Depression.
In psychology, depression is a mood or emotional state that is marked by sadness, inactivity, and a reduced ability to enjoy life. A person who is depressed usually experiences one or more of the following symptoms.
1.feeling of sadness, 2.hopelessness, or pessimism; 3.lowered self-esteem and heightened self-depreciation, 4. a decrease or loss of ability to enjoy daily life, 5.reduced energy and vitality, 6.slowness of thought or action, 7.loss of appetite, 8.disturbed sleep or insomnia.
Depression differs from simple grief, bereavement, or mourning, which are appropriate emotional responses to the loss of loved persons or objects. Where there are clear grounds for a person's unhappiness, depression is considered to be present if the depressed mood is disproportionately long or severe vis-à-vis the precipitating event. When a person experiences alternating states of depression and mania (extreme elation of mood), he is said to suffer from a manic-depressive psychosis.
Depression is probably the most common psychiatric complaint and has been described by physicians from at least the time of Hippocrates, who called it melancholia. The course of the disorder is extremely variable from person to person; it may be fleeting or permanent, mild or severe, acute or chronic. Depression is more common in women than in men. The rates of incidence of the disorder increase with age in men, while the peak for women is between the ages of 35 and 45.Depression can have many causes.
The loss of one's parents or other childhood traumas and privations can increase a person's vulnerability to depression later in life. Stressful life events in general are potent precipitating causes of the illness, but it seems that both psychosocial and biochemical mechanisms can be important causes. The chief biochemical cause seems to be the defective regulation of the release of one or more naturally occurring monoamines in the brain, particularly nor epinephrine and serotonin. Reduced quantities or reduced activity of these chemicals in the brain is thought to cause the depressed mood in some sufferers.
There are three main treatments for depression. The two most important are psychotherapy and drug therapy. Psychotherapy aims to resolve any underlying psychic conflict that may be causing the depressed state, while also giving emotional support to the patient. Antidepressant drugs, by contrast, directly affect the chemistry of the brain, and presumably achieve their therapeutic effects by correcting the chemical imbalance that is causing the depression. The tri-cyclic antidepressant drugs are thought to work by inhibiting the body's physiological inactivation of the monoamine neurotransmitters.
This results in the build-up or accumulation of these neurotransmitters in the brain and allows them to remain in contact with nerve cell receptors there longer, thus helping to elevate the patient's mood. By contrast, the antidepressants drugs known as monoamine oxidise inhibitors interfere with the activity of monoamine oxidise, an enzyme that is known to be involved in the breakdown of nor epinephrine and serotonin.
In cases of severe depression in which therapeutic results are needed quickly, electroconvulsive therapy has proven helpful. In this procedure, a convulsion is produced by passing an electric current through the person's brain. In many cases of treatment, the best therapeutic results are obtained by using a combination of psychotherapy with drug therapy or with electroshock treatment.
Depression, the most common emotional disorder, is classified as an affective disorder, the term affect referring to emotions and feelings. Affective disorders, also called mood disorders, include major depression and bipolar (manic-depressive) disorder. Many drugs are available to treat depression effectively. One is selected over another based on side effects or safety.
The main classes of antidepressants are the tricycles, selective serotonin reuptake inhibitors (SSRIs), monoamine oxidise inhibitors (MAOIs), and others that are often called heterocyclics (trazodone, bupropion). The most recently developed antidepressants are the SSRIs, such as fluoxetine (Prozac [trademark]), sertraline, and paroxetine. They have no sedating effect, anti-cholinergic activity, associated weight gain, or cardiac toxicity, but they can cause nervousness.
The oldest and best-studied class is the tri-cyclics, which are divided into tertiary amines and secondary amines. Most tri-cyclics have a sedating effect, cardiac toxicity, and varying degrees of anti-cholinergic side effects, which some individuals, especially the elderly, have difficulty tolerating, anti-cholinergic effects, which result from the blockage of parasympathetic nerve impulses, include dry mouth, constipation, difficulty urinating, and confusion.
Monoamine oxidise inhibitors have the potential to produce dangerous drug interactions. This is especially true of tyramine, which can cause hypertension and severe headache. Tyramine is found in many foods, which forces patients who take it to adhere to a specific diet. Bipolar disorder is characterized by severe mood swings, from excessive elation and talkativeness to severe depression. The predominantly favoured mood-stabilizing drug is lithium, which requires regular monitoring of blood concentrations to achieve optimum effect. If the patient experiences episodes of mania or depression while taking lithium, additional drugs may be necessary.
The perception of pain is highly variable among individuals. The perception of an instance of pain results from the brain's processing of the new sensory input with existing memories and emotions, in the same way that other perceptions are produced. Childhood experiences, cultural attitudes, genetic makeup, and gender are factors that contribute to the development of each individual's perception of and response to different types of pain. Although some people may be able to physiologically withstand pain better than others, cultural factors rather than heredity usually account for this ability.
The point at which a stimulus begins to become painful is the pain perception threshold; most studies have found this point to be relatively similar among disparate groups. However, the pain tolerance threshold, the point at which pain becomes unbearable, varies significantly among groups. A stoical, non-emotional response to an injury may be a sign of valour in certain cultural or social milieus, but this behaviour can also mask the severity of an injury to an examining physician. Thus, when assessing pain levels, the clinician should not isolate the pain but consider it within the circumstances of the patient's life.
Depression and anxiety have been noted to lower both types of pain thresholds; anger or excitement, however, can obscure or lessen pain temporarily. Feelings of emotional relief can also erase the painful sensation for a time. The context of pain and the meaning it has for the sufferer also play a part in pain perception. The effects that these psychological factors have on the perception of pain illustrate the importance of the patient's attitude toward the condition.
Pain associated with certain psychiatric conditions is believed to arise and be maintained by psychological forces alone. Somatoform disorders, psychosis, and depression are commonly accompanied by vague complaints of chronic pain, which can take on bizarre descriptions in the individual suffering from psychosis. Although chronic pain often gives rise to depression, sometimes the order is reversed, and vague localized pain for which no physiological cause can be found actually masks depression.
Major depression and other mood disorders such as dysthymia, bipolar disorder, and cyclothymia are common and very treatable forms of psychiatric problems. Depression is one of the most common conditions encountered in medical practice and affects up to 25 percent of women and 12 percent of men. Untreated depression can persist for two years or longer. Sixty percent of patients who receive treatment and recover will experience a recurrence of depression within three years. Fortunately, most episodes of major depression respond well to treatment.
For the diagnosis of major depression to be made, a depressed mood or loss of interest or pleasure in almost all activities must be present for at least two weeks and at least four of the following symptoms must be experienced: sleep disturbance (usually early morning awakening), fatigue or loss of energy, feelings of worthlessness or excessive guilt, diminished ability to concentrate or make decisions, agitation (anxiety or restlessness) or slowed movements, change in appetite with or without weight loss, and recurrent thoughts of death or suicide.
Dysthymia, or minor depression, is the presence of a depressed mood for most of the day for two years with no more than two months' freedom from symptoms. In addition at least two of the following symptoms must occur concurrently with the depression: disruption in eating habits--poor appetite or overeating; disturbed sleeping pattern--insomnia or low energy or low self-esteem; poor concentration or difficulty making decisions; and a feeling of hopelessness. Bipolar disorder is characterized by recurrent episodes of mania and major depression. Most of those who suffer from this condition (60 to 80 percent) initially manifest a manic phase, followed by depression. Manic symptoms consist of feelings of inflated self-esteem or grandiosity, a decreased need for sleep, unusual loquacity, an unconnected flow of ideas, distractibility, or excessive involvement in pleasurable activities that have a high potential for painful consequences, such as buying sprees or sexual indiscretions. Lithium is an effective drug for controlling these symptoms, although additional medications such as a benzodiazepine are needed to counteract an acute manic phase, and other antidepressants are necessary to treat bouts of major depression.
Cyclothymia is a chronic mood disturbance and is a milder form of bipolar disorder. For this diagnosis to be made, the patient will have exhibited at least two years of hypomania (moderate mania) and numerous periods of depressed mood that do not meet the criteria for major depression.
Schizophrenia is the most common and the most potentially severe and disabling of the psychoses. Schizophrenia is characterized by a withdrawal from reality, delusions and hallucinations, a loosening and incoherence of a person's thought processes, and deficiencies in feeling appropriate or normal emotions. Other symptoms may include apathy, reduced drive and initiative, inability to feel any emotion whatsoever, and a preoccupation with silly or bizarre fantasies.
The symptoms of schizophrenia typically first manifest themselves during the teen years or early adult life. The course of the disease is variable: some schizophrenics suffer one acute episode and then permanently recover; others suffer from repeated episodes with periods of remission in between; and still others become chronically psychotic and must be permanently hospitalized.
Despite prolonged research, the cause or causes of schizophrenia remain largely unknown. It is clear, however, that there is a genetic predisposition to the disease that is inherited. Thus the children of schizophrenic parents stand a greatly increased chance of themselves becoming schizophrenic. The symptoms of schizophrenia can be treated, but not cured, with such antipsychotic drugs as chlorpromazine and other phenothiazine drugs and by haloperidol. Psychotherapy may be useful in alleviating distress and helping the patient to cope with the effects of his illness.
The affective psychoses, which are also known as major affective disorders, consist of states of extreme and prolonged depression, extreme mania, or alternating cycles of both of these mood abnormalities. Depression is a sad, hopeless, pessimistic feeling that can cause listlessness; loss of pleasure in one's surroundings, loved ones, and activities; fatigue; slowness of thought and action; insomnia; and reduced appetite.
Mania is a state of undue and prolonged excitement that is evinced by accelerated, loud, and voluble speech; heightened enthusiasm, confidence, and optimism; rapid and disconnected ideas and associations; rapid or continuous motor activity; impulsive, gregarious, and overbearing behaviour; heightened irritability; and a reduced need for sleep. When depression and mania alternate cyclically or otherwise appear at different times in the same patient, the person is termed to be suffering from a manic-depressive psychosis.
Manic-depressive patients also frequently suffer from delusions, hallucinations, or other overtly psychotic symptoms. Manic depression often first manifests itself around age 30, and the disease is a long-lasting one. Many such patients can be treated by long-term maintenance on lithium carbonate, which reduces and prevents the attacks of mania and depression.
Depression alone can be psychotic if it is severe and disabling enough, and particularly if it is accompanied by delusions, hallucinations, or paranoia. Depression can be effectively treated by a variety of antidepressant drugs, including the tricyclic antidepressants and the monoamine oxidise inhibitors. Electroconvulsive (shock) therapy is useful in some cases, and psychotherapy and behavioural therapy may also be effective.
Mania and many cases of depression are believed to be caused by deficiencies or excesses of certain neurotransmitters in the brain. (Neurotransmitters are chemicals that play key roles in the transmission of nerve impulses.)Paranoia is a special syndrome that can be a feature of schizophrenia (paranoid schizophrenia) and manic-depressive psychosis or can exist by itself.
A person suffering from paranoia thinks or believes that other people are plotting or trying to harm, harass, or persecute him in some way. The paranoiac exaggerates trivial incidents in everyday life into menacing or threatening situations and cannot rid himself of his suspicions and apprehensions. Paranoid syndromes can sometimes be treated or alleviated by antipsychotic drugs.
The functional psychoses are difficult to treat, and drug treatments are the most common and successful approach. Psychoanalysis and other psychotherapies, which are based on developing a patient's insight into his presumed underlying emotional conflicts, are difficult to apply to psychotic patients.
As with all medical testing, psychological testing is used as an aid in diagnosis, but no test stands alone. Each result must be combined with information gathered from the history, clinical evaluation, and other tests to be of greatest value. Testing, usually by a trained psychologist, is used to differentiate psychiatric from organic problems, to measure intelligence, to detect or confirm depression or other emotional abnormalities, and to evaluate personality or cognitive functioning. Some of the most commonly used tests are listed below.
The Minnesota Multiphasic Personality Inventory (MMPI) is a questionnaire designed for people older than 16 years of age. The 567 true-false statements require a trained psychologist to interpret the 14 personality scales and to determine the clinical significance of the findings. The test is used to assess psychopathologic status and personality functioning.
The Mini-Mental State Examination (MMSE) is the most widely used screening test for impairment of cognitive function. Developed by Marshal F. Folstein and colleagues, this brief and easy-to-administer test is used to identify persons with dementia.
Personality functioning and psychopathologic status can be assessed with the 10 inkblot cards of the Rorschach test. The associations these ambiguous images provoke require expert interpretation; results provide useful information on emotional aberrations.
The Thematic Apperception Test (TAT) uses 20 pictures of people in different situations to which the viewer ascribes meaning, which reflects areas of anxiety, personal conflict, and interpersonal relationships.
Information about a person's concerns and emotional conflicts can be gathered by administering the draw-a-person test and the sentence-completion test. The Beck Depression Inventory (BDI), a 21-item self-administered test, measures subjective experiences and psychological symptoms associated with depression. The Zung Self-Rating Depression Scale, which can be self-administered or given by a trained interviewer, employs 20 items to measure the severity of depression.
