Download depressive disorders in other selected medical conditions

DEPRESSIVE DISORDERS IN
OTHER SELECTED MEDICAL
CONDITIONS
FRANCIS CREED & SANTOSH K CHATURVEDI
Copyright © 2012. World Psychiatric Association
SYMPTOMS SHARED BY RHEUMATOID
ARTHRITIS AND DEPRESSIVE DISORDER
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Feeling helpless and hopeless
Inability to work
Insomnia
Lack of energy
General poor health
Copyright © 2012. World Psychiatric Association
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HEPATOTOXICITY & ANTIDEPRESSANTS
• Most antidepressants undergo extensive hepatic oxidative
metabolism and should be dosed cautiously
• Antidepressants can cause hepatitis, at times
• Most antidepressant agents have the potential to produce idiopathic
liver injury.
• Possible drug discontinuation syndromes can occur if
antidepressants are stopped due to hepatotoxicity.
• Consider early discontinuation of an antidepressant if hepatotoxicity
is suspected.
• Idiopathic drug-induced liver injury cannot be prevented, but the
severity of the reaction may be minimized with prompt recognition
and early withdrawal of the agent.
• Ongoing therapy of the underlying depressive disorder should be
provided using psychological or safe pharmacological methods
Copyright © 2012. World Psychiatric Association
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ETIOLOGY OF DEPRESSION IN RENAL
DISEASE:
• Metabolic changes, including sedative accumulation
• Other drug-induced metabolic disturbances,
• Psychosocial aspects of chronic renal failure, such as
restrictions imposed by the need for lifelong dialysis.
• Stressful life events and dependence on family or others
for help
• Electrolyte disturbances involving sodium, potassium,
calcium, chloride, phosphate, and acid-base balance.
• Related to treatment – steroids, immunosuppressants,
dialysis, or transplantation
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Inter relationship between Chronic Pain &
Depression
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Depression can present with chronic pain
Chronic pain can cause depression
Aches and pains may be symptoms of Depression
Chronic pain may be a variant of depression
Depression can worsen chronic pain
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Psychiatric Management of Chronic pain &
Depression
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Appropriate use of antidepressants
Explaining the relationship between pain and depression
Reattribution of pain to mood and depression
Rehabilitation and Living with pain
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Use of Antidepressants for Chronic Pain
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Elevation of Mood
Reduction of Anxiety
Potentiation Of Analgesics
Primary Analgesic Effect
Relief From Non-Organic Causes of pain
Reduces psychological symptoms as restlessness,
agitation, sleep disturbance
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