2. Depression is a state of intense sadness, low
mood characterized by negative thoughts, altered
behavior and lost sense of well-being,
Depression can be occur due to different life
events like chronic and serious illness, losing
any person in life, failures etc. The major group
of patients affected by this condition are of 20 -
40 years of age. Womens are more susceptible
for this disease. The depression can be remain
for several months to years. Depression can be
endogenous (due to biochemical changes in
body) or exontgenous (Sad events).
3. Depressed mood.
Reduced interest or pleasure in activities previously
enjoyed, loss of sexual desire.
Unintentional weight loss (without dieting) or low
appetite.
Insomnia (difficulty sleeping) or hypersomnia (excessive
sleeping).
Psychomotor agitation, for example, restlessness, pacing
up and down. Delayed psychomotor skills, for example,
slowed movement and speech.
Fatigue or loss of energy.
Feelings of worthlessness or guilt.
Impaired ability to think, concentrate, or make decisions.
Recurrent thoughts of death or suicide, or attempt at
suicide.
4. According to cause and symptoms depression can be categorized in following types.
i) Persistent depressive disorder
Persistent depressive disorder is a depressed mood that lasts for at least two years. A patient may
show the episodes of major depression in between period of less depressive symptoms.
ii) Postpartum depression
As the name indicates it's a depressive condition in women after childbirth. Women may feel the
major symptoms of depression during pregnancy or after child birth. The feelings of extreme sadness,
anxiety tiredness make it difficult for new mothers to complete daily care activities.
iii) Psychotic depression
Psychotic depression occurs when a patient shows major symptoms of depression some along
with psychosis, such delusions or hearing or watching upsetting things that are actually does not exist.
The psychotic symptoms typically have a depressive "theme," such as delusions of guilt, poverty, or
illness.
iv) Seasonal affective disorder
It is also called as Winter depression as this occurs during winter season only. The environmental
and physical changes (less natural light, weight gain etc) in body are the reason for such form of
depression. It is typically accompanied by social withdrawal, increased sleep, and weight gain,
predictably returns every year in seasonal affective disorder.
v) Bipolar disorder
In this condition, the bipolar disorders occur as a primary disorder which further causes the
depression of mood (showing major symptoms of depression). But a person with bipolar disorder also
experiences extreme high - euphoric or irritable - moods called "mania" or a less severe form called
"hypomania."
5. i. Life events
Some extremely bad memories of childhood (like physical abuse, mental abuse, unequal parental treatment)contribute to
depression in adulthood. Childhood physical or sexual abuse has major correlation with development of depression in
adult age.
ii. Gender identity and sexuality
People who are marginalized due to either their gender identity or sexual orientation are more prone to depression.
iii. Medical treatments
Some medicines taken for treatments are also can be the cause of depression. Such medicines include beta blockers,
isotretinoin, contraceptives, anticonvulsants, antimigraine drugs, anti-psychotics and hormonal agents such as
gonadotropinreleasing hormone agonist.
iv. Drug abuse
Several drugs of abuse can cause or increase the depression, whether in intoxication, withdrawal, and from chronic use.
These include alcohol, sedatives, opioids, stimulants, hallucinogens, and inhalants.
v. Non-psychiatric illnesses
Depression can be occur due to some major illness. The chronic form of illnesses are generally a major cause of depression.
It can be occur due to number of infectious diseases, nutritional deficiencies, neurological conditions and physiological
problems, including hypoandrogenism (in men), Addison's disease, Cushing's syndrome, hypothyroidism, multiple
sclerosis, Parkinson disease, chronic pain, stroke, diabetes, and cancer.
vi. Personality
The personality and thoughts of individual also plays important role in the development of depression. The persons having
negative thinking, negative speech, less confidence are easily get depressed.
vii. Hormonal changes and biochemical factors
The hormonal changes are closely associated with the behavioral changes. These hormonal changes are more observed in
case of females therefore females are more prone to develop this condition. Altered secretion of some
neurotransmitters like 5 HT, noradrenaline, dopamine can also increase the risk of depression.
6. The complications of depression includes
following conditions:
Sexual abnormalities (due to disease as well as its
medications).
Sleeping problems.
Serotonine syndrome.
Withdrawal symptoms of medication. Suicidal
tendancy.
9. A stroke is a medical condition in which
poor blood flow to the brain results in
cell death. There are two main types of
stroke: ischemic, due to lack of blood
flow, and hemorrhagic, due to bleeding.
A stroke occurs when the blood supply to
part of your brain is interrupted or
reduced, depriving brain tissue of oxygen
and nutrients.
10. i) Speaking
Person may experience confusion. There may be a slurring of
speech occur or he may feel difficulty in understanding the speech.
ii) Paralytic occurrences
Patient may feel numbness, weakness or paralysis of facial
muscles, arm or leg. This generally affects only one side of body. This
can be identified by observation that one side of your mouth may
droop when you try to smile.
iii) Visual effects
Patient may suddenly have blurred or blackened vision in one
or both eyes.
iv) Headache
A sudden, severe headache, which may be accompanied by
vomiting, dizziness or altered consciousness, may indicate that person
is having a stroke.
Actually the signs and symptoms of the stroke depend on the
part of brain which is damaged due to stroke.
11. If the brain stem is damaged (brain stem stroke) the symptoms
will be like:
Problems in sensation of smell, taste, hearing, or vision.
Drooping of eyelid and weakness of ocular muscles.
Facial muscle weakness.
Problems with maintaining a posture.
Altered breathing and heart rate.
If cerebral cortex is affected the prominent symptoms will be:
Aphasia (difficulty with verbal expression, auditory comprehension,
reading and writing).
Altered voluntary movements.
Visual field defect.
Memory deficits (temporal lobe).
Disorganized thinking, confusion, hypersexual gestures (frontal
lobe).
If the cerebellum is involved, ataxia might be present and this
includes:
Changed pattern of walking.
Less coordination during movements.
Vertigo and or disequilibrium.
12. Ischemic stroke occurs due to decrease in blood supply to part of the brain, initiating the
ischemic cascade. Brain tissues get injured after 60 - 90 seconds of ischemia or less oxygen
supply. Within 3 hours of ischemia brain tissues injured irreversibly (leads to death of
tissue). Atherosclerosis reduces the diameter of blood vessels by forming plaque which
reduces blood supply to the brain.
Due to above mentioned events the blood and oxygen (energy) to the brain decreases.
Therefore to get more energy brain cells undergoes anaerobic energy generation. Anaerobic
metabolism produces less adenosine triphosphate (ATP) but releases a by product called
lactic acid. Lactic acid is an irritant which could potentially destroy cells since it is an acid
and disrupts the normal acid-base balance in the brain.
As oxygen or glucose level decreases the production of high energy phosphate compounds
such as adenosine triphosphate (ATP) fails, leading to failure of energy dependent processes
important for tissue cell survival.
The excessive release of glutamate in extracellular space acts on glutamate receptors or
NMDA receptors. These receptors now promote the influx of calcium. This calcium can lead
to the failure of mitochondria, which can lead further toward energy depletion and may
trigger cell death due to programmed cell death.
Ischemia also induces production of oxygen free radicals and other reactive oxygen species.
These react with and damage a number of cellular and extracellular elements.
These processes are the same for any type of ischemic tissue and are referred to collectively
as the ischemic cascade. However, brain tissue is especially vulnerable to ischemia since it
has little respiratory reserve and is completely dependent on aerobic metabolism.
13. A) Ischemia (Ischemic stroke)
Ischemic strokes occur due to narrowing or blocking
of arteries. About 80 percent of strokes are ischemic
strokes. The most common ischemic strokes include:
i. Thrombus formation (Thrombotic stroke)
A thrombotic stroke means blood supply to the brain
decreases due to formation of clot or thrombus in the artery
which supplies blood to the brain. These clots are made up
of blood itself or of fatty materials.
ii. Presence of emboli (Embolic stroke)
An embolic stroke occurs when a blood clot or other
material originate or form at part of body other than brain
and it reaches to the arteries supplying blood to brain
results in reduction in blood suppply.
14. B) Hemorrhage (Hemorrhagic stroke)
Hemorrhagic stroke occurs when a blood vessel in your brain leaks or
ruptures. Brain haemorrhages can result from many conditions that affect
your blood vessels. These include:
High blood pressure.
Over dose of anticoagulants.
Weak spots in your blood vessel walls (aneurysms).
A less common cause of hemorrhage is the rupture of an abnormal tangle of
thin-walled blood vessels.
Types of hemorrhagic stroke include:
Intracerebral haemorrhage
In an intracerebral haemorrhage, a blood vessel in the cerebrum bursts
and spills into the surrounding brain tissue, damaging brain cells. High blood
pressure, trauma, vascular malformations, use of blood-thinning medications
etc. can cause an intracerebral haemorrhage.
Subarachnoid haemorrhage
In a subarachnoid haemorrhage, an artery on or near the surface of your
brain bursts and spills into the space between the surface of your brain and
your skull. This bleeding is often signalled by a sudden, severe headache.
A subarachnoid haemorrhage is caused by the bursting of a small sack-
shaped or berry shaped aneurysm.
