.
02:09
That can be a subtle sign of depression.
02:12
And finally, recurrent thoughts of suicide
can be another sign
of major depression.
02:19
Because suicide is such an important
component of psychiatry, I want
to emphasize again here the importance of
asking patients about suicide and
self-harm, and then always going one step
further to ask them if they have
any plan to harm themselves or any intention
to do so.
02:38
When you're assessing someone for
depression, it's very critical that you also
ask them about how their symptoms are
influencing their social and occupational
functioning, because it's not enough to meet
five or more of the depressed
symptom criteria, but the symptoms also have
to cause a marked impairment in this
person's ability to function in day to day
life.
03:00
Also, it's vital that you rule out that
their symptoms could be
due to a medical illness or a substance use
problem.
03:09
There are several types of major depressive
disorders.
03:13
Let's consider a few.
03:14
There's anxious distress.
03:17
Atypical features.
03:19
Catatonia. Psychotic symptoms.
03:24
Dysthymia, seasonal patterns, melancholia,
mixed
episodes, and also peripartum depression.
03:34
We'll go through these in a little bit more
detail later.
03:39
I want to summarize first those nine target
symptoms of depression
that we talked about earlier.
03:45
And remember a patient has to meet five or
more of these, with one of two symptoms
being either loss of interest or sleep
disorder in order to qualify for the
depression diagnosis.
03:57
A really handy way to remember the target
symptoms is this
mnemonic SIGECAPS
So let's go through that.
04:04
This is really going to help you remember
the depressed symptoms.
04:08
So the S stands for sleep.
04:10
The I is for interest being low such as
anhedonia.
04:14
There's guilt energy changes concentration
difficulties,
appetite changes, psychomotor activity or
retardation and
suicidal thinking.
04:25
And these again are the symptoms the target
symptoms that you're
screening for in the patient whom you
suspect might have depression.
04:35
Just like with every psychiatric disorder,
it is critical that you rule
out general medical conditions before
diagnosing a psychiatric
disorder. There are a lot of medical
conditions or problems that can mimic
depression. These can be easily treated in
reversed.
04:52
So check out this list of the major medical
causes of depression.
04:57
It includes cerebrovascular disease,
endocrine problems,
neurology problems, various viruses, cancer,
collagen,
vascular diseases, and also chronic pain.
05:09
There are also substances that can cause
depression.
05:13
So here's a list of a few of the common
causes of,
uh, depression brought on by actually a
substance, whether it's an illicit
use or actually a medication.
05:25
Um, so some of the ones to highlight are
things like alcohol.
05:29
This can very much bring on something that
looks like depression, but so can
prescribed drugs, things like diuretics and
beta blockers.
05:37
So keep this in mind when you're assessing a
patient.
05:43
There can also be depressive symptoms due to
specific medications.
05:47
And this is a more exhaustive list here.
05:49
So for any patient whom you're considering a
diagnosis for depression it's very
important to do a couple of things.
05:56
One is to do a thorough medical history as
well as a physical
exam. You really need to screen them for
what kind of medical conditions they
have or symptoms of a medical condition,
because that might be very treatable.
06:10
It's also important to obtain an exhaustive
medication list from your patient, including
a list of over the counter medications that
they're taking, because often these can
mimic symptoms of depression, just as
alcohol and
illicit substances can also bring about the
target symptoms.
06:28
For depression, it's important as well to do
a screening by
doing some baseline blood work or lab work
on your patient, checking things like a
complete blood count, ruling out viruses,
checking their renal and
kidney, their renal or kidney function, and
also their liver function.
06:47
You always want to check a thyroid hormone
as well as their vitamins such as
B12 and folate.
06:53
You always want to do a urine tox screen as
well, to make sure there aren't any drugs
that could be in their system, accounting
for their symptoms.