Common Presentations of Depression and Anxiety

DSM-IV Diagnostic and Statistical Manual of Mental Disorders

Major Depressive Episode Five (or more) of the following symptoms during the same 2-week period; includes at least (1)depressed mood or (2)loss of interest or pleasure.

1, depressed mood 2, diminished interest or pleasure 3, significant weight loss, or decrease or increase in appetite 4, insomnia or hypersomnia 5, psychomotor agitation or retardation 6, fatigue or loss of energy 7, feelings of worthlessness or excessive or inappropriate guilt 8, inability to think or concentrate 9, recurrent thoughts of death, suicidal ideation or a suicidal attempt

Anxiety Disorders Panic Attack Period of intense fear or discomfort, 4 (or more) of the following developed within 10 minutes:

1, palpitation 2, sweating 3, trembling or shaking 4, shortness of breath 5, feeling of choking 6, chest pain or discomfort 7, nausea or abdominal distress 8, feeling dizzy or lightheaded 9, derealization (feelings of unreality) or depersonalization (being detached from oneself) 10, fear of losing control or going crazy 11, fear of dying 12, numbness or tingling sensation 13, chills or hot flushes

1, Panic Disorder 2, Agoraphobia 3, Specific Phobia 4, Social Phobia (Social Anxiety Disorder) 5, Obsessive-Compulsive Disorder 6, Post Traumatic Stress Disorder 7, Generalized Anxiety Disorder

‘Poor performance’ 1 st year student Foreign student from mainland China Failed to show up for classes Did not attend all her examinations Discontinued by the university Asked to come to UHS for advice

Insomnia since October Early morning wakening Depressed mood Fatigue Binge eating, gained 40 lbs in a few months Unable to concentrate and focus Lack of confidence, feeling of worthlessness Feeling of hopelessness Socially withdrawn and isolated Complicated by involving in a ‘difficult’ relationship, confused about her own sexual orientation

‘It was close’ Referred by student counseling service 2 nd year student Feeling depress for 3 months Feeling of hopelessness Very poor motivation Unable to concentrate, affecting his school performance Sleeps more than 12 hours a day No apparent precipitating factor

Attempted suicide 3 times 1 st - electrocution 2 nd - tied a plastic bag over his head 3 rd – tried to strangulate himself by tying clothes around his neck All done in isolation Left a written statement

Suicidal Risk Assessment Has a plan Lethality of the plan Has written about the plan Has informed others Previous history of attempted suicide Co-morbidity e.g. depression, substance abuse Recent crisis

Depression is a medical conditionDepression is a medical condition Depression is NOT a personality flaw or a sign of weaknessDepression is NOT a personality flaw or a sign of weakness There is a 20% chance of developing into a clinical depression in one’s life timeThere is a 20% chance of developing into a clinical depression in one’s life time Depression is the most treatable mental illnessDepression is the most treatable mental illness 80% of depression will respond positively to treatment80% of depression will respond positively to treatment