Cp.99 Atypical Presentations Of Depression In Primary Health Care

Author(s): 
V. Peritogiannis1, C. Lixouriotis2, A. Pappas1, S. Zafiris1, D. Rizos3
1 Department of Psychiatry, University Hospital of Ioannina, Ioannina, Greece
2 General Hospital of Elefsina “Thriasio”, General Practitioner, Athens, Greece
3 Intensive Care Unit, General Hospital of Ioannina, Ioannina, Greece
Text: 
Introduction.
Depressed patients often seek help in primary-care settings. However, it is known that almost half the cases go unrecognised by primary-care physicians, despite their adequate training. The main reason is that atypical presentations of depressive syndromes are common.
Method:
Review of the literature through Medline and Cochrane library.
Results.
Many depressed patients are unable to express depressed mood(masked depression). Instead, they may present to general practitioners with prominent somatic symptoms. In some cases, anxiety and irritability may be the main symptoms. It is important the primary health doctor to inquire for a possible underlying depressive disorder in cases of pain syndromes and alcohol abuse. The later is often used by depressed patients in an effort to elevate their mood. Depressed children and adolescents are more likely to perform atypical presentations of depression. Their mood may be irritable and their behaviour may characterized by anger and hostility, or their school performance may be reduced. Masked depression is common in the elderly. They may appear to be severe retarded or agitated. Cognitive impairment is a usual symptom in cases of late-life depression (depressive pseudodementia) and should be differentiated from dementia. It is common an old person to perform somatization and hypochondriac complaints than describe low mood.
Conclusion.
Primary care physicians should be aware of all these atypical presentations of depression, and be able to recognize and treat depressive syndromes. They also should bear in mind that depression may be due to a general medical condition or to prescribing medication.
Literature: 
CP.99 ATYPICAL PRESENTATIONS OF DEPRESSION IN PRIMARY HEALTH CARE