Anxiety and Depression and Asthma
Jonathan A. Bernstein, Mark L. Levy in Clinical Asthma, 2014
MDD is what is often thought of by the term “depression” and is characterized by the presence of one or more major depressive episodes that cause significant distress and impairment. A major depressive episode is a period of two or more weeks of a depressed or irritable mood and/or markedly diminished interest or pleasure in all or almost all activities. These primary symptoms are accompanied by a combination of the following additional symptoms: significant weight loss or gain, insomnia or hypersomnia, fatigue, psychomotor agitation or retardation, feelings of worthlessness, difficulty concentrating, and suicidal ideation.8 Dysthymia is often thought of as a less severe form of MDD, because many of the symptoms of MDD are present, but to a lesser degree. It is characterized by a chronic, low-grade depressed or irritable mood that lasts for at least 1 year. Bipolar disorder, in its most classic form, can be thought of as alternating periods of major depressive and manic episodes or unusual shifts in mood, energy, activity levels, and the ability to carry out everyday tasks. A manic episode is a period of abnormally elevated or irritable mood that lasts for at least 1 week and is accompanied by symptoms of inflated self-esteem, decreased need for sleep, pressured speech, racing thoughts, and increased activity.8
Life Care Planning for Depressive Disorders, Obsessive-Compulsive Disorder, and Schizophrenia
Roger O. Weed, Debra E. Berens in Life Care Planning and Case Management Handbook, 2018
MDD is characterized by one or more major depressive episodes, with an absence of any hypomanic, manic, or mixed episodes. The fundamental feature of a major depressive episode is a persistent depressed mood that lasts at least two weeks or loss of interest or pleasure in almost all activities. Other symptoms of a major depressive episode include changes in sleep, appetite, weight, or psychomotor activity; lack of energy; feeling guilty or worthless; decreased ability to focus, think, or make decisions; and thoughts of death or suicidal thoughts, plans, or attempts (APA, 2013). At least five of these symptoms must be present and last for at least two weeks in order to meet the criteria of a major depressive episode. MDD can manifest a wide range of impairments, from mild to severe. In severe episodes, individuals with MDD can have psychotic symptoms, characterized by the presence of delusions (false, irrational beliefs) and hallucinations. Another severe manifestation of MDD is the presence of catatonic features, where there is a severe change in motor movements and behavior (e.g., an individual may remain motionless, engage in bizarre postures, or become mute) (APA, 2013).
Sleep, sedation and coma
Ad (Sandy) Macleod, Ian Maddocks in The Psychiatry of Palliative Medicine, 2018
Fitful sleep occurs in the anxious. The restless legs syndrome (RLS) may affect 10% of those over 65 years. Precipitated by rest, and relieved by activity, the discomfort is often described as a crawling and tingling sensation in the calf or thigh. The most severe symptoms tend to occur between midnight and 1 am. ‘Jumpy’ legs responds well to dopaminergic agents; however, both opioids and benzodiazepines may help. In palliative care RLS is often serendipitously treated. The periodic limb movement syndrome (PLMS), a rapid stereotypic flexing of the legs associated with repeated awakenings from stage 2 sleep, may be associated with uraemia, neurological diseases, tricyclic antidepressants and stimulants. REM-sleep behaviour disorders (RSB) may occur in neurodegenerative disorders. Pontine damage results in a failure of skeletal muscle inhibition during sleep, so dreams are able to be enacted. The primary treatment is clonazepam, sometimes a medication regime already established. Palliative care patients are at risk of sleep-disordered breathing conditions. Obstructive sleep apnoea occurs more frequently with age and obesity (induced by corticosteroids). Snoring may be noted by others, daytime drowsiness is often the presenting symptom. Central-acting medications, including opioids,8 are likely to enhance the propensity of apnoea. Awaking hundreds of times during the night severely destroys the recuperative functions of sleep. Early morning awakening (terminal insomnia) may be habitual. It can also be a symptom of a major depressive episode.
Positive factors related to graduate student mental health
Published in Journal of American College Health, 2022
Susan T. Charles, Melissa M. Karnaze, Frances M. Leslie
Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale Revised (CESD-R27). The CESD-R asks participants to rate the extent to which they experienced each of 20 symptoms in the past several weeks on a scale ranging from 1 (Not at all or less than one day in the last week) to 5 (Nearly every day for 2 weeks). Symptoms were based on the Diagnostic and Statistical Manual of Mental Disorders (5th Edition) criteria for a major depressive episode, including feelings of sadness and guilt, loss of interest in activities, fatigue, poor sleep and appetite, and suicidal ideation. To ensure that scores were consistent with the previously validated and reliable CES-D cutoffs,31 the CESD-R scale from 1-5 was recoded to a 0-3 scale, with the two highest scores both recoded to 3, as recommended.27 Only people who responded to all questions were included. A total score of 16 or greater is the cutoff score indicative of, or being at risk for, clinical depression.31 The cutoff value for a severe depressive episode is ≥ 28. Summed scores ranged from 0 to 60 (M = 14.30, SD = 12.11; α = .95).
The Ongoing Mental Health Plight of Depressed College Students: Clinical Recommendations and the Importance of Early Screening and Detection
Published in Issues in Mental Health Nursing, 2023
Evan Schmiedehaus, Ethan Snyder, Jessica Perrotte, Rebecca Deason, Krista Howard, Millie Cordaro
As with traumatic stressor events, heightened concerns about the risk of viral infection and uncertainties about transmission quickly eroded mental health, leading to elevated symptoms of depression (Charles et al., 2021; Taylor, 2019). Major depressive episodes often manifest with symptoms of sadness, hopelessness, irritability, anhedonia (i.e. loss of pleasure in previously enjoyable activities) and lethargy (American Psychiatric Association, 2013). These feelings can be accompanied by a sense of low self-worth and self-esteem, substance abuse, and appetite or sleep disturbances (American Psychiatric Association, 2013; Lopez Molina et al., 2014). In fact, recent findings showed that a provisional diagnosis of MDD increased during the pandemic when compared to pre-pandemic averages, which were frequently accompanied with symptoms of sleep loss, worry over pandemic related uncertainties, and the onset of other maladaptive coping mechanisms including increased substance use (Uwadiale et al., 2022). Prior to the pandemic, MDD was estimated in the college student population, at a rate of 10.4% and ranged between 8 and 16% for lifetime prevalence (Hasin et al., 2018; Soria & Horgos, 2021). According to the Healthy Minds Study (HMS), findings indicated a high prevalence rate of MDD (39%) on university campuses. Generally, college students with depressive symptomology are experiencing significant deficits in functioning across all major life domains (e.g. academics, family and peer relationships, and work obligations).
Bio-psycho-social interaction: an enactive perspective
Published in International Review of Psychiatry, 2021
Recently I have been interviewing people who suffer from recurrent major depressive episodes. ‘John’ was one of them: a kind, clever man, 63 years old, who had just come to accept that he would not be holding a paid job anymore. He wanted to understand how these depressions that had, and still have, so much impact on his life had come about. He felt the strong need to make sense of his depressions – also in order to do as much a possible to prevent them from happening again. Was it down to genetics?, he wondered. Looking back, he concluded that his mother must have had depressive episodes herself, even though she was never diagnosed. Or was it his upbringing in an emotionally unsafe environment, with a largely absent father and an emotionally frail mother? As the eldest son he was expected to be tough, not show any feelings, and help out with his younger brothers and sisters. It was also clear that his depressive episodes typically coincided with feeling overburdened at work, by too much responsibility and too many tasks. Some of his personality traits probably did not help either, he thought, like his perfectionism, his tendency to feel responsible, and to prioritize helping others instead of recognizing his own needs. But then again, where did these personality traits come from? And what did it mean that some medication worked quite well for him?
Related Knowledge Centers
- Anxiety
- Appetite
- Attentional Control
- Insomnia
- Irritability
- Major Depressive Disorder
- Suicide
- Depression
- Emptiness
- Guilt