EVOLVING MODALITIES AND COMPLICATIONS

 EVOLVING MODALITIES AND COMPLICATIONS   1.9.   Evolutionary modalities   Short-term development:   Not treated, depression progresses towards recovery in 4 to 12 months.   Under treatment, symptoms disappear more quickly.   There is a risk of relapse which is constituted by the reappearance of symptoms before recovery, that is to   say before 6 months.   Long-term evolution:   Several evolving possibilities   ●   Permanent disappearance of depression (isolated episode)   ●   Recurrenceseither exclusive of depressive episodes (disorderrecurrent depressive disorder)   (For a depressive disorder to be considered recurrent, there must be an interval   of at least two consecutive months between distinct episodes, during which the criteria for a   characterized depressive episode are not met)   ●   Recurrencesalternating with manic episodes( bipolar disorder).   ●   Evolution towards chronicity(15 to 20% of cases): depression persists beyond 2   years (resistance to treatment, somatic pathology, personality disorder, inadequate environment, presence of   associated disorders, etc.)   1.10.   Complications and signs of severity of a depressive state   ●   Suicide constitutes the most formidable complication of a depressive state. THE   risk factors are: personal or family suicidal history, gender   male,  ges  nts, elderly subjects), presence of  ly   (especially  anxious  or  delusional),  emotional  isolation  (widowhood,  divorce),  organic  illness  causing   despair and resistance to treatment (failure of two antidepressant treatments).   ●   Alcoholism and drug addiction   ●   Impact on operation and impairment of quality of life   ●   IN CHILDREN AND ADOLESCENTS:   -Conduct disorders   -Substance abuse   -School failure   -Suicide attempts especially among adolescents   -Risk of recurrence of depression in adolescence and adulthood   -Progression towards bipolar disorder 

 2.   PREDICTIVE FACTORS OF BIPOLARITY   The prediction of a bipolar evolution is mentioned in the presence of:   Factors inherent to current depressive symptomatology   ●   Hypersomnia and/or daytime sleepiness   ●   Overeating and/or weight gain   ●   Marked psychomotor slowing   ●   Marked psychological anxiety   ●   Psychotic features and or pathological guilt   ●   Labile mood and or manic symptoms (mixed features)