Abnormal mood: Depression

Question 1

Give definitions of the following:

• Anhedonia
• Anergia
• Amotivation
• Diurnal variation
• Early morning wakening
• Psychomotor retardation
• stupor
• Euthymia

Answer 1

• loss of enjoyment
• lack of energy
• lack of motivation
• mood varies over day
• waking at least 2 hours before expected time
• subjective or objective slowing of thoughts/movement
• the absence of relational functions
• normal mood

Question 2

Presentation of depression?

• Appearance & behaviour?
• Speech?
• mood & affect?
• thought?
• perception?
• cognition?
• insight?

Answer 2

-reduced fail expression
brow furrowed
Reduced eye contact
limited gesturing
rapport hard to establish

-reduced rate
lowered pitch
reduced vol, ie. quiet 
monotonous
increased speech latencies 
limited content 

-mood= subjective, will be low, unhappy, flat, empty, black
affect= objective, depressed, reduced range, limited reactivity 

-From- normal
Flow- slow, might be absent
Content- negative, guilt, low self esteem, pessimism
delusions can occur (guilt, poverty, nihilism)
maybe paranoia (self conscious, sensitive to criticism

-hallucinations: almost always auditory
usually second person and derogatory

-cognition slow with complaints of poor memory
pseudo dementia

-preserved, people are aware of symptoms but might attribute to personal failings

Question 3

Give the 6 forms of depression in ICD10?

Answer 3

Mild depressive episode Moderate depressive episode
Severe depressive episode without psychotic symptoms
Severe depressive episode with psychotic symptoms
Other depressive episodes
Depressive episode, unspecified

Question 4

General criteria

• last for how long?
• what must not be present?
• what core features must be present?
• What additional symptoms might be present?
• how is severity assessed?
• moderate depression?
• severe depression?
• mild?

Answer 4

• at least 2 weeks
• no hypomanic or manic symptoms or episodes at any point in life

-at last 2 of:
depressed mood
loss of interest or pleasure
decreased energy

-need to have a total of at least 4:
loss of confidence
unreasonable/excessive guilt
recurrent thought of death/suicide, suicidal behaviour 
reduced concentration

psychomotor retardation/agitation
sleep disturbance
change in appetite

• rating scales or ICD10
• at least 2 core symptoms and a total of 6 with additional symptoms
• 3 core symptoms and a total of 8 with additional symptoms
• resolves by itself normally

Question 5

What are the 3 syndrome subtypes of depression?

Answer 5

Somatic syndrome

Atypical depression

psychotic depression

Question 6

Somatic syndrome

-features? (8)

Answer 6

Four of the following symptoms should be present :
1. marked loss of interest or pleasure in activities that are
normally pleasurable
2. lack of emotional reactions to events or activities that normally produce an emotional response
3. waking in the morning 2 hours or more before the usual time
4. depression worse in the morning
5. objective evidence of marked psychomotor retardation or agitation (remarked on or reported by other people)
6. marked loss of appetite
7. weight loss (5 % or more of body weight in the past month)
8. marked loss of libido

Question 7

Atypical depression

-features? (5)

Answer 7

Mood reactivity

B, 2 or more of the following:
weight gain or inc appetite
Hypersomnia
leaden paralysis 
long-standing pattern of interpersonal rejection sensitivity- social or occupational impairment

Question 8

Psychotic depression

-features?

Answer 8

might be paranoid (mood congruent or hypochondriac)

Cotard’s syndrome