Senile depressive disorder

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First, the concept of what is the elderly depression?1, generalized depression in the elderlySenile depression in old age refers to the gene

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First, the concept of what is the elderly depression?

1, generalized depression in the elderly

Senile depression in old age refers to the generalized (usually greater than or equal to 60 years old) this particular group of depressive symptoms, including depression of senile onset, including old age before the onset of depression in old age to old age or recurrence, including all secondary depressive disorder. Old age;

2, the narrow sense of depression in the elderly

Senile depression is especially narrow onset senile primary depressive disorder, with persistent depressive mood as the main clinical manifestations, clinical features in the mood, anxiety, and physical discomfort. There are hysteresis. Mental disorders can not be attributed to physical disease or brain organic disease. The general course of disease is long, with the tendency of remission and relapse, some cases of poor prognosis, the development of refractory depression.

3, the characteristics of senile depression

The age of onset of unipolar depression was distributed in Shuangfeng, 50 years after the onset of another peak, in all patients over the age of 65, 2/3. The first onset of depression in older people is more than 40%-50%. Bipolar disorder is rare. The prevalence rate of depression in the elderly in Beijing was 12.89%, of which the male was 10.43% and the female was 16.89%.

Unipolar depression of senile and young adults have many differences, that senile depression may be a subtype of mood disorders, and suggested that named late onset depression.

The disease is one of the most common dysfunction in the elderly. However, there are few epidemiological studies on depression in the elderly. 7.59%-7.36% of the first year old cases. The total number of hospitalized patients accounted for 21%-54%.

As people live longer, the absolute number and proportion of elderly people with depression will increase. Depression has become one of the main problems that seriously affect the mental health of the elderly.

Another problem closely related to depression is suicide. The elderly Dutch act and attempted Dutch act the mortality rate was 4.8/10000 Dutch act in 39 countries, in the reporting WHO fourth, the rural elderly women Dutch act mortality is 3 times more than the city elderly women, rural elderly male mortality is 4 times the city Dutch act in elderly men. Because of the particularity of the elderly physical, psychological and social relationship, diagnosis of the depression of old than the young and middle-aged patients are more complex; on the other hand is the elderly often associated with somatic diseases and physiological condition is young change, treatment is much more complicated than in young patients.

Two. What are the causes and pathogenesis of senile depression?

So far, the etiology of mood disorders is unclear, involves many aspects of biological, social, psychological, and may be associated with genetic, premorbid personality characteristics, biochemical metabolism, neuroendocrine changes, brain anatomy and pathological changes and the social environment and life events and other psychological factors.

1, genetic factors

Both domestic and foreign studies have suggested that genetic factors play an important role in senile depression.

2, social psychological factors

On the one hand, the elderly tolerance to physical disease and mental frustration is declining; on the other hand, suffer all kinds of psychological stress opportunities are more and more, so the role of psychosocial factors in the pathogenesis of depression in the elderly is more outstanding. Such as colleagues and friends of the deceased spouse died, especially children to participate in the work and living with parents after marriage, changes in social status (such as retired, leg Hugh), economic difficulties (no economic aid), many factors can lead to disease or aggravate the elderly lonely, lonely, helpless and useless to be the cause, depressed mood and depression. The elderly in physiological aging and impaired ability of psychological defense and psychological adaptation, once encountered life events are more difficult to reconstruct the stability of the environment, if the lack of social support, psychological activities more difficult to maintain balance, which will promote depression, including various psychiatric disorders. Even ordinary life events can be pathogenic, which is of great significance in the elderly.

Social demographic data suggest that single, low educational level, less interest, no independent income and less social interaction are the high risk group of elderly depression.

3, premorbid personality traits

The process is often accompanied by personality changes in normal aging, such as introverted, withdrawn, passive, dependent, stubborn emotional instability, neuroticism and self-willed etc.. Elderly patients with depression have obvious personality defects, and compared with the normal elderly people have a prominent avoidant and dependent personality characteristics. The presence of somatic diseases in older adults can make these features more prominent.

4, biochemical metabolic abnormalities

Involving multiple neurotransmitter systems and biochemical basis of depression, which are surely the noradrenergic system and 5-HT system, but the specific mechanism is not clear, according to the research of senile depressive disorder. Mainly from the locus coeruleus, the globus pallidus, the shell, the prefrontal cortex of the 5 - HT2 receptor binding rate decreased, suggesting that the reduction of HT - or - 5 - HT2 receptor in the 5 - HT excess. The concentration of NE and 5 - HT decreased with age. Decreased DA levels in the brain are associated with aging.

5, anatomical and pathological changes

The incidence of degenerative brain disease in elderly patients with depressive disorder is higher than that in the general population, but it is still not sure the causal relationship with the disease and its exact effect on the course and prognosis of the disease. Senile depressive patients have a tendency to ventriculomegaly, late onset and ventricle enlargement of the 2 year mortality rate was significantly increased, suggesting that organic brain damage has a certain significance to the etiology of senile depression may. Brain tissue degeneration may be more important for the pathogenesis of late onset depression.

Three, clinical manifestations (after the disease have those clinical manifestations?)

1, clinical type

Generalized geriatric depression includes 3 clinical types:

(1), before the onset of senile depression in old age to old age or recurrence, or the general sense of depression in nature, but with the increase of the age of the patient, the clinical symptoms may be not typical;

(2), senile depressive disorder secondary to other diseases including various somatic diseases and caused by foreign matter (secondary depression), senile secondary depression, a part of the depression is often the primary clinical symptoms of the disease, generally do not have the characteristics of severe depressive symptoms, greater volatility, and close the original course primary disease, often with the change of the primary disease and change;

(3) the first episode of depression in the elderly, which is a group of elderly onset, and the cause of depression is not clear.

Considering the severity of depressive disorder and the duration of senile depression can be divided into severe depression (single depressive episode and recurrent depressive episodes of bipolar depression and severe depression) and dysthymia (neurotic depression) and mood disorders depressive phase.

2, mental symptoms

(1) the general clinical manifestations of depression can be manifested as depression, slow thinking, will activity and physical discomfort.

(2), symptomatic features of senile depression of senile depression clinical features are as follows: positive family history of neurological disease and less body disease accounted for more than a major, somatic complaints or discomfort, the concept of hypochondriasis more; the changes of body weight, wake up early, loss of libido, lack of energy. Because of the age factor is not prominent; the part of senile depression patients with irritable and hostile attack, as the main performance; significantly decreased the insomnia, loss of appetite, emotional vulnerability, emotional volatility; and often not a good expression of sadness; the concept of Dutch act disclosure are not clear, such as the patient may say "a shot to let me die!" , but denied that he had the idea of suicide. Generally speaking, the clinical manifestations of senile depressive disorder are often not typical, and the symptoms are more prominent in the clinical manifestations of depression.

2.1 patients with depressive disorder hypochondriacal symptoms over the age of 60 period, 65.7% male patients with hypochondria symptoms. The female patient was 62%, the symptoms of patients in the older group about 1/3 with depressive disorder for hypochondriasis. Therefore, some scholars have proposed the term "hypochondriasis depression". Hypochondria involves the digestive system, constipation, gastrointestinal discomfort is one of the most common symptoms of these patients are earlier. The patient often start with a less serious physical illness, and then worry about their condition will deteriorate, even with an incurable disease, although the explanation but still cannot explain, although the symptoms of depression, anxiety and increasingly improved, but grow with each passing day. Therefore, if the elderly on the normal physical function of excessive concern for mild disease over reaction, should take into account the possibility of depression in the elderly.

2.2 anxiety, depression and agitation of the elderly depression are often not very good expression, the use of "no fun, no spirit, psychological discomfort" and "boring, do not want to move" in the blues, unhappy, decreased interest, not with people, not to go out, do not participate in the activities, not love watching TV, listening to the radio, home to people or hate people, loneliness, want to lay a small number of patients, emotional indifference or slightly dull, often accompanied by obvious symptoms of anxiety, hostility and sometimes manifested as irritability, anxiety can sometimes completely conceal depression. The intense agitation. Agitated depression is most common in the elderly. Agitation is often more severe depression secondary symptoms may also become the main symptom of the patient. The clinical manifestations of anxiety and fear, all day worried about themselves and their families will suffer, the catastrophe, and anxious and breast, on tenterhooks, in a constant state of anxiety. Night insomnia or repeated memory past unpleasant things, blame yourself wrong, leading to family and other people's misfortune, no interest in all things in the environment. The light to tell their experience and chatter without stop "tragic circumstances", or torn clothes, hair pulling, writhing, anxiety, pessimism and despair on consciousness, depressed mood background images and unprovoked self denial, self evaluation decline, also often appear self blame, since the crime and pessimistic ideas, even strangulation, electric shock, in an attempt to Dutch act.

2.3 latent symptoms (somatization symptoms) many elderly people deny the presence of depressive symptomatology and performance for a variety of physical symptoms, emotional symptoms and family can easily be ignored, until the old man has found Dutch act attempts or behavior when they come to the psychiatric clinic. Some people with this depression as a symptom of depression are called "latent depression"". These symptoms can be expressed as: the digestive system symptoms such as anorexia, anorexia, abdominal distension, constipation or vague epigastric discomfort; the pain syndrome: such as headache, chest pain, back pain, abdominal pain and generalized pain; the symptoms such as palpitation, chest tightness and palpitation; the autonomic nervous system the symptoms such as flushing, fever, sweating, tremor, and general fatigue etc.. Among them, the organic background of headache and other parts of the pain the most common to find, general fatigue and sleep disorders are common symptoms. Ill find out the positive signs of patients should take into account the occult depression may have repeatedly complained of clinical body.

2.4 is the hysteresis depression behavior block, usually in the lack of voluntary movement and slow as the characteristic, it affects physical activity, and accompanied by facial expressions, reduce language block, patients feel mental retardation and attention drops, clinical manifestations, response slow thinking and initiative to reduce the difficulty of speech. The majority of elderly patients with depressive disorder for performance, stuffy not bend the brows and interest, thought of slow, often do not immediately answer questions, repeatedly asked to brief low verbal reply. The content of thought is poor, and the patient is mostly silent and slow in action. Severe binocular gaze, apathy, Speechless is strong, completely indifferent to the outside world. Depressive disorder behavior is consistent with slow psychological process.

2.5 delusions of late onset of depression patients with delusions symptoms, more than 60 years of age after the onset of depressive disorder patients than before the onset of the disease have more abundant delusions symptoms, think of depression is more common in the elderly. The age of onset later than single-phase delusional depression of old that non - delusional depressive disorder in elderly. In delusions, hypochondriacal delusions and nihilistic delusion is the most typical, followed by paranoia, delusions, paranoia and poor relationship between the delusion of sin. This kind of delusion is generally based on the mental state of the elderly, and their living environment and their attitude towards life.

2.6 people with dementia have been generally recognized that cognitive impairment is a common symptom in elderly patients with depressive disorder. About 80% of the patients complained of memory impairment, cognitive impairment obviously, similar dementia accounted for 10-15%, such as decreased computation, memory, understanding and judgment, after the inspection is pseudodementia. Some of them have dementia.

2.7 mild cases and suicidal behavior will decrease the enthusiasm and initiative, strong dependence, he hesitates; reduce the activity slightly heavier, avoidance of social interaction, slow, serious person can increase the time in bed; in no desire, no self-care in daily life. The risk of suicide in elderly patients with depression is much greater than that of other age groups. Suicide often occurs in patients with somatic disease, and the success rate is high (suicide rate 10%). The ratio of attempted suicide to suicide was 20 at the age of 40: after the age of 60, the number was about 4: 1. The main risk factors have led to Dutch act alone, guilt, hypochondriacal symptoms, agitation, persistent insomnia. Personality characteristics and cognitive level of depressive disorder are important factors to determine the risk of suicide, such as helplessness, hopelessness and negative attitude towards life often aggravate the risk of suicide. Have a chronic tendency for senile depression, depressive symptoms, some patients also unbearable torture, Dutch act has become more and more intense in order to escape the idea that Dutch act. Elderly depression once determined to commit suicide, often more resolute than the younger patients, behavior is more subtle.

2.8 other elderly depressive disorders may manifest as acute confusional state (consciousness) mood of light weight day and night rhythm is often used as a marker for diagnosis of endogenous depression, but the change of circadian rhythm in elderly patients with depressive mood is not obvious.

3, the form of attack, course of disease and prognosis (prognosis?)

(1) the form of onset and the onset of depression in the elderly also had a single episode and repeated episodes of the 2 forms.

(2), duration, onset is slow, compared with younger patients, senile depression longer course, the average seizure lasts for more than a year, was longer than patients with senile depression early onset, and frequent seizures, often turn into chronic disease. Patients with depression at the age of 31 to 50 years without the natural course of treatment was 9 ~ 18 months, and 50 years of age increased from 3 to 5 years.

(3) the prognosis, in general, the prognosis of senile depression is relatively poor, easy to relapse, senile first-episode depression can become chronic, even effective antidepressant treatment, the improvement rate is still low, the recurrence rate and mortality were higher.

Including the favorable prognostic factors of senile depressive disorder: (1), 70 years of age; (2), episode within 2 years; (3), early onset of recovery; (4), positive affective psychosis family history; (5), outgoing personality; (6), the typical symptoms of depression.

Including the adverse prognostic factors of senile depressive disorder: (1), cardiovascular and cerebrovascular diseases and other somatic comorbidity; (2), sleep disorders continued or residual; (3), with brain atrophy and brain changes; (4), history of repeated episodes and the curative effect is not good; (5) and the existence of delusions; (6), the age of onset of late; (7) before the disease exists bad personality basis; (8), lack of social support system.

Four, diagnosis and differential diagnosis (how to find is suffering from depression?)

It is best to look for a specialist in the mental health department in order to rule out other diseases.

Five, treatment (how to get depression treatment?)

1. Mild depression can be treated with psychotherapy, such as supportive psychotherapy, cognitive behavior therapy and family therapy.

2. Moderate depression can be treated with sleep deprivation therapy for the treatment of depression. In general, sleep deprivation therapy takes a longer time to develop, sometimes dramatically reducing depression symptoms within 24 hours. The specific method is to let the patient often awake during the day, night, stay up all night, the next day still keep awake, do not break, until the afternoon or at night, for a treatment. Deprived of one or two times weekly sleeping through the night, the middle interval of 2 ~ 3 days, symptoms improved gradually after the interval of time, a period of 8 to 10 times. Almost no secondary.

3, drug treatment because antipsychotic drugs are prescription drugs, many side effects need to be used under the guidance of a doctor. And under the guidance of doctors need to constantly adjust the dosage and observe the change of condition.

Finally, I wish the elderly friends healthy.

 

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