Abnormal Mood - Depressed Flashcards
At what age do mood disorders peak in prevalence?
From 2nd - 4th decade
The 50th percentile of mood disorders is at age 30. WHat does this mean?
50% of all mood disorders start before the age of 30
It is uncommon for the first episode of a mood disorder to present at age 60 or older. TRUE/FALSE?
TRUE
What do the terms euthymic, hyperthymic and cyclothymic mean?
Euthymic - normal mood
Hyperthymic - elevated mood
Cyclothymic - variable mood
What symptoms do “anhedonia” and “anergia” describe in mood disorders?
Anhedonia – loss of enjoyment/ pleasure
Anergia – lack of energy
What is meant by Diurnal variation of mood and how is this different to atypical depression?
Diurnal variation = Mood varies throughout the day
Depression = usually worse in the morning
Atypical Depression = gets progressively worse throughout the day
What is meant by the symptom of “early morning wakening”?
- waking at least 2 hours before the expected/ normal waking time
- struggle to get back to sleep
What is meant by “psychomotor retardation”
- subjective or objective
- slowing of thoughts and/ or movement
Stupor is almost an extreme form of psychomotor retardation. What does this mean the patient struggles to do?
- absence of relational functions, i.e. action and speech
- often cannot care for themself anymore
Patients with stupor usually benefit from what type of treatment?
Electro-convulsive therapy
How may patients with low mood/depression appear and behave in an MSE?
Reduced facial expression ‘furrowed’ eyebrows Reduced eye contact Limited gesturing – movements slowed (can be due to psychomotor retardation) Rapport difficult to establish
How may a patients speech in an MSE be affected by depression/ low mood?
- 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)
Describe the change in a persons thoughts when they have low mood/depression?
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)
Is perception affected in depressive disorders?
- 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
Is cognition usually affected in depressive disorders?
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
Is insight usually preserved in depressive disorders?
Yes - patient can acknowledge symptoms and condition
BUT they often blame themself for it
How are depressive disorders classified?
DSM-5 (American classification system)
ICD-10 (UK and Europe)
What are the main differences between the DSM classification system and the ICD classification system?
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
What are the main general criteria for a diagnosis of depression?
- 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)
What are the main 3 core features of depression?
Depressed Mood
Lack of enjoyment/pleasure
Lack of energy
(Mood, Enjoyment, Energy = MEE)
What additional features can occur in depressive disorders?
- 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
What scales can be used to rate depressive disorders, and when is this used?
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
What combination of symptoms distinguishes a moderate depressive episode from a severe depressive episode?
Moderate Depressive Episode
= Two core symptoms + four others (TOTAL = 6)
Severe depressive episode
= ALL 3 core symptoms + 5 others (TOTAL = 8)
Mild depression is generally self-limiting, and anti-depressants have little or no effect. TRUE/FALSE?
TRUE
Give examples of types of depressive disorder?
Atypical depression (increased sleeping and appetite) Psychotic depression (paranoid - think people are out to get them)
What is meant by “chronic” depression?
Depression persisting for over 2 years
How does unipolar depression affect cortisol levels in the body?
- 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
