SYMPT OM PRESENT AT IONS OF MAJOR DEPR ESSIVE DISOR DER Jhunu - PDF document

Bangladesh Journal of Psychiatry, December, 1995, 8, 2,14 SYMPT OM PRESENT AT IONS OF MAJOR DEPR ESSIVE DISOR DER Jhunu Shamsu n N ahar1 , M SI M ullick2, G u lshan A ra M aliha3 Summary Fifty two patients suffering from major depressive disorder (M DD) were included in this stu dy in order to determine and assess the presentations of major depressive disorder in our culture. Diagnosis was made on the basis of D S M - IV criteria for M DD Somatic sym ptom s are almost a constant feature among patients with depressive disorder. Out of 52 patients 41 (78.85%) patients were found to have associated significant somatic symptoms. Burning all over the body, heat in the head, headache, bodyache and gastrointestinal sym ptom s w ere the common associated somatic presentations. Agitation (16 cases) were more than retardation (13 cases). A good member of patients were house­ wives (44.23%). Introduction M ost psychiatrists w ho work in a general Th e ob jective o f the stu dy is to determine and hospital psychiatric unit are referred from assess the presentations o f sym ptom s of Major general physicians and su rgeons patients w ho D epressive D isorder in our culture. com plain of severe and chronic physical sym ptom s for which no organic cau se can b e Materials and methods fou nd1 ,2 . M any o f them are suffering from depressive disorder which is a com m on Th e stu dy w as carried ou t on 52 patients psychiatric problem. In our culture many collected over a period o f seven months from patients presents with com plaints that are not b oth the in - p a tien ts and ou t- pa tien t enlisted in D S M - IV criteria for M ajor depressive departm ent o f the p sych ia try o f Institute of D isorder3 . O n e stu dy reported that a large P os t- G ra d u a te M edicin e and Research, Dhaka. number o f patients presenting with som atic com plaints may b e su ffering from depression4. A s em i- s tru ctu red qu estionnaire w as designed to interview the patients. Inform ations were N o n - s p ecific medical entities has b een fou nd collected from the patients and their relatives. often to b e a ffective or an xiety syndrom e in Releva n t S ociod em ogra p h ic inform ations and disguise. inform ations relating to d ep ress ive disorder and a ccom pa n yin g s om a tic fea tu res w ere carefully 1 Assistant Professor (c.c.) noted. o Assistant Professor Th e diagn osis o f depressive disorder w as based 3 Medical Officer Department of Psychiatry, IPGM&R on D S M - IV d ia gn ostic criteria for Major

Symptom Presentations of Major D epressive Disorder Bangladesh Journal of Psychiatry, December, 1995, 8, 2,15 patients w ere from 19 yrs to 60 yrs with mean D epressive D isorder. Th e data w ere presented in age 39.69 years. Tw enty seven patients w ere tabu lation form and statistical analysis was fem ale and 25 patients w ere male and the male done where required. fem ale ratio w as - 1:1.08. Tw enty three (44.23% ) patients ou t o f 52 w ere hou sew ives Results: (Tab le N o. 1). A m on g the 52 patients under stu dy 41 patients Tab le No. 2 show s the D S M - IV criteria for w ere fou nd to have associated som atic M ajor D epressive D isorder (M D D ). A ll the the sym ptom s (Tab le No. 3a). This finding is patients fulfilled the D S M - IV criteria for MD D . Agitation was more (16 ca ses) than retardation Table No. I: Socio-demographic characteristics of the (13 cases). Tab le N o. 3b show s the a ssocia ted patients % % C haracteristics N o. Cha racteristics N o. A ge O ccu pation House wife 23 44.23 15- 24 4 7.70 Business 5 9.60 2 5 - 3 4 14 26.92 Service 14 26.92 3 5 - 4 4 16 30.76 Retired 3 5.76 4 5 - 5 4 13 25.00 Unemployed 2 3.85 5 5 - 6 4 5 9.62 Cultivator 2 3.85 Mean = 39.69 (SD = 1L02) yrs Student 3 .76 Range = 1 9 - 6 0 yrs S ex Edu cation Illiterate 10 19.23 48.08 Male 25 Primary 11 21.15 51.92 Female 27 Secondary 4 7.70 M a le: Female = 1:1.08 S.S.C 5 9.62 H.S.C 11 21.15 Graduate 8 15.38 M arital status Post-gradu ate 3 5.76 9 17.30 Unmarried 75.00 Married 39 S ocia l b ackgrou nd 2 33.85 Separated Urban 35 67.31 17 32.69 Rural 2 3.85 Divorced

Bangladesh Journal of Psychiatry, D ecember, 1995, 8, 2,16 Symptom Presentations of Major D epressive Disorder Table No. I I : D S M - IV criteria for D epressive present among the patients. (M ore than one symptom was p r e s e n t ) ___________ _____ _______ N o. o f Patients Symptoms _________ 49 a. D epressed mood 49 h Loss of interest and pleasure 9 c. W eight loss (no weight gain was reported) 46 d. L Insomnia 2 ii. Hypersomnia 16 i. Psychomotor agiatation 13 it Psychomotor retardation 41 f. Fatigue or loss of energy 38 Feeling of worthlessness and guilt 9 - h. Diminished ability to think 46 concentrate or indecisiveness 32 i Recurrent thoughts of death or recurrent suicidal ideation suicide attempt specific plan for committing suicide Table N o. I l l : Patients with associated somatic symptoms. Table N o. Ilia Somatic symptoms N q of Patients % 41 Yes 78.85 N o 11 21.15 Total 52 100.00 X2 = 1 7 .3 1 , df= l,P<0.001 Table No. IHb Somatic symptoms N q of patients 3 2. Buring all over the body and heat in head 16 3. Headahe 15 4. Gas in Abdomen 8 5. Bowel disturbance 6 6. Pain all over the body 8 7 . Abdominal pain 2 8. White discharge with urine 4 9. Sound in ear 3 (More than one symptom was presenfj

Symptom Presentations of Major D epressive D isorder Bangladesh Journal of Psychiatry, D ecember, 1995, 8, 2,17 patients with depressive disorder. Th is finding is Table No. I V : Treatment received by the patients consistent with the findings o f a n oth er stu dy N q of patients Drugs done in our culture b y Karim and M u llick4. Imipramine 20 18 Fluoxetine O u t o f 52 patients 23 patients w ere hou sew ife. Amitriptyline 11 Th is number is qu ite b ig and this is consistent Thioridozine 9 with the fact that the w om en popu lation withou t fu ll- tim e or p a r t- tim e em ploym en t (Some of the patients received more than one drug). ou tside hom e are m ore vu lnerab le to depression7 . Th e com m on presentaing som a tic som atic sym ptom s. B u rning all over the body, featu res w ere bu rning all over the b ody, heat in heat in the head, headache, b odya ch e and the head, headache, b od ya ch e and ga s tro- in tes tin a l sym p tom s w ere the com m on gastrointestinal distu rb ances. Four patients a ssociated som a tic sym ptom s. com plaining of w hite discharge w ith urine met the criteria of major depressive disorder. Th is Th e patients w ere trea ted with Imipramine, finding is consistent with the findings o f another Flu oxetine, Am itriptylin e and Thioridazin e stu dy where 38.79% patients having w h ite (Tab le N o. 4) discharge with urine w ere su ffering from Discussion depression8. It is know n that depression is tw ice as com m on Fifty tw o patients su ffering from depressive in w om en than men and fem ale patients u su ally disorder collected over a period o f seven months com plain more som atic sym ptom s than male. In from b oth the in - p a tien t and ou t- p a tien t our stu dy male fem a le ratio is 1:1.08. Th is is departm ent o f the psychiatry unit o f Institu te of m ost prob ab ly due to the fa ct that fem a les are P os t- g ra d u a te M edicine and Research, D haka m ore neglected grou p in ou r cou ntry and u su ally w ere inclu ded in the present study. O u t of 52 avoid hospital or seek treatm ent du e to variou s patients 41 patients w ere fou nd to have cultural factors. Psych om otor a gita tion w a s a ss ocia ted som a tic su m ptom s (w hich is highly slightly m ore than p sych om otor retardation. significant) like buring sensations, heat in the Actu ally in ou r culture a m on g depressed head, headache, b od y ache and gastrointestinal patients agitation is m ore than retardation. sym ptom s. A large proportion o f patients w h o Patients w ere treated with imipramine, consu lts physicians w ith som a tic sym ptom s are su ffering from depressive illness3 ,4 ,5 . O ften Flu oxetine, Am itriptylin e and Thioridazin e. W e know that thioridazine is very effective in patients d o not m ention ab ou t their depressive m ood to doctors. S evera l fa ctors are thought to agitated depressed patien ts6 bu t w e cou ld not prescrib e it su fficiently b ecu a se o f its high price. influ ence this presentation. O n e m ore im portant N in e patients ou t o f 16 a gita ted depressed stigm a is that m entally ill patients b elief that received thioridazine therapy. d octors are m ore interested in physical than p sych ologica l com pla in ts6. A p p rop ria te diagnosis is im porta n t b eca u se the b odily C o n clu s io n sym ptom s are com m on ly u sed as reason for com ing to the doctor. It m ay b e said on the b asis o f the present stu dy that cu ltu re can influ ence the exp erien ce and Th e present stu dy findings reveal that som a tic com m u nication o f sym p tom s o f depression. sym ptom s are a lm os t a con s ta n t featu re a m on g