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REFERAT

MDD VS. MDE


Oleh:
Mahar Matul Hilma
1102010155
Pembimbing:
Dr. Prasila Darwin, Sp.KJ

Kepaniteraan Klinik Ilmu Kesehatan Jiwa RSI Jiwa


Klender
Periode 7 September 10 Oktober 2015

Definisi
Depresi merupakan satu masa terganggunya
fungsi manusia yang berkaitan dengan alam
perasaan yang sedih dan gejala penyertanya,
termasuk perubahan pada pola tidur dan nafsu
makan, psikomotor, konsentrasi, anhedonia,
kelelahan, rasa putus asa dan tak berdaya, serta
gagasan bunuh diri (Kaplan et al., 2007)
Major
depressive
episodes
(MDEs)
are
characteristic of pure MDD (unipolar depression),
occur frequently in patients with bipolar disorder (
Angst et al., 2011)

Epidemiologi
Gangguan depresi berat, paling sering terjadi,
dengan prevalensi seumur hidup sekitar 15
persen. Perempuan dapat mencapai 25%. Sekitar
10% perawatan primer dan 15% dirawat di rumah
sakit. Pada anak sekolah didapatkan prevalensi
sekitar 2%. Pada usia remaja didapatkan
prevalensi 5% dari komunitas memiliki gangguan
depresif berat (Ismail et al., 2010)

Insidensi
1.
2.
3.
4.

Jenis Kelamin
Usia
Status Perkawinan
Sosialekonomi dan budaya

Sign and symptoms

Penurunan vitalitas umum


Variasi diurnal
Bunuh diri
Retardasi atau perlambatan bepikir
Perasaan bersalah
Halusinasi
Depersonalisasi dan derealisasi
Pikiran menyalahkan diri sendiri
Insomnia
Anoreksia

MDD vs MDE

MDD (DSM IV)


MDD SINGLE EPISODE
Presence of a single major
depressive episode.
The major depressive episode
is not better accounted for by
schizoaffective disorder and is
not superimposed on
schizophrenia,
schizophreniform disorder,
delusional disorder, or
psychotic disorder not
otherwise specified
There has never been a manic
episode, a mixed episode, or a
hypomanic episode

MDD RECURRENT
Presence of two or more major
depressive episodes (each
separated by at least 2 months
in which criteria are not met for
a major depressive episode.)
The major depressive episodes
are not better accounted for by
schizoaffective disorder and are
not superimposed on
schizophrenia, schizophreniform
disorder, delusional disorder, or
psychotic disorder not otherwise
specified.
There has never been a manic
episode, a mixed episode, or a
hypomanic episode

Tabel 3. DSM-IV-TR sub tipe dan spesifikasi MDD1,2,6


Sub tipe
Spesifikasi DSM-IV-TR
Depresi melankolis
Dengan
gambaran
melankolis

Kunci
Mood

nonreaktif,

anhedonia,

kehilangan

berat badan, rasa bersalah,


agitasi

dan

retardasi

psikomotorik, mood yang


memburuk

pada

pagi

hari, terbangun di pagi


Depresi atipikal

Dengan

gambaran

atipikal

buta
Mood

reaktif,

terlalu

banyak

tidur,

makan

berlebihan, paralisis yang


dibuat,
Depresi
(waham)

psikotik

Dengan
psikotik

gambaran

sensitive

pada

penolakan interpersonal
Halusinasi atau waham

Depresi katatonik

Dengan

gambaran

katatonik

Katalepsi,

katatonik,

negativism,

mutisme,

mannerism,

echolalia,

echopraxia (tidak lazim


pada klinis sehari-hari)

Depresi kronik

Gambaran kronis

2 tahun atau lebih dengan


kriteria MDD

Gangguan

afektif

Musiman

musiman

Onset yang seperti biasa


dan kambuh pada saat
musim tertentu (biasanya
musim gugur/dingin)

Depresi postpartum

Postpartum

Onset depresi selama 4


minggu postpartum

MDE (DSM IV)

At least five of the following symptoms have been present during the same 2-week
period and represent a change from previous functioning: at least one of the
symptoms is either 1) depressed mood or 2) loss of interest or pleasure.
1. Depressed mood most of the day, nearly every day, as indicated either by
subjective report (e.g., feels sad or empty) or observation made by others (e.g.,
appears tearful)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of
the day, nearly every day (as indicated either by subjective account or
observation made by others)
3. Significant weight loss when not dieting or weight gain (e.g., a change of more
than 5% of body weight in a month), or decrease or increase in appetite nearly
every day
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day (observable by others, not
merely subjective feelings of restlessness or being slowed down)
6. Fatigue 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 subjective account or as observed by others)
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt or specific plan for committing suicide

MDE (DSM IV)


The symptoms do not meet criteria for a mixed episode.
The symptoms cause clinically significant distress or
impairment in social, occupational, or other important
areas of functioning.
The symptoms are not due to the direct physiological
effects of a substance (e.g. a drug of abuse, a medication)
or a general medical condition (e.g., hypothyroidism).
The symptoms are not better accounted for by
bereavement, i.e., after the loss of a loved one, the
symptoms persist for longer than 2 months or are
characterized by marked functional impairment, morbid
preoccupation with worthlessness, suicidal ideation,
psychotic symptoms, or psychomotor retardation.

A major depressive episode also is generally not


diagnosed when the same symptoms could be
attributed toBereavement(normal feelings of
sadness after the loss of a loved one) (Grohol,
2013)

Daftar Pustaka
American Psychiatric Association. Practice Guideline for the Treatment of Patients
With Major Depressive Disorder (MDD). 3rd Edition. American Psychiatric
Association, 2010. Available at: http://
alerecares.com/pl/MultiSiteIncludes/PDF/pdfs/Depression%20Guideline%20Summ
ary%2003-11.pdf
. Accessed on Sept 17, 2015.
Angst J, Azorin JM, Bowden CL et al. Prevalence and Characteristics of
Undiagnosed Bipolar Disorders in Patients With a Major Depressive Episode, 2011.
Arch Gen Psy. Aug 2011;68(8): 791-9.
Grohol, JM. 2013. Major Depressive Episode Symptoms. Available at:
http://psychcentral.com/disorders/major-depressive-episode-symptoms/. Accessed
on Sept 17, 2015.
Ismail RI, Siste K. Gangguan depresi. Dalam : Elvira SD, Hadisukanto G. Buku Ajar
Psikiatri. Balai Penerbit Fakultas Kedokteran Universitas Indonesia. Jakarta;
2010.h.209 22.
Naudin M, Carl T, Surguladze S et al. Perceptive Biases in Major Depressive
Episode, 2014. Plos One. Feb 2014; 9(2): 1-8.
Sadock BJ, Sadock VA. Kaplan & Sadocks Synopsis of Psychiatry. Behavior
Sciences/Clinical Psychiatry. 10th ed. Lipincott Williams & Wilkins, 2007, p.527-30.