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 mood2, diminished interest or pleasure3, significant weight loss, or decrease or increase

in appetite4, insomnia or hypersomnia5, psychomotor agitation or retardation6, fatigue or loss of energy7, feelings of worthlessness or excessive or

inappropriate guilt8, inability to think or concentrate9, 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, palpitation2, sweating3, trembling or shaking4, shortness of breath5, feeling of choking6, chest pain or discomfort7, nausea or abdominal distress8, feeling dizzy or lightheaded9, derealization (feelings of unreality) or depersonalization

(being detached from oneself)10, fear of losing control or going crazy11, fear of dying12, numbness or tingling sensation13, 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’

• 1st 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Unable to concentrate and focus• Lack of confidence, feeling of worthlessness• Feeling of hopelessness• Socially withdrawn and isolated• Complicated by involving in a ‘difficult’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• 2nd 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

• 1st - electrocution

• 2nd - tied a plastic bag over his head

• 3rd – 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 Depression is NOT a personality flaw or a sign of weaknesssign of weakness

• There is a 20% chance of developing into There is a 20% chance of developing into a clinical depression in one’s life timea clinical depression in one’s life time

• Depression is the most treatable mental Depression is the most treatable mental illnessillness

• 80% of depression will respond positively 80% of depression will respond positively to treatmentto treatment