WPA Educational Programme on Depressive Disorders

Volume One: Fundamentals

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Patients with moderate depressive episode:

• May also have considerable difficulty maintaining personal and vocational roles functions;

• Some symptoms may be quite severe but on the whole fewer in number and less intense than severe episodes.

• Must fulfill general criteria for a depressive episode, have two of three typical symptoms and have four additional symptoms as outlined in ICD-10 Classification of Mental Disorders.

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Epidemiologic Findings:

• Several large epidemiological studies have been conducted.

• One of the earliest by National Institute of Mental Health (NIMH) Epidemiologic Catchment Area (ECA) found:– 9.5% of the US population over 18 years of age was afflicted by a

mood disorder in any one year period (Regier et al. 1993)

• More recent studies in other population groups, using similar ascertainment tools have provided additional results.– Lifetime prevalence approaches 17-18%

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Impact of Depressive Illnesses

• Impact of depression on society is well-documented (Desjarlais et al. 1995)

• The Global Burden of Disease study found depression was the fourth most burdensome of all medical conditions throughout the world in 1990;

• And predicted it would rise to second by 2020 (Murray and Lopez 1996)

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Impact of Depressive Illnesses

• Disability Adjusted Life Years (DALY) is a metric, introduced in 1998 by the Harvard School of Public Health in collaboration with the World Bank and World Health organization.

• DALY represents the sum of years of life lost due to premature mortality (YLL) in the population and years lost due to disability for incident cases of the health condition.

• Neurospsychiatric disorders accounted for about 28% of total DALYs lost due to non-communicable diseases in 2005.

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The Three Phases of Treatmentfor Depression

• Depressive disorders are often recurrent.• Therefore, treatment is generally viewed in three phases:

acute, continuation, and maintenance (or prophylaxis) phases.

• Demarcations between the different phases is often somewhat blurred.

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