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Office Psychiatry and the Primary Care Physician, Part I
Kenneth D. Cohen, MD, is clinical professor of psychiatry at the University of Pennsylvania Medical School, and training and supervising analyst at Philadelphia's Center for Psychoanalysis. Here, he discusses mood disorders and depression, antidepressant medications, and the importance of the doctor-patient relationship in treatment. Dr. Cohen defines depression as a disease of the mind, brain, and body. Depression is often difficult to recognize and may be missed up to 50% of the time because, unlike other disorders, the diagnosis is based on listening and watching for subtle speech and body signals in the absence of physiologic abnormalities.The best approach is the structured interview format which is 88% accurate and can be downloaded from the lecture site. He describes the signs and symptoms of mood disorders in hypothetical patients, noting three categories – bereavement, major depression, and adjustment reactions, which are, respectively, transient, persistent, and intermittent in duration, and are common in primary practice. Symptoms of major depressive disorder may include guilt and thoughts of suicide, while dysthymic disorder consists, says the author, using three case histories, of "feeling blue off and on." Depressive mood disorders may present with an opposite reaction – bipolar mania, and major depression with psychotic features may be accompanied by delusion and hallucination. The lecture concludes with a discussion of the difficulty of diagnosing depression in the elderly, the frequency and characteristics of depression in women, and the relationship of mood disorders to concomitant medical problems such as cancer particularly, but also to stroke and Alzheimer's disease. The lecture is extensively illustrated and includes a section on antidepressant medications. |
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