Social, Cultural and Ethnic Aspects of Mood Disorders
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A lecture by Dr Imran Waheed, Consultant Psychiatrist, delivered in Birmingham, UK on February 7th 2012. The audience was medical students in Birmingham
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Social, Cultural and Ethnic Aspects of Mood Disorders
- 1. Dr Imran Waheed Consultant Psychiatrist Birmingham Central Home Treatment Team Social, Cultural and Ethnic Aspects of Mood Disorders
- 5. “ And yet in certain of these cases there is mere anger and grief and sad dejection of mind…those affected with melancholy are not every one of them affected according to one particular form but they are suspicious of poisoning or flee to the desert from misanthropy or turn superstitious or contract a hatred of life. Or if at any time a relaxation takes place, in most cases hilarity supervenes. The patients are dull or stern, dejected or unreasonably torpid…they also become peevish, dispirited and start up from a disturbed sleep. ” Arateus (AD 150)
- 18. Physical Symptoms in Psychiatric Patients Data from Kellner R, Sheffield BF. The one-week prevalence of symptoms in neurotic patients and normals. Am J Psychiatry 1973;130:102–105 Psychiatric Healthy Symptom Patients % Subjects % Tiredness, lack of energy 85 40 Headache, head pains 64 48 Dizziness or faintness 60 14 Feeling of weakness in parts of body 57 23 Muscle pains, aches, rheumatism 53 27 Stomach pains 51 20 Chest pains 46 14
Notas del editor
- Phrenitis was employed in ancient Greece by Hippocrates and his followers. It refers to acute inflammation of mind and body, not in a theoretical but in a descriptive sense. Its presumed seat was never anatomically or conceptually well determined. The diagnosis was used during the Middle Ages : a mental confusion or continuous delirium with fever . Phrenitis means an inflammation of the brain, or of the meninges of the brain, attended with acute fever and delirium. Symptoms vary widely in severity, from short-lived, relatively slight effects of headache, drowsiness, and fever to paralysis , coma , and death . The ancient phrenitis concept was used until the 19th century. After that time the concept was replaced by the word delirium. By their epigonic character the detailed descriptions of phrenitis by Gerard van Swieten mark only the end of an uncritical use of the term. The epoch-making work of Morgagni , based on clinical-anatomical observations, provides a definitive insight into the location of the condition and into many pathologic features. Pinel is the last author who mentions phrenitis in a classification of diseases In Europe, mentally ill were seen as responsibility of clerics rather than doctors
- Phrenitis was employed in ancient Greece by Hippocrates and his followers. It refers to acute inflammation of mind and body, not in a theoretical but in a descriptive sense. Its presumed seat was never anatomically or conceptually well determined. The diagnosis was used during the Middle Ages : a mental confusion or continuous delirium with fever . Phrenitis means an inflammation of the brain, or of the meninges of the brain, attended with acute fever and delirium. Symptoms vary widely in severity, from short-lived, relatively slight effects of headache, drowsiness, and fever to paralysis , coma , and death . The ancient phrenitis concept was used until the 19th century. After that time the concept was replaced by the word delirium. By their epigonic character the detailed descriptions of phrenitis by Gerard van Swieten mark only the end of an uncritical use of the term. The epoch-making work of Morgagni , based on clinical-anatomical observations, provides a definitive insight into the location of the condition and into many pathologic features. Pinel is the last author who mentions phrenitis in a classification of diseases
- PURPOSE OF THE SLIDE Establish that depression is a complex disorder that can be manifested through a variety of emotional, physical, and other associated symptoms (e.g., anxiety, worry, and pain). Note that the complexity of the symptom presentation can lead to depression being a difficult condition to diagnose. The variety of symptoms of depression suggests that many areas of the brain and neural networks may be involved in depression. KEY POINTS There is a broad range of major depressive disorder (MDD) symptoms. The mood in major depression is a period of at least 2 weeks during which there is either depressed mood or the loss of interest or pleasure in nearly all activities. The mood is often described by the person as depressed, sad, hopeless, discouraged, or “down in the dumps”. Some individuals emphasize somatic complaints (e.g., body aches and pains) rather than reporting feelings of sadness. Many individuals report or exhibit increased irritability. Loss of interest or pleasure is nearly always present, at least to some degree, and not feeling enjoyment in activities that were previously considered pleasurable. Appetite is usually reduced, yet other individuals have increased appetite. When appetite changes are severe, there may be significant loss or gain in weight. The most common sleep disturbance associated with depression is insomnia. Less frequently, individuals present with over-sleeping in the form of prolonged sleep episodes at night or increased daytime sleep. Psychomotor changes include agitation (e.g., the inability to sit still, pacing, hand-wringing) or retardation (e.g., slowed speech, thinking, and body movements). Decreased energy, tiredness, and fatigue are common. The sense of worthlessness or guilt associated with depression may include unrealistic negative evaluation of one's worth or guilty preoccupations or ruminations over minor past failings. Many individuals report impaired ability to think, concentrate, or make decisions. They may appear easily distracted or complain of memory difficulties. Frequently, there may be thoughts of death, suicidal ideation, or suicide attempts. BACKGROUND The symptom groupings were based on the DSM-IV-TR core criteria and text description of associated symptoms. REFERENCE American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders . Text Revision. 4th ed. Washington, DC: American Psychiatric Association; 2000;352,356.
- PURPOSE OF THE SLIDE Focus on the high prevalence of associated pain in patients with depression. KEY POINTS In a major meta-analysis, two-thirds of patients with depression experienced pain symptoms as well. Symptoms included headaches, and back, neck, extremity/joint, chest, pelvic, abdominal, and general pain. The prevalence rates of associated painful symptoms in patients with depression did not differ in psychiatric versus primary care settings. BACKGROUND Bair et al searched the MEDLINE database from 1966 through July 30, 2002, using the combined search terms depression or depressive disorders and pain. Articles were identified by a manual search of bibliographies from all retrieved articles. Studies were limited to human studies reported in English. Studies were eligible for inclusion if they addressed both depression and pain symptoms, loosely defined. The definition of pain condition, location of pain, and duration of pain complaint varied considerably among studies. Several different scales were used to assess depression. REFERENCE Bair MJ, et al. Depression and pain comorbidity. Arch Intern Med . 2003; 163 :2433–2445.