1、DepressionDepressionDepressionFrameworkFrameworkPart1Part2Part3Part4CausesSocialPsychologicalBiologicalDiagnosisTwo systemsSpecific diagnosisExisting problemsTreatmentDrug therapy PsychotherapyPresentation IntroductionDefinitionEpidemiologyClinical manifestationsPsychiatristDepressionDepressionFrame

2、workFrameworkPart1Part2Part3Part4CausesSocialPsychologicalBiologicalDiagnosisTwo systemsSpecific diagnosisExisting problemsTreatmentDrug therapy PsychotherapyPresentation IntroductionDefinitionEpidemiologyClinical manifestationsDepressionDepressionFrameworkFrameworkDefinition what is depression Epid

3、emiology prevalence years lost to disability burden of the diseaseClinical manifestations mentally physicallyPart1BriefIntroduction&Clinical manifestationmental health disorderpsychiatric condition mood disorder persistently sadnesslow energydifficult in functioning normally.DefinitionWhat is depres

4、sion?Definitionpersistentaverage episode lengh: 68 months passingusual mood fluctuationsshort-lived emotional responseISNOTWHOmost common illness worldwideat least 350 million people women manEpidemiologyEpidemiologyNature prevalence of depressionPsychiatrists per 100,000 peopleprevalence of depress

5、ionPsychiatrists per 100000 peopleEpidemiologyyears lost to disability（YLD） 76.4 million percent of the total burden of disease10.3%ranked by disability and death combined9thbehind heart disease, stroke and HIVdepressionback and neck painAnaemia1 MentallyClinical manifestation2 Physically1 MentallyP

6、ersistently depressed mood Reduced interest Worsened ability to think, concentrate or make decisionsRecurrent thoughts of death or suicideFeelings of worthlessness or guiltNO positive thoughts to the future2 PhysicallyUnintentional weight loss Fatigue or loss of energyDifficulty in sleepingSlowed mo

7、vements and speechNausea, vomiting, flustered, chest tightness, sweatingIf a person feel depressive and sorrow because of the death of someone close, do you think he or she is suffering the depression? QClinical manifestationDepressionDepressionFrameworkFrameworkPart1Part2Part3Part4CausesSocialPsych

8、ologicalBiologicalDiagnosisTwo systemsSpecific diagnosisExisting problemsTreatmentDrug therapy PsychotherapyPresentation IntroductionDefinitionEpidemiologyClinical manifestationsDepressionDepressionFrameworkFrameworkSocial factorsvulnerability &resilienceonset of an episodespeed of recoveryPsycholog

9、ical theoriesBiological factorsPart2EtiologyWhat causes depression?1Factors that contribute to vulnerability and resilience, trigger an episode, or influence the speed of recoveryPsychological theoriesBiological factorsEtiology32Vulnerability and resilienceEarly life experience Maternal separation o

10、r neglectEmotional, physical or sexual abuseHyper-responsiveness of HPA axisGenetic factors No specific gene identified Vulnerability ResilienceStimulation of episodeLife eventsVulnerability and resilienceLack of supportChronic social disadvantageSevere physical health problems1Bereavement, separati

11、on and divorce, physical disability, prolonged unemploymentFeeling threatened or trappedWomen more sensitive than men The speed of recovery32Psychological theoriesBeckcognitivebehavioural therapyschemasact better to feel betterFreudloss and mourning Biological factorsMedical treatment and non-psychi

12、atric diseasesDiminishing hippocampus Inflammatory mechanisms influence HPA axisMonoamine hypothesis:deficiency of NE & 5-HT DepressionDepressionFrameworkFrameworkPart1Part2Part3Part4CausesSocialPsychologicalBiologicalDiagnosisTwo systemsSpecific diagnosisExisting problemsTreatmentDrug therapy Psych

13、otherapyPresentation IntroductionDefinitionEpidemiologyClinical manifestationsDepressionDepressionFrameworkFrameworkPart3DiagnosisTwo major diagnostic systemsExisting problems and reformsSpecific diagnosis Age-based diagnosis Antenatal and postnatal diagnosisTwo major diagnostic systemsthe Diagnosti

14、c and Statistical Manual of the American Psychiatric Association (DSM, the 5th edition)the International Classification of Diseases ( ICD, the 10th edition)DepressionDepressionFrameworkFrameworkPart3DiagnosisTwo major diagnostic systemsExisting problems and reformsSpecific diagnosis Age-based diagno

15、sis Antenatal and postnatal diagnosisExisting problems: Simply add up depression symptoms discard data about specific symptoms treating all symptoms as equivalent DSM criterion symptoms clinical consensus instead of empirical evidence Existing Problems and ReformsExisting problemsConclusion : identi

16、fy specific forms of treatment effective for specific depression subtypes have been disappointing most rating scales for depression are multifactorial and do not measure one underlying factor. Existing Problems and ReformsExisting problemsPossible reforms: personalized treatment of depression. Analy

17、zing specific symptoms and their causal associations Applying psychometric tools item response theory (IRT) structural equation modeling (SEM)Existing Problems and ReformsPossible improvementsDepressionDepressionFrameworkFrameworkPart3DiagnosisTwo major diagnostic systemsExisting problems and reform

18、sSpecific diagnosis Age-based diagnosis Antenatal and postnatal diagnosis1Specific DiagnosisAge-based diagnosisAntenatal and postnatal diagnosis2Older peopleAge-based DiagnosisAdultsChildren and adolescentsDistinguishing normal fears from anxiety disorder Differential and comorbid diagnosis Exclude

19、other medical disorders Risk assessment by consolation to aid diagnosisAge-based DiagnosisChildren and adolescentsSteps of Assessing Risk What methods of self-harm (or suicide) are being used orconsidered? What is the (perceived) intent? To relieve distress? To communicatefeelings? To die? Have they

20、 got any firm plans? How, what, where? Is the young person unsafe at home? Is there abuse or bullying? What protective factors are there? What might stop them frommaking an attempt? (e.g. impact on family and friends, or futureambitions and hopes). Who is available for them to talk to?Children and a

21、dolescentsAge-based DiagnosisGP(abbreviation of General Practitioner,全科醫生)AdultsThe Quality and Outcomes Framework (QoF) Symptom scales the nine-item Patient Health Questionnaire (PHQ9), the Beck Depression Inventory (BDI) the General Anxiety Disorder seven-item questionnaire (GAD7) Bio-psychosocial

22、 assessmentAge-based DiagnosisAdultsThe bio-psychosocial assessment Current symptoms including duration and severity. Personal history of depression. Family history of mental illness. The quality of interpersonal relationships with, partner, children and/or parents. Living conditions. Social support

23、. Employment and/or financial worries. Current or previous alcohol and substance use. Suicidal ideation. Discussion of treatment options. Any past experience of, and response to, treatments.Age-based DiagnosisOlder peopleClinical features: Comorbid with somatic symptoms Somatic preoccupation Hypocho

24、ndriasis The morbid fear of illnessSpecific diagnostic methods: access memory the General Practitioner Assessment of Cognition (GPCOG) the Abbreviated Mental Test Score case-finding consultation Age-based DiagnosisOlder peopleAge-based DiagnosisCase-finding consultation: history mental state risk as

25、sessment focused physical examination appropriate investigations1Specific DiagnosisAge-based diagnosisAntenatal and postnatal diagnosis2Antenatal and PostnatalAntenatal and PostnatalDiagnosisCase-finding is recommended Antenatal women current depression history of serious mental illness puerperal ps

26、ychosis psychiatric admission or treatment by mental health services Postpartum women Edinburgh Postnatal Depression Scale (EPDS) Patient Health Questionnaire 9 (PHQ-9) Hospital Anxiety and Depression Scale Postpartum Depression Screening ScaleDepressionDepressionFrameworkFrameworkPart1Part2Part3Par

27、t4CausesSocialPsychologicalBiologicalDiagnosisTwo systemsSpecific diagnosisExisting problemsTreatmentDrug therapy PsychotherapyPresentation IntroductionDefinitionEpidemiologyClinical manifestationsDepressionDepressionFrameworkFrameworkPart4Treatment&PreventionTreatmentPsychotherapyDrug therapyTenden

28、cy of committing suicidePharmacological mechanismPharmacokineticsAdverse reaction AddictionDoseFour phases: Initial, Cure, Consolidate, Reduce drug Minimum effective dose & Destructive doseState (Pregnancy, lactation)Interactions with other medicationsPrevention1Why Need DrugWho Need Drug2Drug TherapyDrug Therapy Sertraline HydrochlorideTendency of Committing SuicidePharmacologicalMechanismPharmacokeniticsDrug TherapyTendency of Committing SuicideHigh effect on adolescent and young adultLow eff