Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Depressed

depressedDepressed: There are two ways to approach the diagnosis of depression in an injured worker.  Allow me to provide you with the long and more precise method followed in five areas.

Below this, I shall propose a very simple, brief and direct means of detecting the depressed patient?

SLEEP

  1. Difficulty falling asleep
  2. Difficulty staying asleep
  3. Early morning awakening
  4. Sleeping too much

APPETITE

  1. Decreased appetite with weight loss
  2. Increased appetite with weight gain

MOOD

  1. Feeling sad
  2. Feeling pessimistic
  3. Thinking about the concept of death
  4.         Feeling irritable and impatient
  5.         Feeling worthless
  6.         Feeling self-blame or self-critical

CONCENTRATION AND DECISION MAKING

  1. Forgetfulness
  2. Inattention
  3. Anxiety or agitation

DECREASED INTEREST

  1. Less interest in people
  2. Less interest in activities
  3. Less interest in hobbies or objects
  4. Less interest in intimate relations

However, you can also detect probable depression with the following five simple questions will indicate that you might want to consider that the patient is depressed and may require care:

  1. Has your appetite and eating changed?
  2. Has your sleep pattern changed?
  3. Do you find yourself forgetful?
  4. Are you feeling sad or guilty?
  5. Do you feel restless and impatient?
  6. These five questions can be applied to review of medical records as well.  For example:  “The patient is not following and does not appear to recall what he is told.  He is very short with me, suddenly tearful and then quite irritable. He seems fatigued, and we measured a 5% increase in weight in the past few months.”
  7. A nurse case manager could shorten this even further with the question:  “You seem very tense.  Are you eating and sleeping as you had before injuries?”

These brief methods do not confirm a diagnosis, but they do suggest that the possible diagnosis of depression should be pursued.

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