Depression and suicide

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โรคซึมเศร้าและการฆ่าตัวตาย

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<ul><li> 1. . </li></ul> <p> 2. Disability-Adjusted LifeYearsDeathBirth80 yr40 yr20 yr0 yrYear lost due topremature death :YLLYear lived with diability: YLDill 3. Year lived with disability : YLD(2003)male femaleRankDisease % YLD Disease % YLD1 Alcoholdependence19.8 Depression 12.72 Depression 8.6 Osteoarthritis 7.73 Schizophrenia 6.7 Cataracts 7.34 Deafness 6.6 Deafness 7.35 Anemia 5.3 Anemia 7.26 Osteoarthritis 5.0 Schizophrenia 7.17 Asthma 4.9 Anxietydisorder6.78 Diabetes 4.6 Diabetes 5.79 Cataracts 3.9 Dementia 5.310 COPD 3.7 Asthma 5.3 4. Disability-Adjusted Life Years : DAILY(2003)rankmale femaleDisease %DAILY Disease %DAILY1 HIV/AIDS 12.3 Stroke 7.72 Traffic accident 11.4 HIV/AIDS 7.53 Alcoholdependence6.2 Stroke 6.94 Stroke 5.7 Depression 4.95 CA Liver 5.6 CA Liver 3.66 Ischemic heart 3.4 Traffic accident 3.57 COPD 3.2 Ischemic heart 3.08 Diabetes 2.6 Osteoarthritis 3.09 Depression 2.5 COPD 2.910 cirrhosis 2.3 Cataract 2.8 5. Lifetime Prevalence Rates of Depressive DisordersType Life time prevalence(%)Major depressiveepisodeRange 5-17Average 12Dysthymic disorder Range 3-6Average 5Minor depressivedisorderRange 10Average -Recurrent briefdepressive disorderRange 16Average -Full unipolarspectrum20-25 6. 2 (lifetime prevalence) = 10-25% 5-12% 25-40 7. ..2546-2547 15-59 1.2 871,700 ( 2.4% 3.98%) (major depressivedi s3o2r1d,e3r0:M0 DD )( 0.77% 1.61%) (Dysthymic disorder) 8. 55-59 45-54 9. 10. 1. Abnormal metabolism of NT2. Neuro-endocrinedysregulation3. Neuro-immunedysregulation4. Genetic cause5. Brain pathology 11. 1. : 1.82. : , , , , , , 3. Life event: 11, , , , ,4. , 12. 13. 95.4 95.3 94.3 93.1 87.4 86 83.7 83.7 82.8 14. Major Depressive Disorder (MDD)(with psychotic features, with catatonic features,with melancholic features ,with atypical features,with postpartum onset ) Minor depressive disorder Mixed anxiety-depressive disorder (MADD) Dysthymic disorder Adjustment disorder with depressed mood 15. Premenstrual dysphoric disorder (PMDD) Seasonal affective disorder (SAD)Mood disorder due to a gen. med. con.(MDGMC)Substance-induced mood disorder (SIMD) 16. Major Depressive Disorder() (1) (2) (1) 17. (2) (3) (4) 18. (5) Psychomotor agitation Retardation (6) (7) 19. (8) (9) 20. DysthymicDisorderA. B. 2 21. 1. 2. 3. 4. self-esteem5. 6. 22. C. A B 2 23. (Adjustment Disorder) 3 24. (Coexisting Disorders) Anxiety Medical Conditions Alcohol Dependence Other Substance-Related Disorders 25. TWO QUESTIONSSCREENING1. 2 2. 2 26. PATIENT HEALTH2QUESTIONNAIRE : PHQ-91. 0 1 2 32. 0 1 2 33.0 1 2 34. 0 1 2 35.0 1 2 36. 0 1 2 37.0 1 2 3 27. ........................................................ 28. 2 1. 0 1 2 32. 0 1 2 33.0 1 2 34. 0 1 2 35. 0 1 2 36. 0 1 2 3 7. 0 1 2 38. 0 1 2 3 9.0 1 2 3 29. 2 1. 0 1 2 32. 0 1 2 33.0 1 2 34. 0 1 2 35. 0 1 2 36. 0 1 2 3 7. 0 1 2 38. 0 1 2 3 9.0 1 2 3 30. 2 1. 0 1 2 32. 0 1 2 33.0 1 2 34. 0 1 2 35. 0 1 2 36. 0 1 2 3 7. 0 1 2 38. 0 1 2 3 9.0 1 2 3 31. PHQ-91-4 19 Majordepression:severe 32. 33. 34. 1-2 35. Treatment : selective serotonin reuptakeinhibitors (SSRIs fluoxetine) tricyclic antidepressants (TCAs imipramine, amitriptyline) 60-80% 36. meta-analysis SSRIs TCAs lithium (ECT) 37. : 4-9 : 3 2 cognitive therapy interpersonal psychotherapy 38. 3 2 mood disorder 1 (20 ) 3 HHS Depression Guideline for Depression in Primary Care. 1993 39. , 20-30 2/3 , 1/3 MDD episode 1, 2, 3 50%, 70% 90% 40. SSUUIICCIIDDEEBBEEHHAAVVIIOORR 41. ((ssuuiicciiddaallbbeehhaavviioorr)) 11.. ((ssuuiicciiddaalliiddeeaattiioonn)) 22. ((ssuuiicciiddeeaatttteemmppttss)) ppaarraassuuiicciiddee 42. ddeelliibbeerraattee sseellff hhaarrmm 33.. ((ccoommpplleetteedd ssuuiicciiddee)) 43. 11 11 4400 55--1100 66 1100 33 1155--3355 44. 44,,550000--55,,000000 33,,000000--33,,880000 ((,, 22554466)) 2255,,000000--2277,,000000 (( ,, 22554466)) 45. 55..9966 11 2233..77 2211..99 2211..66(())1177..44 1100..55 46. 6666 3344 (( 3300--4400 )) (( 6600 )) 47. 8.27.77.1 6.96.45.75.9698765432102544 2545 2546 2547 2548 2549 25502544254525462547254825492550() 48. 18.04 17.98 161215.77181512.92 12.28 11.75 11.2610.16 10.03024681014202548 49. 17.7615.33 1412.1413.33 13.1510.95 10.89 10.21 9.48 9.20246810121618202549 50. 16.2613.5812.41 11.88 121011.07 10.7 10.669.83 9.8 9.63024681416182550 51. .12.4422.5141.6965.4213.79.3121.4916.5161.6148.830.0941.127060504030201002546 2547 2548 2549 2550 2551 52. 7060504030201002547 2548 2549 2550 2551 53. 50403020100&lt; 15 15-24 25-34 35-44 45-54 55-64 65 2548254925502551 54. 50403020100&lt; 15 15-24 25-34 35-44 45-54 55-64 65 254825492550 55. 255022.959.8 1.64 4.9229.516.568.211.48 56. 4504030201002546 2547 2548 2549 2550PsychosisDepressionAnxietyAlcoholicinduce psychicproblem 57. ((EEttiioollooggyy)) ((BBiioollooggiiccaall ffaaccttoorrss)) ((ccoonnccoorrddaannccee ccoommpplleettee ssuuiicciiddeerraattee)) sseerroottoonniinn (( CCSSFF 55--HHIIAAAA )) 58. ((PPssyycchhoollooggiiccaall ffaaccttoorrss)) ((rreeuunniioonn)),, ((rreebbiirrtthh)) ,,((rreettaalliiaattiioonnaabbaannddoonnmmeenntt)) ,, 59. ((SSoocciiaall ffaaccttoorrss)) ssttrreessssffuull eevveenntt)) 60. (( RRiisskk FFaaccttoorrss))11.. 9900 61. 11..11 2200--3355 62. 1.2 63. (( ppaarraaddooxxiiccaallssuu iicciiddee)) aaggiiaattiioonn 64. 33 5500 ((ssuubbssttaannccee aabbuussee)) 65. 66. 11..44 iimmppuullssiivviittyy)) BBoorrddeerrlliinnee ppeerrssoonnaalliittyyddiissoorrddeerrAAnnttiissoocciiaall ppeerrssoonnaalliittyy ddiissoorrddeerr 67. 22 22 ((ccoommoorrbbiiddiittyy)) 68. 66 69. psychopathology ppssyycchhoollooggiiccaall 70. 110000 1177 (( )) 3300 71. 72. 55.. 73. HHIIVV 74. 75. 1. 0 12. 0 23. 0 6() 084. 0 85. 0 96. 0 4 76. 1-8 9-16 17 77. 78. 79. 80. 81. 88.. 99.. 82. 11.. AAmmbbiivvaalleennccee22.. 33.. 83. 84. 11.. 85. ttrriiccyycclliicc 86. 22.. aakkaatthhiissiiaa bboorrddeerrlliinnee 87. EECCTTEECCTT 88. 89. SSAADDPPEERRSSOONN SSCCAALLEE SS SSeexx ((mmaallee)) AA AAggee ((eellddeerrllyy oorr aaddoolleesscceenntt &gt;4455)) DD DDeepprreessssiioonn PP PPrreevviioouuss ssuuiicciiddee aatttteemmppttss EE EEtthaannooll aabbuussee RR RRaattiioonnaall tthiinnkiinngg lloossss ((ppssyycchoossiiss)) SS SSoocciiaall ssuuppppoorrttss llaacckiinngg OO OOrrggaanniizzeedd ppllaann ttoo ccoommmmiitt ssuuiicciiddee NN NNoo ssppoouussee ((ddiivvoorrcceedd &gt;&gt; wwiiddoowweedd &gt;&gt; ssiinnggllee)) SS SSiiccknneessss ((pphyyssiiccaall iillllnneessss))Adapted from Patterson et al0 -3 close follow up consider admit, 4 -5 consider admit, &gt;5 admit 90. aallccoohhoolliicc ddeeppeennddeennccee,,ssuubbssttaannccee aabbuussee,, ddeepprreessssiivveenneeuurroossiiss 91. ((eessttaabblliisshhiinngg aa ccoonnttrraacctt)) 92. </p>

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