Common Mental Disorders In Primary Care Flashcards
Mental Health Care in Primary Care
The provision of basic preventive and curative mental health care at the first point of contact of entry into the health care system
Reasons for low recognition of CMD in developing countries
High patient loads
Poor undergraduate training in psychiatry
Stigma associated with mental illness
Somatic presentation of mental disorders
Common mental disorders
Depressive disorders
Anxiety disorders
Define Depression/major depression
A persistent feeling of sadness and Los of interest.
Epidemiology of Depression
Third cause of burden of disease worldwide
Projected to be first by 2030
80% in low and middle income countries
16% in Africa
Major contributor to death by sucide
Course of Depression
Variable chronicity and remission
80% lifetime recurrence
Risk factors for depression
Family History and genetics
F:M 2:1
History of trauma/abuse
Chronic Stress
Unresolved grief or loss
Personality traits
Medication and substance use
History of other mental disorders
Chronic medical condition
Medications that can cause depression
Acyclovir
Phenytoin
Benzodiazepines
Barbiturates
Antihistamines
Calcium Channel blockers
Isotretinon
Opioids
Varenicline
Disease that can trigger depression
Hypothyroidism
Substance use disorder
Chronic illnesses ( DM, CVD, Athritis, kidney disease, HIV, lupus, MS)
Chronic pain
List the Depressive disorders according to DSM-V classification
Disruptive mood dysregulation disorder
MDD/ Clinical Depression
Persistent depressive disorders
Premenstrual dysphoric disorder
Substance/medicatio -induced depressive disorder
Depressive disorder due to another medical condition
Unspecified depressive dosorders
DSM-5 Criteria for MDD
Five or more out of 9 symptoms in >/=2 week
Each of these symptoms represents a change from previous functioning and needs to be present for nearly everyday
The Nine symptoms of DSM
- Depressed mood (can be irritable in children and adolescents)
- Loss of interest or pleasure most of the day
- Change in wt or appetite. Wt 5% change over 1 month
- Insomnia
- Psychomotor retardation or agitation
- Loss of energy or fatigue
- Worthlessness or guilt
- Impaired concentration or indecisiveness
- Recurrent thoughts of death or suicidal ideation or attempt.
Important point to note in diagnosis of MDD
Symptoms cause significant distress or impairment in daily function
Symptoms are not secondary to substance use or general medical condition
Clinical course
Untreated episodes last>= 6 months
Median time to recovery is 20 weeks with adequate txt
50% will have a chronic or recurrent
Increased risk of Suicide
Risk factors for suicide
I Ideation
A Substance use
P Purposelessness
A Anger
T Trapped
H Hopelessness
W Withdrawal
A Anxiety
R Recklessness
M Mood Change
