Book contents
- Frontmatter
- Contents
- Editor biographies
- List of contributors
- Preface
- Introduction
- Part I Medical management
- 1 Anesthesia management of the surgical patient
- 2 Nutrition
- 3 Preoperative testing
- 4 Chronic medications around the time of surgery
- 5 Ethical considerations in the surgical patient
- 6 Cardiovascular disease
- 7 Postoperative chest pain and shortness of breath
- 8 Perioperative management of hypertension
- 9 Perioperative pulmonary risk evaluation and management for non-cardiothoracic surgery
- 10 Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS)
- 11 Postoperative pulmonary complications
- 12 Peptic ulcer disease
- 13 Liver disease
- 14 Inflammatory bowel disease
- 15 Postoperative gastrointestinal complications
- 16 Disorders of red cells
- 17 Assessment of bleeding risk in the patient with no history of hemostatic problems
- 18 Surgical issues affecting patients with hemotologic malignancies
- 19 Prophylaxis for deep venous thrombosis and pulmonary embolism in surgery
- 20 Blood transfusion/preoperative considerations and complications
- 21 Prevention of surgical site infections
- 22 Medical care of the HIV-infected surgical patient
- 23 Fever and infection in the postoperative setting
- 24 Surgery in the patient with renal disease
- 25 Postoperative electrolyte disorders
- 26 Diabetes mellitus
- 27 Disorders of the thyroid
- 28 Disorders of the adrenal cortex
- 29 Disorders of calcium metabolism
- 30 Pheochromocytoma
- 31 Rheumatologic diseases
- 32 Cerebrovascular disease
- 33 Management of the surgical patient with dementia
- 34 Neuromuscular disorders
- 35 Perioperative management of patients with Parkinson's disease
- 36 Delirium in the surgical patient
- 37 Surgery in the elderly
- 38 Obesity
- 39 Depression
- 40 Substance abuse
- 41 Care of the peripartum patient
- Part II Surgical procedures and their complications
- Index
- References
39 - Depression
Published online by Cambridge University Press: 12 January 2010
Book contents
- Frontmatter
- Contents
- Editor biographies
- List of contributors
- Preface
- Introduction
- Part I Medical management
- 1 Anesthesia management of the surgical patient
- 2 Nutrition
- 3 Preoperative testing
- 4 Chronic medications around the time of surgery
- 5 Ethical considerations in the surgical patient
- 6 Cardiovascular disease
- 7 Postoperative chest pain and shortness of breath
- 8 Perioperative management of hypertension
- 9 Perioperative pulmonary risk evaluation and management for non-cardiothoracic surgery
- 10 Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS)
- 11 Postoperative pulmonary complications
- 12 Peptic ulcer disease
- 13 Liver disease
- 14 Inflammatory bowel disease
- 15 Postoperative gastrointestinal complications
- 16 Disorders of red cells
- 17 Assessment of bleeding risk in the patient with no history of hemostatic problems
- 18 Surgical issues affecting patients with hemotologic malignancies
- 19 Prophylaxis for deep venous thrombosis and pulmonary embolism in surgery
- 20 Blood transfusion/preoperative considerations and complications
- 21 Prevention of surgical site infections
- 22 Medical care of the HIV-infected surgical patient
- 23 Fever and infection in the postoperative setting
- 24 Surgery in the patient with renal disease
- 25 Postoperative electrolyte disorders
- 26 Diabetes mellitus
- 27 Disorders of the thyroid
- 28 Disorders of the adrenal cortex
- 29 Disorders of calcium metabolism
- 30 Pheochromocytoma
- 31 Rheumatologic diseases
- 32 Cerebrovascular disease
- 33 Management of the surgical patient with dementia
- 34 Neuromuscular disorders
- 35 Perioperative management of patients with Parkinson's disease
- 36 Delirium in the surgical patient
- 37 Surgery in the elderly
- 38 Obesity
- 39 Depression
- 40 Substance abuse
- 41 Care of the peripartum patient
- Part II Surgical procedures and their complications
- Index
- References
Summary
Depressive disorders are the most common psychiatric problem seen in medical–surgical patients. The point prevalence rate for depression is 10%–36% for general medical inpatients. The presence of depression has a significant effect on the patient's morbidity and mortality. Patients with depression following a myocardial infarction are 3.5 times more likely to die in the next 6 months than patients without depression.
The causes of depression in medically ill patients are multiple, including dealing with loss, helplessness, pain, lowered self-esteem, and financial and marital strain after illness. In many cases, depressive symptoms may result from the underlying physical illness or medications used in treatment.
Most depressive reactions in medical–surgical patients are relatively short, resolve after surgery, and do not cause major disturbances in social, occupational, interpersonal, physical, or psychological functioning. If depressive symptoms persist, they become major depression.
Major depression is characterized by a markedly depressed mood or loss of interest or pleasure in life (see Table 39.1). This depressed mood lasts longer than 2 weeks and causes significant disruptions in patient's occupational, social, and interpersonal functioning. Physical symptoms of depression can include sleep disturbances, appetite disturbance or weight change, fatigue, and physical feelings of being slowed down. Emotional symptoms can include disinterest, apathy, low self-esteem, hopelessness, helplessness, and guilt. Some patients will have suicidal thoughts or active plans for suicide. When severe, depression in the medically ill may give rise to psychotic symptoms, including paranoia, hallucinations, delusions (including somatic delusions of insect infestation), and obsessive–compulsive behavior.
- Type
- Chapter
- Information
- Medical Management of the Surgical PatientA Textbook of Perioperative Medicine, pp. 479 - 492Publisher: Cambridge University PressPrint publication year: 2006
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