Depression in General Medicine

In recent years, the concept of depression as a condition occurring mainly in psychiatry has been revised. This problem becomes one of the central and general medical practice. In foreign and domestic literature, considerable attention is paid to the diagnosis and therapy of depressive disorders occurring on the background of somatic pathology.

Among those who applied for medical help, patients with manifestations of depression are quite common. These patients often do not realize that they suffer from depression and go to doctors with complaints that make it difficult to assess their condition M. Rendon (1991), examining patients in urban hospitals in New York, in 65% of cases showed signs of depression, and in 30% of patients depression was mild, in 24% – moderately, in 10% – significantly.

According to other authors, depression is recorded in approximately 10% of all patients seeking medical care (Katon W., Sulliven M., 1990; Ustun V., Sartorius N., 1995; Berkow R., Fletcher E., 1997). There is an increase in the share of depressions in general medicine. Thus, among patients with somatic practice in 1973, 7% of patients suffering from depression were registered, and in 1982 – already 17% (Kielholz P., 1982).

By the beginning of the 90s in developed foreign countries (Sweden, Spain, USA, Australia, Japan) the frequency of depressions in somatic hospital patients who applied for specialized psychiatric care corresponded to 20-29% (Ruskin P., 1985; Pauser H. et al., 1987; AI Ansan E. et al., 1990, Hatton T et al., 1990; BertoloL. et al., 1996).

According to research O.P. Vertogradova (1997), anxiety-depressive disorders are detected in 68% of patients who come to the district clinic. According to estimates by a number of domestic scientists, the proportion of depressions in patients with a somatic hospital is 22–33%. The results of the examination of patients in the therapeutic area of ​​Moscow showed that typical depressions were detected in 13.4% of cases, of which 15% were bipolar depressions, and in 64.1% a pronounced depressive episode.

Depressed patients account for 17.4% of the elderly and old people who come to the clinic. In the study of patients in the psychiatric cabinet of one of the territorial polyclinics, the proportion of depressive disorders was 38.2%, of which with a depressive episode of mild severity – 28.1%, moderate – 18.9% and severe – 9.2%, respectively. The remaining 10.1% of cases were chronic depressions within the framework of cyclotymy. As a result of the clinical and epidemiological examination of the patients of the territorial polyclinic who applied to the local physician, A.B. Smulevich et al. (1999) it was found that depressive disorders occur in 21.5% of cases.

According to the results of a clinical and epidemiological examination of patients at a large multi-field hospital, 20.5% of patients suffer from depression. Unlike the outpatient population, psychogenic depressions are the most common (59.3% of all variants of depression). A part of depressive disorders appeared to be represented by “nosogenic depressions” (45%), reactive depressions were detected in 14.3% of cases.

According to the results of research presented by N.A. Kornetov (1999), for 30 patients who applied to general practitioners, there are 2-3 patients with “major” depression and 7-8 with any of its symptoms. According to the author, 10% of regular visitors of the clinic are patients suffering from depression, from 24 to 46% of inpatients with somatic pathology have a disorder of the depressive spectrum. The author notes that 3-4% of people over 65 suffer from depression, in nursing homes this condition is detected in 15-25% of cases.

Depression can occur due to diseases of various internal organs, toxic effects, medication. In these cases, it is usually combined with anxiety and irritability. It has become generally accepted to consider that depression is a frequent disorder that occurs in many chronic diseases of internal organs and, as a rule, occurs in their severe course. A general practitioner, communicating with his patient, should remember to ask the latter about the feelings he has experienced in recent months, especially paying attention to depressed mood, reduced interest in life and the disappearance of pleasure from those things and activities that in the past gave this feeling.

local_offerevent_note March 6, 2019

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