2 - PSY - Depression

Question 1

Core Sx of depression

Answer 1

low mood
loss of interest and enjoyment
reduced energy

Question 2

Additional symptoms of depression

Answer 2

reduced concentration
reduced confidence and self esteem
ideas of guilt and unworthiness
pessimism about the future
ideas/acts of self harm/suicide
disturbed sleep
changes in appetite

Question 3

symptoms of somatic syndrome

Answer 3

reduced appetite
wt loss
early morning wakening
diurnal variation in mood
psychomotor agitation/retardation
loss of libido
anhedonia
blunted affect

Question 4

Depression with psychosis - which hallucinations?

Answer 4

olfactory - filth/rotting flesh

2nd person auditory - accusing etc

Question 5

Depression with psychosis - delusions - 4 points

Answer 5

• mood congruency with (low mood)
• worthlessness/guilt/ill health/poverty/disaster
• nihilistic delusions
• persecutory delusions may occur

Question 6

Mild depressive episode criteria

Answer 6

2/3 core Sx
+additional Sx - totalling to 4 Sx
-w/w/o somatic syndrome

Question 7

Moderate depressive episode

Answer 7

2/3 core Sx
+additional Sx totalling to 6 Sx
-w/w/o somatic syndrome

Question 8

Severe depressive episode

Answer 8

3 core Sx

+additional Sx totalling to 8 Sx

Question 9

Severe depressive episode with psychotic symptoms

Answer 9

3 core Sx
+ additional Sx totalling to 8 Sx
+delusions/hallucinations/depressive stupor

Question 10

Epidemiology of depression:
m:f
lifetime prev
point prevalence

Answer 10

M:F = 1:2
lifetime prev = 10-20%
point prev = 5%

Question 11

Biological aetiology

Answer 11

genetics, hormonal changes, substance misuse, serious illness

Question 12

Psych aetiology

Answer 12

learned helplessness
negative thoughts
psychodynamic defence mechanisms

Question 13

social aetiology

Answer 13

life events
social isolation
bereavement
loss
childhood abuse
social adversity

Question 14

Bio Tx of depression

Answer 14

antidepressants 1st line SSRI
ECT for severe
Augmentation with Lithium/T3/atypical AP in treatment resistant depression

Question 15

Psych Tx of depression

Answer 15

psychoeducation
CBT
Interpersonal therapy
self help materials

Question 16

Social Tx of depression

Answer 16

carer support
support with regard to housing, benefits, education, training, employment
CPN and OP appntmts to monitor Sx, mood, mental state for severe depression
work around social inclusion

Question 17

Step 1 of management

Answer 17

assessment, monitoring, psychoeducation, CBT on computer, sleep hygiene, guided self help

Question 18

Step 2 of management (mild/mod)

Answer 18

primary care - low intensity psych interventions, -medication (SSRI)

Question 19

Step 3 of management (mod/severe)

Answer 19

primary care - medication, high intensity psych interventions, consider secondary care referral

Question 20

Step 4 of management (severe complex/severe self neglect)

Answer 20

Secondary care

• meds
• high intensity psych interventions
• ECT
• Crisis team
• MDT approach
• inpatient care

Question 21

preventing relapse - how long pharmacotherapy following recovery from single epsiode + recurrent depression?

Answer 21

6 months for single episode

2y for recurrent depression