Professional Documents
Culture Documents
Somatic Complaints in Depression Psikosomatik Untad 2012
Somatic Complaints in Depression Psikosomatik Untad 2012
DEPRESSION
Blok XX
Psikosomatik
Universitas Tadulako
2012
Physical Symptoms Common In
Psychiatric Patients
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
Data from Kellner R, Sheffield BF. The one-week prevalence of symptoms in neurotic
patients and normals.
Am J Psychiatry 1973;130:102–105
Why Focus on Physical
Symptoms?
• A growing literature explores the mind-
body connection in mental illness
• Depression may have physical causes and
consequences (like appetite and sleep
disturbance, fatigue, and chronic pain)
• The presence of physical symptoms in
depression may affect response to
treatment
Patients With Major Depressive
Disorder
• Report only physical symptoms in up to 69% of primary care
cases1
– E.g.,insomnia or hypersomnia, psychomotor agitation or
retardation, changes in appetite, fatigue
• Are at 4x greater risk than nondepressed patients for having a
chronic painful physical condition (CPPC)2
• Are more likely than nondepressed patients to have long-term
medical conditions3
1Simon GE, VonKorff M, Piccinelli M, et al. An international study of the relation between somatic symptoms
and depression. N Engl J Med 1999;341:1329–1335
2Ohayon MM, Schatzberg AF. Using chronic pain to predict depressive morbidity in the general population. Arch Gen Psychiatry
2003;60:39–47
3Patten SB. Long-term medical conditions and major depression in a Canadian population study at waves 1 and 2. J Affect Disord
2001;63:35–41
Depression. It’s not only a state of
mind.
The symptoms of depression
Emotional Symptoms Include: Physical Symptoms Include:
Sadness Vague aches and pains
Anxiety Fatigue
In patients
N = 1146 Primary care primary withcare, physical
major depression symptoms are often
the chief complaint in depressed patients
Reference:
1. Simon GE, et al. N Engl J Med. 1999;341(18):1329-1335.
Aches/pain – a physical symptom
of significance
Aches/Pain as common as anxiety among depressed patients
70 National Comorbidity
Survey
60 58%
55%
% of Depressed Patients
NIMH Epidemiology
50 Study
40 38% 37%
35%
30 28%
25%
20 17%
10
0
Aches/Pain Aches/Pain Anxiety Disorder Anxiety Disorder
(Women) (Men) (Women) (Men)
Adapted from
1.Silverstein B. Am J Psychiatry. 1999;156(3):480-482.
2.Silverstein B. Am J Psychiatry. 2002;159(6):1051-1052.
The importance of emotional and
physical symptoms
• 76% of compliant depressed
patients with lingering symptoms
of depression relapsed within 10
months1*
Reference:
1. Adapted from: Paykel ES, et al. Psychol Med. 1995;25:1171-1180.
Serotonin5HT and NorepinephrineNE
in the brain
Limbic System
Prefrontal
Cortex
Locus Ceruleus
Raphe Nuclei (NE Source)
(5-HT source)
Anxiety
Sex Concentration
HAM-D17
Scores Depression
(Major Depressive Disorder)
15
Response
50% reduction from baseline HAM-D score
7
Remission: HAM-D Score 7
References:
1. Frank E. Conceptualization and rationale for consensus definition terms in MDD, Arch Gen Psych. 1991; 48:851-855.
Treatment outcome:Effect on work & social functioning
3
(Mean ± SD)
*
*
**
2
1
Normal Remission Response Nonresponse
(n=482) (n=202) (n=122) (n=299)
Study in chronic depressed patients
*p.05 vs nonresponse. **p.05 vs response.
Miller IW, et al. J Clin Psychiatry. 1998;59(11):608-619.
Many depressed patients are still
depressed.
• Depressed patients present with emotional
and physical symptoms.
• Approximately 30% of depressed patients
achieve remission in clinical trials2*
• Up to 70% of patients who respond fail to
remit2*
References:
1. Nierenberg AA, et al. J Clin Psychiatry. 1999:60(suppl 22):7-11.
2. O’Reardon JR, et al. Psychiatr Ann. 1998;28:633-640.
3. Lynch ME. J Psychiatry Neurosci. 2001;26(1):30-36.
5-HT
cytokine dysregulation
neurotransmitter
dysregulation
Mechanisms
circadian rhythm
proposed as
vagal afferent disruption
underlying Fatigue
activation