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4001 > 8 The social and psychological bases of depression and suicide > Flashcards

8 The social and psychological bases of depression and suicide Flashcards

1
Q

How many people suffer form dperession globally?

A

300 million

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2
Q

Examples of affective disorders

A
  1. Major depression
    - unipolar depression
  2. Dysthymia
    - persisten subthreshold depressive symtpoms that have lasted for at least 2 years
  3. Bipolar disorder
    - aka manic-depressive illness
    - characterised by severe highs (mania) and lows (depression)
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3
Q

Major depression referes to a wide range of issues characterised by?

A
  1. Loss of interest and enjoymeny in ordinary things and expereicnes and low energy
  2. Emotional, cognitive, physical, and behavioural symtpoms
  3. Low/ depressed mood
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4
Q

What should assessents for depression include?

A
  • number and severity of symptoms
  • duration of current episode
  • course of illness
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5
Q

Key symptoms of depression? (NICE guidelines CG90)

A
  1. Persistent sadness or low mood
  2. Marked loss of interest or pleasure

-at least one of these, most days, most of the time for at least 2 weeks

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6
Q

If any of the key symptoms of depression are present, ask about associated symptoms. What are they? (NICE guidelines CG90)

A
  1. Disturbed sleep (decreased or increased compared to usual)
  2. Decreased or increased appetite and/ or weight
  3. Fatigue or loss of energy
  4. Agitation or slowing of movements
  5. Poor concentration or indecisiveness
  6. Feelings of worthlessness or excessive or inappropriate guilt
  7. Suicidal thoughts or acts
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7
Q

Definition of anhedonia?

A

loss of interest or pleasure in hobbies and activites that were once enjoyed

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8
Q

Emotional symptoms of depression?

A
  1. Anhedonia
  2. persistent sandess or low mood, unresponsiveness to circumstances
  3. irritability, tearfulness
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9
Q

Cognitive symptoms of depression?

A
  1. Negative view of the self:
    - lowered self-esteem and self-confidence
    - feelings of guilt and worthlessness
    - feelings of hopelessness and helplessness
    - pessimistic and recurrently negative thoughts about oneself, world, and future (negative cognitive triad)
  2. Poor concentration and reduced attention, difficulty making decisions
  3. Mental slowing or rumination
  4. Suicidal ideation may be present
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10
Q

BIological/ behavioural symptoms of depression?

A
  1. Lowered appetite, wieght loss/gain
  2. Insomia, early-morning awakening, feeling worse in the morning
  3. Low energy, fatigue
  4. Loss of libido
  5. Social withdrawal
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11
Q

RIsk factors for depression?

A
  1. Genetic and family factors
  2. Early life experiences
  3. Stressful life events
  4. Social support
  5. Gender
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12
Q

What is the increased risk for major depression in 1st degree relatives of individuals with major dperession vs. general population?

A

3-fold increase

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13
Q

Early life experiences as risk factor for depression?

A
  1. Poor parent-child relationship
  2. Marital discord and divorce
  3. Neglect
  4. Physical and sexual abuse
  5. Early childhood loss
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14
Q

Stressful life events as risk factor for depression?

A
  1. failure at work, school, loss of a job
  2. Marital seperation
  3. Rejection by a loved one
  4. Death of a child
  5. Illness of a family member
  6. Physical illness
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15
Q

Social support as risk factor for depression?

A
  • availabilty of good-quality support from friends and family offer protection to the individual in dealing wih stressors
  • lack of intimate or confiding relationship can increase risk of depression
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16
Q

Depression and gender?

A

-more common in women (2:1)

  • women may express and report symptoms more than men
  • hormones
  • early life stress e.g. sexual abuse
  • additional stresses e.g. responsibilities both at home and work, single parenthood, caring for children and aging parents
17
Q

Depression and chronic illness?

A
  • depression 2-3 times more common in patients with a chronic physical health problem than healty people
  • 20% of people with chronic helath problem suffer
18
Q

How is depression linked to chronic illness?

A
  • adapting unhealthy behaviours (e.g. smoking, bad diet, lack of exercise, poorer sleep, alcohol and substance abuse)
  • not adhering to medical regiments
  • direct effects on physioogical mechanisms
19
Q

Treatment options for depression

A
  1. Pharmacological treatments
  2. Physiological treatments
  3. Physical activity (mild and moderate depression or persistent subthreshold depressive symptoms)
  4. Electoconvulsive treatment (for severe and complex depression)
  5. Stepped care model
20
Q

Pharmacological treatment for depression?

A

Antidepressants

21
Q

Low-intensity psychosocial interventions?

A
  • individual guided self-help base on the principles of cognitive behavioural therapy (CBT)
  • computerised cognitive behavioural therapy (CCBT)
  • strucutres group physical activity programme
22
Q

What is cognitive behavioural therapy (CBT)?

A
  • short-term psychological treatment
  • emphasises the role of thinking in how we feel and what we do
  • indentifying and challenging unhealthy modes of thinking that cause depressed feelings and behaviour
23
Q

Psycholoigcal interventions for relapse prevention?

A
  1. Individual CBT
    - for people who have relasped despite antidepressant medication
    - for people with a significatn history of depression and residual symptoms despite treatment
  2. Mindfullness-based cognitive therapy
    - for people who are currently well but have experiences 3 or more previous episodes of depression
24
Q

Suicidal behaviour?

A
  • 804,000 deaths in 2012
  • High income countries: 3 times as many men die
  • Low/middle income countries: 1.5 men to women
  • Highest rates in 70 or older
  • 2nd leading cause of death in 15-29 year olds
25
Q

Health system and suicide?

A
  • health care access, access to means to suicide, media reporting
  • stigma against seeking healp for suicidal beh/ mental health issues/ substance abuse
26
Q

Community/ relationships and suicde?

A
  • war/ disaster

- discrimination; isolation; abuse/ violence

27
Q

Indiviudal factors and suicide?

A
  • previous suicide attempts
  • etnal disorders
  • harmful use of alcohol
  • financial loss
  • chronic pain
  • family hx of suicide
28
Q

What to do when a patient is assessed to be a suicidal risk?

A
  1. Additional support - more frequent direct contacts with primary care staff or telephone contacts
  2. Inquire about social support and awareness of sources of help
  3. Referral to specialists

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