- General description

- most common symptom of depression:: generalized psychomotor retardation

- psychomotor agitation is also sometimes seen in older px

- most common symptom of agitation

- hand wringing

- hair pulling

- posture:: stooped

- no spontaneous movement

- downcast , averted gaze

- may appear gross symptoms of psychomotor retardation like those in catatonic schizophrenia

 Mood, Affect and Feelings

o depression is the key symptom
 50% deny depressive feelings
o family members bring the px because of social withdrawal and
o decreased activity
 Speech
o decrease rate and volume
o respond to questions with single words
 delayed responses to question
o may have to wait 2-3 min
 Perceptual Disturbance
o with delusions or hallucinations are said to have:: major depressive episode with
psychotic features
o Psychotic depression or having catatonic features
 for grossly regressed px
 mute
 not bathing
 soiling
o mood congruent if:: delusions and hallucinations are consistent with depressed
mood
o mood congruent delusions
 guilt
 sinfulness
 worthlessness
 poverty
 failure
 perscution
 terminal somatic illness
 o mood incongruent delusions or hallucinations is:: not consistent with a depressed
mood
 might involve grandiose themes of
 exaggerated power
 knowledge
 worth
 when this occur consider:: schizophrenic disorder
 thought
o have negative views of the world and of them selves
o though content includes
 nondelusional rumination about
 loss
 guilt
 suicide
 death
o 10 percent of px have
 though blocking
 profound poverty of content
 sensorium and cognition
o orientation
 oriented to person, place and time
 some may not have sufficient energy to answer questions
o memory
 50-70% have cognitive impairment
 aka as:: depressive pseudodimentia
 complain of
 impaired concentration
 forgetfulness

- Impulse control

- 10-15% of all depressed px commit suicide

- 2/3 have suicidal ideation

- px with psychotic features

- consider killing other person

- result of delusional systems

- most severely depressed px:: lack motivation or the energy

- to act in an impulsive or violent way

- px with depressive disorder are at increased risk of suicide

 - as they begin to regain energy needed to plan and carry out a suicide

- known as paradoxical suicide

- unwise too give px a large prescription for a large number of antidepressants

- especially tricyclic drugs

- fluoxetine may be prescribed

- so that energizing qualities are minimized

 Judgement and Insight

o assessed by reviewing px actions in recent and passed and during interview
o patients descriptions of their disorder is hyperbolic
 over emphasize their symptoms, their disorder, and life problems
o difficult to convince px that improvement is possible
 reliability
o over emphasize the bad and minimize the good
o common clinical mistake:: ask and believe the px that their medications doesnt
work
 such statements are false
 may require confirmation
o do not view it as intentional fabrication
 admission of any hopeful information may be impossible
 for a person in depressed state of mind