Dr. Ahmad AlHadi

68 Pages·2014·5.75 MB·English

Dr.
 Ahmad
 AlHadi

Assistant
 Professor,
 Consultant
 of
 Psychiatry
 and
 Psychotherapy

Department
 of
 Psychiatry,
 College
 of
 Medicine

King
 Saud
 University

Riyadh,
 Saudi
 Arabia
Agenda

•  IntroducCon

•  Depression

•  CBT

•  CBT
 for
 Depression

•  Behavioral
 acCvaCon

•  Summary
 &
 feedback
Needs
 Assessment

•  What
 do
 you
 want
 from
 this
 workshop

(CBT
 for
 Depression)?
Objec0ves:

•  AMendants
 of
 this
 workshop
 will:

1.  Know
 the
 basic
 concept
 of
 CBT.

2.  Know
 the
 CBT
 techniques.

3.  Learn
 how
 CBT
 can
 be
 used
 in
 treatment
 of

Depression.
Why
 Depression?

•  The
 2nd
 leading
 cause
 for
 disability
 now

•  The
 1st
 in
 2020

•  Chronic

•  Common
Exercise

•  Write
 down
 as
 much
 as
 you
 can
 of
 Depression

symptoms
 and
 signs
 in
 one
 minute.
Major
 Depressive
 Disorder

DSM5
 Diagnos0c
 Criteria

A.
 Five
 (or
 more)of
 the
 following
 symptoms
 have
 been
 present
 during
 the

same
 2-­‐week
 period
 and
 represent
 a
 change
 from
 previous
 func0oning:
 at

least
 one
 of
 the
 symptoms
 is
 either
 (1)
 depressed
 mood
 or
 (2)
 loss
 of

interest
 or
 pleasure.
 Note:
 Do
 not
 include
 symptoms
 that
 are
 clearly

aNributable
 to
 another
 medical
 condi0on.

1.  Depressed
 mood
 most
 of
 the
 day,
 nearly
 every
 day,
 as
 indicated
 by

either
 subjec0ve
 report
 (e.g.,
 feels
 sad,
 empty,
 hopeless)
 or

observa0on
 made
 by
 others
 (e.g.,
 appears
 tearful).
 (Note:
 In
 children

and
 adolescents,
 can
 be
 irritable
 mood.)

2.  Markedly
 diminished
 interest
 or
 pleasure
 in
 all,
 or
 almost
 all,
 ac0vi0es

most
 of
 the
 day,
 nearly
 every
 day
 (as
 indicated
 by
 either
 subjec0ve

account
 or
 observa0on).

3.  Significant
 weight
 loss
 when
 not
 die0ng
 or
 weight
 gain
 (e.g.,
 a
 change

of
 more
 than
 5%
 of
 body
 weight
 in
 a
 month),
 or
 decrease
 or
 increase
 in

appe0te
 nearly
 every
 day.
 (Note:
 In
 children,
 consider
 failure
 to
 make

expected
 weight
 gain.)

4.  Insomnia
 or
 hypersomnia
 nearly
 every
 day.
Major
 Depressive
 Disorder

DSM5
 Diagnos0c
 Criteria

5.  Psychomotor
 agita0on
 or
 retarda0on
 nearly
 every
 day
 (observable
 by
 others,

not
 merely
 subjec0ve
 feelings
 of
 restlessness
 or
 being
 slowed
 down).

6.  Fa0gue
 or
 loss
 of
 energy
 nearly
 every
 day.

7.  Feelings
 of
 worthlessness
 or
 excessive
 or
 inappropriate
 guilt
 (which
 may
 be

delusional)
 nearly
 every
 day
 (not
 merely
 self-­‐reproach
 or
 guilt
 about
 being

sick).

8.  Diminished
 ability
 to
 think
 or
 concentrate,
 or
 indecisiveness,
 nearly
 every
 day

(either
 by
 subjec0ve
 account
 or
 as
 observed
 by
 others).

9.  Recurrent
 thoughts
 of
 death
 (not
 just
 fear
 of
 dying),
 recurrent
 suicidal
 idea0on

with-­‐
 out
 a
 specific
 plan,
 or
 a
 suicide
 aNempt
 or
 a
 specific
 plan
 for
 commi[ng

suicide.

B.
 The
 symptoms
 cause
 clinically
 significant
 distress
 or
 impairment
 in
 social,

occupa0onal,
 or
 other
 important
 areas
 of
 func0oning.

C.
 The
 episode
 is
 not
 aNributable
 to
 the
 physiological
 effects
 of
 a
 substance
 or
 to

another
 medical
 condi0on.
Major
 Depressive
 Disorder

DSM5
 Diagnos0c
 Criteria

Note:
 Criteria
 A-­‐C
 represent
 a
 major
 depressive
 episode.

D.
 The
 occurrence
 of
 the
 major
 depressive
 episode
 is
 not

beMer
 explained
 by
 schizoaffecCve
 disorder,
 schizophrenia,

schizophreniform
 disorder,
 delusional
 disorder,
 or
 other

specified
 and
 unspecified
 schizophrenia
 spectrum
 and
 other

psychoCc
 disorders.

E.
 There
 has
 never
 been
 a
 manic
 episode
 or
 a
 hypomanic

episode.
 Note:
 This
 exclusion
 does
 not
 apply
 if
 all
 of
 the

manic-­‐like
 or
 hypomanic-­‐like
 episodes
 are
 substance-­‐induced

or
 are
 aMributable
 to
 the
 physiological
 effects
 of
 another

medical
 condiCon.
Diagnosis

•  one
 or
 more
 Major
 Depressive
 Episode
.

DSM-­‐IV-­‐TR
 diagnosCc
 criteria:

A.  At
 least
 5
 of
 the
 following,
 during
 the
 same
 2-­‐week
 period,
 represenCng

a
 change
 from
 previous
 funcConing;
 must
 include
 either
 (a)
 or
 (b):

1.  Depressed
 mood

2.  Diminished
 interest
 or
 pleasure

3.  Significant
 weight
 loss
 or
 gain
 (AppeCte)

4.  Insomnia
 or
 hypersomnia
 (sleep)

5.  Psychomotor
 agitaCon
 or
 retardaCon
 (acCvity)

6.  FaCgue
 or
 loss
 of
 energy

7.  Feelings
 of
 worthlessness
 (guilt)

8.  Diminished
 ability
 to
 think
 or
 concentrate;
 indecisiveness

9.  Recurrent
 thoughts
 of
 death,
 suicidal
 ideaCon,
 suicide
 aMempt,
 or
 specific

plan
 for
 suicide