Depression somatization

The target symptoms of psychoneurosis that respond to doxepin include anxiety, tension, depression, somatic symptoms and concerns, insomnia, guilt, lack of energy, fear, apprehension, and worry. 

Depression and mania are both affective disorders but their symptoms and treatments are quite distinct. Mania is expressed as heightened mood, exaggerated sense of self-worth, irritability, aggression, delusions and hallucinations. In stark contrast, the most obvious disturbance in depression is melancholia that often co-exists with behavioural and somatic changes (Table 20.1). Some individuals experience dramatic mood swings between depression and mania. This is known as "bipolar disorder which, like mania itself, is treated with lithium salts or neuroleptics. 

Somatic upsets are the primary symptoms of depression among the Chinese, in contrast to the affective and dysphoric manifestations that are more common in the West (Cheung Bernard, 1982 Kleinman, 1977,1988 Marsella, Kinzie 8c Gordon, 1973 Tseng, 1975). 

Kleinman (1986) claimed that neurasthenia was a cultural form of chronic somatization that outlined several different types of psychopathological disorders, the major depressive disorder included in western classifications being the one that best accounted for this disorder. This would explain the lower rate of prevalence of the diagnosis of depressive disorder among the Chinese population. 

The classic symptoms of depression are listed in Table 12.1, which is based on DSM-IV criteria. For a diagnosis of major depressive disorder, most of these symptoms must be present, including the first two (APA, 2000). These symptoms should be of sufficient intensity and chronic duration (at least 2 weeks) to cause clinically significant distress and impairment in social or economic functioning. However, they should not be a result of another psychiatric or somatic illness, nor of drug misuse or bereavement. For a diagnosis of mania, the symptoms are a mirror image of those for depression (Table... 

Beach and Amir have demonstrated that with a given sample using the same procedures, some markers of depression may define a taxon, while others do not. In other words, both continuous and taxonic forms of depression exist. However, questions remain about the nature of the identified taxon. Is it really a depression taxon or has the exclusive focus on vegetative symptoms changed the nature of the construct Interestingly, certain somatic symptoms, such as sleep and appetite disturbance, are common in many disorders and can be considered the physical component of nonspecific distress (Clark Watson, 1991). Thus, perhaps the identified taxon is not a depression taxon at all and actually reflects general somatic complaints. Only construct validation can address these concerns. 

Hamilton Depression Scale. The HAMD is one of the most widely used tests to evaluate the severity of depressive illness quantitatively in adults. The most widely used form of this test contains 21 items covering a broad range of symptomatology, with a three- to five-point scale for most items. The minimum time required to complete this test is usually 10 to 20 minutes, and it requires a skilled interviewer. Either the present time or the period within the last week is rated. Six subscales are obtained in the HAMD anxiety/somatization, weight, cognitive disturbance, diurnal variation, retardation, and sleep disturbance. 

Hopkins Symptom Checklist. The Hopkins Symptom Checklist (HSCL) is a scale that has been used to measure the presence and intensity of various symptoms in outpatient neurotic patients. It is a 58-item self-rating scale and has generally been replaced by the Self-Report Symptom Inventory (SCL-90). It measures the symptoms during the past week and requires approximately 20 minutes to complete. There are five subtests somatization, obsessive-compulsive, interpersonal sensitivity, depression, and anxiety. 

Self-Report Symptom Inventory. Each of the 90 items in the SCL-90 uses a five-point scale of distress. It was designed as a general measure of symptomatology for use by adult psychiatric outpatients in either a research or clinical setting. It rates either the present or previous week. It requires about 15 minutes for the patient to complete this form and about 5 minutes for a technician to verify identifying information. This test is sensitive to drug effects and may be used with inpatients. Nine subscales are measured somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, anger-hostility, phobic anxiety, paranoid ideation, and psychoticism. 

Hubner WD, Lande S, Podzuweit H. (1994). Hypericum treatment of mild depressions with somatic symptoms. J Geriatr Psychiatry Neurol. 7(suppl 1) S12-4. 

Several natural products have been evaluated in rodent models of nicotine withdrawal. An extract of Hypericum perforatum (St. John s Wort, a putative antidepressant, and inhibitor of serotonin reuptake) reversed somatically expressed withdrawal behaviors and locomotor depression in spontaneous withdrawal (Catania et al. 2003). A benzoflavone compound isolated from Passiflora incarnata, interfered with the induction of physical dependence. Coadministration with chronic nicotine prevented various subsequent indicators of withdrawal syndrome in the mouse, including jumping, locomotor inactivity, immobility in the swim test and naloxone-precipitated escape jumping (Dhawan et al. 2002). 

Major depression is a triad of psychological, somatic and physical symptoms. Over 75% of depressed patients report painful physical symptoms involving the neck, back, head, stomach and the skeleto-muscular system. Not only can chronic pain lead to depression, but also vice versa. 

Antipsychotics or neuroleptics are used for intervention in patients with severe and chronic psychosis of an organic as well as induced nature. These drags are used for controlling manic phases in manic-depressive psychosis such as relieving anxiety, fear, excitement associated with somatic diseases, controlling aggression, tics, and other unequal conditions. 

Cydobenzaprine (Flexeril) [Skeletal Muscle Relaxant/ANS A nt] Uses Relief of muscle spasm Action Centrally acting skeletal muscle relaxant reduces tonic somatic motor activity Dose 5-10 mg PO bid-qid (2-3 wk max) Caution [B, ] Shares the toxic potential of theTCAs urinary hesitancy, NAG Contra Do not use concomitantly or w/in 14 d of MAOIs hyperthyroidism heart failure arrhythmias Disp Tabs SE Sedation anticholinergic effects Interactions t Effects of CNS d ression W/ CNS dqjressants, TCAs, barbiturates, EtOH t risk of HTN convulsions W/MAOIs EMS Use caution w/ other CNS depressants concurrent EtOH use can t CNS d ession OD May cause N/V,... 

In the United States, the three MAOIS available for the treatment of psychiatric conditions are phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan). All three agents have indications for adult major depression (>16 years old) and, more specifically, atypical depression (anergia, hypersomnia, hy-perphagia, somatization, and anxiety symptoms). Although not indicated for anxiety, the MAOIs can also be particularly helpful in treatment of these disorders. Selegiline or L-deprenyl (Eldepryl) is also available in the United States and indicated for symptoms of Parkinson s disease and depression. 

Preschoolers Child Behavior Checklist/ 2-3 100 items rated 0—2, 6 subscales social withdrawal, depressed, sleep problems, somatic problems, aggressive, destructive P Achenbach et ah, 1992... 

Anorectic patients are usually brought to professional attention by family members after the patients have lost a large amount of weight. If they seek help on their own it is usually because of their subjective distress over the somatic and psychological consequences of starvation. These include weakness, fatigue, difficulty concentrating, sleep disturbances, and depression. Because individuals with AN have considerable denial of the seriousness of their problem, they are often unreliable historians. Thus it is necessary to ob-... 

Given the available data, it is extremely important that clinicians evaluate patients with major depression for features of psychosis, because the failure to do so may result in inadequate treatment for the patient. A practical problem encountered by clinicians, however, is the subtlety of delusions. For example, it is not unusual in geriatric depression for patients to present with a somatic preoccupation that borders on delusional. These so-called near delusions may put the patient into the arena of psychotic depression. Some evidence exists that patients with depression with near delusions may respond more favorably to combinations of antidepressants and antipsychotics or ECT. Once the presence of both major depression and psychosis is determined, other psychotic disorders including bipolar disorder and schizophrenic spectrum illness must also be ruled out because this may influence long-term treatment decisions. 

Antidepressants are medications used to treat depression, i.e. states of severe dejection lasting for weeks or months. The term depression does not designate a single disease but a syndrome that needs to be characterized more precisely on the basis of the prevailing symptoms present and taking the patient s prior history into account. On the basis of the patient s clinical status, differentiation is made between inhibited and agitated forms of depression states of depression that are almost exclusively expressed in the form of physical complaints and symptoms are also termed somatized or masked depressions. 

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