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04.10.2014

10 signs of depressions, personality disorder symptoms and causes - .

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My depression started downward-spiraling when I made the decision to come back to Korea for my first long-term stay. I called one of the Seoul Mental Health hotlines, where they tentatively confirmed my depression and urged me to seek therapy at one of the centers.
ABSTRACT: Depression is a common complication of cancer, occurring in about 25% of all patients. Because many clinicians believe that they themselves would be depressed if they had cancer, depression is sometimes viewed as being “appropriate” in cancer patients. Given the seriousness of depression, it is important for caregivers to recognize and treat it. The two major diagnoses for significant depressive symptoms are adjustment disorder (reactive depression) and major depression. Because these criteria may not be specific for depression in medical illnesses, a set of psychological criteria is often used in their place. Since depression is both prevalent and treatable in cancer patients, caregivers should routinely screen patients for its presence. Assessment for depression with a rapid mental status examination is feasible and should be done in the context of a regular medical visit. Some screening tools used in oncology settings include the Hospital Anxiety and Depression Scale (HADS), Primary Care Evaluation of Mental Disorders (PRIME-MD), and the Zung Self-Rating Depression Scale.[20-22]. Once depressive symptoms have been identified, the clinician should eliminate other possible diagnoses besides major depression. Physical Illness—As noted above, it is important to try to distinguish between symptoms resulting from the medical illness and neurovegetative symptoms of depression. Adjustment Disorder—When a patient has significant depressive symptoms that develop after an identifiable stressor, such as a cancer diagnosis or recurrence, but does not fully meet the criteria for a major depressive episode, a diagnosis of adjustment disorder is made. Although a significant number of chemotherapeutic agents are known to have potentially severe side effects, relatively few of these drugs cause depression.


Dementia—When patients have difficulty with memory and concentration, it may be difficult to tell whether the symptoms are due to dementia or major depression.
Neuropsychological testing may be helpful in distinguishing between dementia and the pseudodementia of depression. Bipolar Disorder—It is important to ask the patient about any personal history of manic episodes or a family history of bipolar disorder (ie, symptoms of episodic euphoria, grandiosity, increased energy and physical activity despite sleeplessness, spending sprees, or hypersexuality), as the treatments for depression and bipolar disorder differ. Last Spring my fiance was visiting Korea and decided to completely break off our engagement (not due to my depression accordingly but due to his own emotional issues). If left untreated, depression can contribute to poor treatment compliance, increased hospital stays, and mortality.
However, it is never appropriate for cancer patients to suffer with significant depression. Past studies have shown that oncologists and primary care providers have difficulty recognizing depressive symptoms in cancer patients.[14,15] Major depression is a clinical entity with specific signs, symptoms, and treatments. Major depression is usually distinguished from an adjustment disorder by the degree, duration, or amount of symptoms. Many of the neurovegetative symptoms of depression— especially loss of energy, loss of appetite, and sleep disturbance—overlap with common symptoms of cancer or other medical illnesses, and with side effects of medical treatments used in cancer patients.
Endicott suggested substituting the psychological symptoms of self-pity, brooding, crying spells, and pessimism for the neurovegetative symptoms.[17] Some clinicians highlight the importance of the cognitive symptoms of depression, such as depressed thoughts, hopelessness about appreciating any degree of quality in their lives, guilt or worthlessness, or persistent suicidal ideation. Several predisposing factors have been correlated with the development of depression in cancer patients.
Symptoms typically associated with depression can be seen with other situations related to cancer. Debilitating symptoms, such as recurrent nadir fevers, a new significant pain, or severe, continuous nausea and vomiting, can also engender feelings of despair and an inability to cope. Because the depression is the direct result of medical illness, psychiatrists technically call it a mood disorder secondary to a medical condition.


Endocrinologic abnormalities that should be looked for include hyperthyroidism or hypothyroidism, Cushing’s syndrome, hyperparathyroidism, and adrenal insufficiency.[26] Depression occurs with greater frequency and severity in patients with pancreatic cancer, although the mechanism is not fully understood.
The glucocorticosteroids, prednisone and dexamethasone frequently cause alterations in mood, which range from euphoria to irritability to severe depression, as well as delirium and psychosis. Depressed patients are usually able to do the cognitive tasks with significant coaxing and motivation. Patients with personality disorders, particularly borderline personality disorder, describe lifelong histories of depression and long-standing patterns of intense, conflictual relationships, self-destructive behaviors, and chronic feelings of emptiness.
Medical issues, as well as psychosocial stressors, can complicate the diagnosis of depression in people with cancer. Referred to as the “neurovegetative symptoms” of depression, some of these symptoms are related to bodily functions. Neurologic problems unrelated to cancer, such as cerebral vascular disease, Parkinson’s disease, and Huntington’s disease, have also been known to produce depression. Depression can sometimes have psychotic features, but hallucinations are not typically visual. The history, including the onset, time course of depressive and cognitive symptoms, course of illness, and responses to treatment, is often helpful in making this determination.[16] In patients with dementia, there is usually a history of slowly declining cognitive function, whereas in those with major depressive episode, there is usually an abrupt onset of cognitive difficulties associated with the depression.
They may, however, also experience a comorbid episode of depression and require psychotropic medication. This article describes the clinical presentation of depression in cancer patients, reviews the differential diagnosis, and discusses various treatment options, including antidepressants. I have a history of depression and I suspect that both my parents were undiagnosed for depression, but I wouldn’t just give into it so I received counseling all throughout high school and college.



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