Recently, the news of Qiao Renliang’s suicide due to depression swept through the circle of friends on Weibo and WeChat. News of stars committing suicide due to depression is common, and there are not a few ordinary people troubled by depression. According to WHO survey, there are at least 350 million depressed patients worldwide.
Depression patients do not only go to psychiatric departments, because many diseases may be accompanied by depression. How to quickly identify depression patients and their suicidal tendencies is especially important for medical workers.
The latest edition of the Diagnostic and Statistical Manual of Mental Illness (DSM) released in 2013, DSM-5, is a new weathervane for the classification and diagnosis of psychiatric diseases. Based on DSM-5, the author of this article teaches you how to quickly remember 9 diagnostic items of depression.
The symptoms of depression (major depressive disorder) can actually be summarized by an English word, namely Depression, in which each letter represents the following meanings:
D depression mood;
E energy determined fatigue or lack of energy;
P psychomotor changes;
R reduced concentration in decision-making;
Esteem decreased, excessive guilt self-esteem and excessive self-reproach;
S sleep changes;
Suicidal idea/behavior;
I interest decreased;
O
N nutritional and weight change 食欲和体重改变.
Is it very simple and clear? Let’s look at it letter by letter.
D depressive mood
Depression mood.
This can be either depressive or irritable (more likely to occur in children and adolescents).
Because some patients have alexithymia (alexithymia, a = unable, lex = using words, thymia = mood) and have obvious difficulties in correctly describing their emotional state, doctors need to repeatedly ask: sadness, depression, depression, sorrow, depression, and decreased interest. Switching to these words can triple the positive diagnosis of patients.
E lack of energy or fatigue
Energy determined.
For lack of energy or fatigue, it can be evaluated through the following two questions:
1. In the past 2 months, do you feel more tired or less energetic than before or at ordinary times?
2. (If Question 1 is no) Even if you do very little exercise, such as shopping, your body is more tired than you think?
P psychomotor changes
Psychomotor changes.
Psychomotor changes are psychomotor agitation and retardation, including 4 groups of symptoms. The 4 groups of symptoms of depression patients may occur in any combination.
Spiritual agitation: irritability and inner tension are exciting inner experiences.
Sports agitation: pacing, nervousness and sweating hands are manifestations of agitation.
Mental retardation: Slow feeling, slow thinking, slow emotional response and inability to think, which is the internal experience of slow mental activities or slow processing of emotional information.
Motion retardation: Obvious decrease in activity, slow walking, slow reaction speed, stunned or staring.
Since these four groups of symptoms are usually mixed, do not look for simple mental changes or motor changes. Ask each of the four groups of symptoms one by one before judging whether the patient is mental or motor, agitated or delayed.
R Attention Decreases When Making Decisions
Reduced concentration in decision-making.
The following 3 questions can evaluate the patient’s attention:
1. Can you sit and watch a movie? Can you remember the main plot of the story?
2. When you read a newspaper, can you read from the beginning to the end of the text? Can you understand the meaning of the words?
3. After a short break, can you continue with the original topic? Or did you forget the conversation just now?
The performance of children’s attention decline may be a sharp drop in performance. However, the performance of the elderly’s decreased attention may be memory difficulty, which needs to be distinguished from dementia.
E Low self-esteem, excessive self-guilt
Esteem decreased.excessiveguilt.Esteem decreased.Esteem decreased.excessiveguilt.
In addition to suicidal ideas, self-accusation and self-guilt are the most unpleasant and annoying symptoms of depression patients, and 85% of patients may exist. Even if they are not in the depressive episode, patients can still have a persistent sense of self-guilt. When depression breaks out, these feelings may become more intense.
Three Issues of Assessing Self-accusation and Self-Crime:
1.In the past 5 weeks, have you been more depressed or guilty than before?
2.In the past 5 weeks, have you been more depressed or guilty than before?
3. Have you lost confidence in yourself in the past 5 weeks?
Some patients believe that due to their current state, they cannot perform their roles and duties, disappointing relatives, friends or colleagues, which will undoubtedly increase their psychological burden.
In addition, it should be noted that the self-guilt of patients with severe depression can reach the level of delusion, so that patients think they are responsible for things unrelated to them.
Sleep too much or too little
Sleep changes.
Most patients with depression, whether they sleep too much or too little, will be depressed.
For depression patients with insomnia, the following inquiries can be made to judge the type of insomnia:
Initial insomnia (difficulty falling asleep): In the past few years, when you felt depressed, did you have difficulty falling asleep?
Midcourse insomnia (difficulty maintaining sleep or frequent awakening): Have you been able to sleep soundly in the past few years? Do you often wake up at night?
Terminal insomnia (wake up early and cannot continue to fall asleep after waking up): In the past few years, have you found that you woke up earlier than expected? Or do you think you should sleep a little longer, but you can’t sleep?
Suicidal ideation or behavior
Suicidal idea/behavior.
If it is determined that the patient has suicidal ideas or behaviors, the following 4 questions should be asked:
1. How long have you wanted to end your life? Do you think about suicide every day, or how many times a week? -Assess whether patients often consider suicide.
2.Have you ever planned a suicide? If there is no successful suicide, are there any other suicide plans? -Ask about the details of the suicide plan and alternative plans for suicide.
3.How is your suicide plan going? -Assessment process.
4. Is it difficult to resist these ideas when the will to commit suicide is getting stronger and stronger? -Ask the patient how to find this idea and the patient’s intention to act.
I Less interest or lack of pleasure
Interest determined.
The patient did not carry out a lot of physical activity, but still felt that it took a lot of effort to complete the tasks that required little physical activity.
N Changes in appetite and body weight
Nutritional and weight change.
Appetite change refers to loss or increase of appetite. Some patients may also prefer some specific foods, such as sweets. For children, a special group, weight change can refer to weight failure to meet the expected standard.
Special mention should be made of the fact that according to the diagnostic criteria of DSM-5, the diagnosis of depression (major depressive disorder) must meet 5 of the above 9 items, and one of D (depressive mood) and I (reduced interest or lack of pleasure) must be included. Symptoms must last for more than 2 weeks. And mental disorders caused by other reasons need to be eliminated.