Abnormal Mood - Depressed

Question 1

At what age do mood disorders peak in prevalence?

Answer 1

From 2nd - 4th decade

Question 2

The 50th percentile of mood disorders is at age 30. WHat does this mean?

Answer 2

50% of all mood disorders start before the age of 30

Question 3

It is uncommon for the first episode of a mood disorder to present at age 60 or older. TRUE/FALSE?

Answer 3

TRUE

Question 4

What do the terms euthymic, hyperthymic and cyclothymic mean?

Answer 4

Euthymic - normal mood
Hyperthymic - elevated mood
Cyclothymic - variable mood

Question 5

What symptoms do “anhedonia” and “anergia” describe in mood disorders?

Answer 5

Anhedonia – loss of enjoyment/ pleasure

Anergia – lack of energy

Question 6

What is meant by Diurnal variation of mood and how is this different to atypical depression?

Answer 6

Diurnal variation = Mood varies throughout the day
Depression = usually worse in the morning
Atypical Depression = gets progressively worse throughout the day

Question 7

What is meant by the symptom of “early morning wakening”?

Answer 7

• waking at least 2 hours before the expected/ normal waking time
• struggle to get back to sleep

Question 8

What is meant by “psychomotor retardation”

Answer 8

• subjective or objective

- slowing of thoughts and/ or movement

Question 9

Stupor is almost an extreme form of psychomotor retardation. What does this mean the patient struggles to do?

Answer 9

• absence of relational functions, i.e. action and speech

- often cannot care for themself anymore

Question 10

Patients with stupor usually benefit from what type of treatment?

Answer 10

Electro-convulsive therapy

Question 11

How may patients with low mood/depression appear and behave in an MSE?

Answer 11

Reduced facial expression 
‘furrowed’ eyebrows
Reduced eye contact 
Limited gesturing – movements slowed (can be due to psychomotor retardation)
Rapport difficult to establish

Question 12

How may a patients speech in an MSE be affected by depression/ low mood?

Answer 12

• Reduced rate (slow)
• Low pitch
• Reduced volume (quiet)
• Reduced intonation (monotonous)
• Increased speech latencies (longer time between end of a question and them starting to speak)
• Limited content (answers are short/brief)

Question 13

Describe the change in a persons thoughts when they have low mood/depression?

Answer 13

Form = usually normal
Flow = slowed OR thoughts themself are absent

Content = usually guilt, self-accusatory
Can have delusions of guilt, poverty, nihilism (life is meaningless)

Question 14

Is perception affected in depressive disorders?

Answer 14

• Not usually affected
• Sometimes patients report self-referential thinking (“people are talking about me”)
• If hallucinations do occur, they are usually derogatory, second person, auditory hallucinations
• the voices usually represent depressive themes, e.g. guilt

Question 15

Is cognition usually affected in depressive disorders?

Answer 15

Pts claim their cognition is slowing and their memory is getting poor
HOWEVER the real problem is inattention when memories are trying to be registered.
Their mind is elsewhere => don’t remember as they didn’t form memory in the first place

Question 16

Is insight usually preserved in depressive disorders?

Answer 16

Yes - patient can acknowledge symptoms and condition

BUT they often blame themself for it

Question 17

How are depressive disorders classified?

Answer 17

DSM-5 (American classification system)

ICD-10 (UK and Europe)

Question 18

What are the main differences between the DSM classification system and the ICD classification system?

Answer 18

ICD separates bipolar and mania into different disorders

DSM separates Major Depressive and Persistent Depressive, whereas in the ICD these correspond to Depressive disorder and Dysthymia respectively

Question 19

What are the main general criteria for a diagnosis of depression?

Answer 19

• Abnormal for individual
• lasts 2 weeks
• interferes with normal function
• No hypomanic/manic symptoms at any point in life (or else this would make us consider Bipolar Disorder)

Question 20

What are the main 3 core features of depression?

Answer 20

Depressed Mood
Lack of enjoyment/pleasure
Lack of energy

(Mood, Enjoyment, Energy = MEE)

Question 21

What additional features can occur in depressive disorders?

Answer 21

• loss of confidence or self esteem
• unreasonable feelings of guilt
• recurrent thoughts of death/suicide,
• difficulty concentrating
• change in psychomotor activity => agitation or retardation
• sleep disturbance
• change in appetite

Question 22

What scales can be used to rate depressive disorders, and when is this used?

Answer 22

1) Hamilton Rating Scale for Depression
2) Montgomery-Asperg Depression Rating Scale
3) Beck Depression Inventory (BDI)

Important as ICD uses these scores to rate severity

Question 23

What combination of symptoms distinguishes a moderate depressive episode from a severe depressive episode?

Answer 23

Moderate Depressive Episode
= Two core symptoms + four others (TOTAL = 6)

Severe depressive episode
= ALL 3 core symptoms + 5 others (TOTAL = 8)

Question 24

Mild depression is generally self-limiting, and anti-depressants have little or no effect. TRUE/FALSE?

Answer 24

TRUE

Question 25

Give examples of types of depressive disorder?

Answer 25

Atypical depression (increased sleeping and appetite)
Psychotic depression (paranoid - think people are out to get them)

Question 26

What is meant by “chronic” depression?

Answer 26

Depression persisting for over 2 years

Question 27

How does unipolar depression affect cortisol levels in the body?

Answer 27

• Patients constantly in “fight or flight” response
• Depression causes high cortisol release with lack of negative feedback
  => Adrenal glands are increased in size, and there is increased excretion of cortisol in the urine
  => cortisol levels can often not be suppressed by dexamethasone