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Year 2 - BRS > 4.5 - Depression (tutorial) > Flashcards

4.5 - Depression (tutorial) Flashcards

1
Q

What are the three triads of depression?

A
  • core symptoms
  • biological symptoms
  • cognitive symptoms
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2
Q

What are the three core symptoms of depression?

A
  • low mood
  • anergia
  • anhedonia
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3
Q

What are the three biological symptoms of depression?

A
  • sleep
  • libido
  • appetite
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4
Q

What are the three cognitive symptoms/aspects of depression?

A
  • the world
  • oneself
  • the future
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5
Q

How long must symptoms be present for to diagnose depression?

A

Symptoms must be present for more days than not over a period of at least two weeks

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6
Q

What do we assess in a mental state examination?

A
  • appearance and behaviour
  • speech
  • mood/affect
  • thought (content and form)
  • perceptions
  • cognition
  • insight
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7
Q

What do we look out for in appearance and behaviour in depression? (6)

A
  • clothes
  • poor self-care e.g. greasy hair, smell
  • tearful
  • limited eye contact, looking down
  • usually no evidence of psychomotor agitation/retardation
  • normal movements
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8
Q

What do we look out for in speech in depression? (3)

A
  • quietly spoken
  • monotonous
  • normal/slightly reduced rate
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9
Q

What do we look out for in mood (objective) in depression? (3)

A
  • low in mood
  • flattened affect (reduced emotional range)
  • tearful
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10
Q

What do we look out for in mood (subjective) in depression? (6)

A
  • fed up, miserable
  • reduced energy and motivation
  • anhedonia
  • feels guilty and useless
  • poor concentration
  • biological symptoms - disturbed sleep, early morning waking, reduced appetite, reduced libido
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11
Q

What do we look out for in thought form in depression?

A

Thoughts are logically connected and easy to follow - no evidence of formal thought disorder

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12
Q

What do we look out for in thought content in depression?

A

Evidence of hopelessness (‘what is the point’, ‘everything seems black’)

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13
Q

What do we look out for in perceptions in depression? (2)

A
  • objective - not objectively responding to perceptual stimuli
  • subjective - no hallucinatory experiences reported
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14
Q

What do we look out for in cognition in depression?

A
  • not formally assessed using a validated measure (e.g. ACE-III)
  • cognition intact, oriented to time, place and person
  • no obvious confusional state
  • NB pseudodementia important differential to consider in older adults presenting with cognitive symptoms
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15
Q

What do we look out for in insight in depression?

A
  • reasonable in depression
  • consider insight in several domains - unwell? physical/psychiatric? treatment? risk to themself/others?
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16
Q

What are the key features to look for on mental state examination in depression? (5)

A
  • low mood
  • poor self-care (self neglect)
  • reduced eye contact
  • flattened affect
  • speech that is monotonous and lacking in prosody
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17
Q

When can depression present with a mood congruent psychosis?

A

E.g. delusions of nihilism guilt or Cotard’s syndrome

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18
Q

What makes up the psychiatric history - depression? (5)

A
  • history of presenting complaint
  • past psychiatric history
  • family history
  • treatment history
  • substance misuse
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19
Q

What do we ask about history of presenting complaint? (8)

A
  • insidious vs acute onset (i.e. due to life event)
  • core/cognitive/biological symptoms
  • current episode duration?
  • diurnal variation?
  • suicidal ideation/plans/intent?
  • thoughts/acts of self-harm?
  • exacerbating and relieving factors - are they taking meds and is it helping? psychological stressors/support?
  • relevant physical health conditions e.g. hypothyroidism, anaemia, Cushing’s, chronic pain
20
Q

What do we ask about past psychiatric history as part of psychiatric history (depression)? (7)

A
  • previous episodes? duration?
  • did previous episodes resolve with/without treatment?
  • history of any other mental illness? (important to rule out manic episodes)
  • previous admissions (informal vs under mental health act)
  • collateral history (important if patient guarded/poor historian)
  • medical notes if available
  • previous self harm/suicide attempts
21
Q

What do we ask about family history as part of psychiatric history (depression)? (3)

A
  • any mental illness/intellectual disability/neurodevelopmental diagnoses?
  • who e.g. first degree relative?
  • what are family relationships like?
22
Q

What do we ask about treatment history as part of psychiatric history (depression)? (7)

A
  • antidepressants?
  • antipsychotics?
  • mood stabilisers?
  • side effects?
  • ECT?
  • psychology?
  • ask: when? how long? what exact medication? doses? well tolerated? did it help?
23
Q

What do we ask about substance misuse as part of psychiatric history (depression)? (2)

A
  • cannabis/alcohol/cocaine/heroin (opiates)/hallucinogens?
  • used as self-medicating?
24
Q

What do we ask about forensic history as part of psychiatric history (depression)? (4)

A
  • offending as a youth (consider oppositional defiance disorder and conduct disorder), Youth Rehabilitation Orders
  • arrests/cautions/incarcerations/forensic mental health act admissions/probation involvement
  • include offences that were perpetrated but for which they were not caught
  • NB comorbid substance misuse is biggest risk factor for offending
25
Q

What do we ask about personal history as part of psychiatric history (depression)? (6)

A
  • birth and early developmental (antenatal/perinatal complications, developmental milestones)
  • schooling (academic performance, truancy at school, peer relationships/bullying)
  • higher/further education
  • employment
  • psychosexual history
  • premorbid personality
26
Q

How is the risk assessment for depression classified?

A
  • to self
  • to others
  • from others
27
Q

How can one pose a risk to oneself? (5)

A
  • current suicidal ideation/plans/intent
  • previous attempts (method/how many episodes/how did they feel when they survived)
  • self harm/cutting
  • self neglect/poor care of physical illness
  • risk of misadventure (accidental injury due to impulsive and disinhibited acts e.g. in mania)
28
Q

How does one pose a risk to others (depression)?

A
  • rarer in depression but still ask
  • thoughts/plans to harm others?
  • command hallucinations (general risk factor for violence)
  • relevant forensic history - arson, violent offending etc
29
Q

How are depression patients at risk from others?

A
  • vulnerability to exploitation
  • risk of retaliation from others (esp in manic states when overfamiliar, irritable, disinhibited)
30
Q

What are some differentials to consider when thinking about depression and mania? (6)

A
  • bipolar disorder vs unipolar depression
  • bipolar disorder vs borderline personality disorder/EUPD
  • depression vs psychotic prodrome
  • psychotic depression vs schizoaffective disorder (depressive type)
  • mania vs schizoaffective disorder (manic type)
  • mania vs ADHD
31
Q

Why aren’t antidepressants used for bipolar disorder?

A
  • appear to be mostly ineffective in acute bipolar depression and in prophylaxis
  • can cause acute manic/hypomanic episodes
  • have been shown to worsen the long-term course of bipolar illness in some subjects, especially those with a rapid-cycling course (>4 mood episodes in 12 months)
  • in rapid-cycling cases they appear to lead to more mood episodes, including depressive states
32
Q

What is a personality disorder?

A
  • maladaptive patterns of behaviour, cognition and inner experience, exhibited across many contexts and deviating from those accepted by the individual’s culture
  • these patterns develop early, are inflexible, and are associated with significant distress or disability
33
Q

How do the signs of personality disorder manifest?

A

As clusters (A, B, C), with each cluster containing different signs

34
Q

What signs of personality disorder are in cluster A? (3)

A
  • paranoid - pattern of irrational suspicion and mistrust of others
  • schizoid - lack of interest and detachment from social relationships, apathy, and restricted emotional expression
  • schizotypal - extreme discomfort interacting socially, and distorted cognition and perceptions
35
Q

What signs of personality disorder are in cluster B? (4)

A
  • antisocial - pervasive pattern of disregard for and violation of the rights of others, lack of empathy, bloated self-image, manipulative and impulsive behaviour
  • borderline - pervasive pattern of abrupt mood swings, instability in relationships, self-image, identity, behaviour and affect, often leading to self-harm and impulsivity
  • histrionic - pervasive pattern of attention-seeking behaviour and excessive emotions
  • narcissistic - pervasive pattern of grandiosity, need for admiration, and a perceived or real lack of empathy

Antisocial, borderline and narcissism make this hard to distinguish with bipolar affective disorder (BPAD)

36
Q

What signs of personality disorder are in cluster C? (3)

A
  • avoidant - pervasive feelings of social inhibition and inadequacy, extreme sensitivity to negative evaluation
  • dependent - pervasive psychological need to be cared for by other people
  • obsessive-compulsive personality disorder - rigid conformity to rules, perfectionism, and control to the point of satisfaction and exclusion of leisurely activities and friendships (distinct from OCD)
37
Q

What are the similarities between bipolar affective disorder (BPAD) and borderline personality disorder (BPD)?

A
  • rapid mood changes
  • unstable interpersonal relationships
  • impulsive sexual behaviour
  • suicidality
38
Q

What are the differences between bipolar affective disorder (BPAD) and borderline personality disorder (BPD)?

A
  • BPAD - episodic, genetic, grandiosity, mood states typically less affected by environment
  • BPD - mood changes over course of hours/days rather than days/weeks, poor self image, fear of abandonment, feeling of emptiness, history of self-harm, history of trauma/disrupted attachment
39
Q

What are the similarities between bipolar affective disorder (BPAD) and schizoaffective disorder?

A

Both can present with psychosis and mood symptoms (depression and mania)

40
Q

What are the differences between bipolar affective disorder (BPAD) and schizoaffective disorder?

A
  • BPAD - episodic delusions/hallucinations (rarely chronic)
  • schizoaffective disorder - episodic delusions/hallucinations (residual symptoms more likely); more prominent disorganisation of thought, paranoid delusional beliefs and auditory hallucinations
41
Q

What are the similarities between bipolar affective disorder (BPAD) and attention deficit hyperactivity disorder (ADHD)?

A
  • hyperactivity
  • impulsivity
  • impaired concentration
  • impairment of executive function
  • abnormal working and short term memory
42
Q

What are the differences between bipolar affective disorder (BPAD) and attention deficit hyperactivity disorder (ADHD)?

A

BPAD:

  • not necessarily present in childhood
  • episodic
  • family history (genetic)
  • recurrent depressive episodes
  • amphetamines worsen mania
43
Q

What are some organic/iatrogenic causes of depression? (5)

A
  • endocrine - hyper/hypothyroidism, hyper/hypoparathyroidism, hypoglycaemia, Cushing’s syndrome, Addison’s disease
  • systemic - viral infections, SLE, HIV, cancers (cytokines can cause depression)
  • deficiencies - vitamin B12, folic acid
  • neurological - MS, Alzheimer’s, Parkinson’s
  • medications - beta blockers, steroids, anti-Parkinson’s, some antibiotics (e.g. ciprofloxacin), statins, oestrogen, opiates, acne medications
44
Q

What are two types of depression caused by organic causes?

A
  • vascular depression (subcortical ischaemic depression)
  • poststroke depression
45
Q

What is vascular depression (subcortical ischaemic depression)?

A
  • associated with white matter hyperintensities
  • these can impact on cognitive function making the individual more vulnerable to stressors
  • important to treat vascular risk factors e.g. diabetes/hypertension and address smoking and alcohol use
46
Q

What is poststroke depression?

A
  • sometimes becomes persistent
  • retardation in thinking and behaviour is sometimes prominent
  • it has been reported that lesions in left frontal lobe or basal ganglia are able to cause depression
  • more frontal the lesion, more severe the symptoms

Year 2 - BRS (84 decks)

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