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Psychosocial Aspects of Patient Care: Understanding Loss and Depression

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A mood state or illness diagnosed according to various criteria ... Fatigue or lack of energy (anergia) Feelings of worthlessness or guilt ... – PowerPoint PPT presentation

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Title: Psychosocial Aspects of Patient Care: Understanding Loss and Depression


1
Psychosocial Aspects of Patient Care
Understanding Loss and Depression
2
Dealing with Loss
  • Self-image
  • Home
  • Privacy
  • Independence

3
Privileges of Patients
  • Temporary respite
  • Financial gain
  • Social gain

4
Personal Life of the Patient
  • Fragility of relationships
  • Lack of sustained interest
  • Changing relationships
  • Uncertainty about the future
  • Stigma and support systems
  • Depression

5
Depression
  • A mood state or illness diagnosed according to
    various criteria
  • Approximately 17 of all patients seen by primary
    care providers are depressed
  • Can be
  • Adjustment disorders
  • Major depressive disorder
  • Dysthymic disorder
  • Depressive disorder not otherwise specified (NOS)

6
Adjustment Disorders
  • Brief periods of depression in response to
    certain events or crises that occur in a persons
    life
  • Have a good prognosis

7
Major Depressive Disorder
  • Characterized by at least four of the following
  • Depressed mood and/or loss of interest or
    pleasure in most activities (anhedonia)
  • Change in weight or appetite
  • Increased or decreased sleep
  • Increased or decreased psychomotor activity
  • Fatigue or lack of energy (anergia)
  • Feelings of worthlessness or guilt
  • Decreased ability to think
  • Recurrent thoughts of death or suicide

8
Dysthymic Disorder
  • Chronic or fluctuating form of depression for at
    least a 2-year duration
  • Depressed mood or loss of pleasure in activities
    and additional symptoms of depression, but
    insufficient in number or intensity to warrant dx
    of major depression

9
Depressive Disorder NOS
  • Disorders with depressive symptoms that dont
    meet the criteria for the three previous disorders

10
Screening for Symptoms of Depression by Physical
Therapists
  • Physical therapists are relatively poor in
    screening for symptoms of depression in their
    patients
  • 35 - 47 LBP patients have depressive symptoms
  • Haggman S, Maher CG, Refshauge KM. Screening
    for symptoms of depression by physical therapists
    managing low back pain. Phys Ther.
    2004841157-1166.

11
Instruments Used to Test for Depression
  • Beck Depression Inventory (BDI)
  • Beck Anxiety Inventory (BAI)
  • Depression Anxiety Stress Scales (DASS)

12
A Screening Tool The Two-Question Instrument
  • During the past month, have you often been
    bothered by feeling down, depressed, or hopeless?
  • During the past month, have you often been
    bothered by little interest or pleasure in doing
    things?
  • Whooley MA, Avins AL, Miranda J, Browner WS.
    Case-finding instruments for depression Two
    questions are as good as many. J Gen Intern Med.
    199712439-445.
  • Haggman S, Maher CG, Refshauge KM. Screening for
    symptoms of depression by physical therapists
    managing low back pain. Phys Ther.
    2004841157-1166.

13
Using the 2-question screening tool
  • If the patient answers yes to either or both,
    this is a positive result for moderate to severe
    depression
  • Monitor the patient
  • If continues to have positive result, refer for
    more intensive testing

14
Depression and Rehabilitation
  • The longer depression goes undetected, the
    greater the likelihood of
  • Increased disability
  • Prolonged physical therapy
  • Result is
  • Increased cost (economic and social) to society
    and the patient
  • Possibly recurring cycle of depressive and
    disabling episodes

15
Questions for Thought and Discussion
  • Purtilo Haddad, pp. 139 - 140
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