Abnormal Mood - Depression Flashcards
What % of all mental disorders start before the age of 14?
50%
50% of all mood disorders start before what age?
30
Anhedonia
Loss of enjoyment/pleasure
Anergia
Lack of energy
Amotivation
Lack of motivation
Diurnal variation
Mood varies throughout the day
Early morning wakening
Waking at least 2 hours before the expected/normal waking time
Stupor
The absence of relational functions ie. action and speech
Euthymia
Normal mood
What are the key features of the appearance and behaviour of a person with depression?
- Reduced facial expression.
- Brow is classically ‘furrowed.’
- Reduced eye contact.
- Limited gesturing – movements may be slowed or absent.
- Rapport is often difficult to establish.
Describe the speech of someone with depression.
Slow rate
Low pitch
Reduced speed
Speech latencies
Describe speech latencies in someone with depression,
Are increased longer time between the end of a question and them starting to speak
What is the content of speech like in someone with depression?
Limited – answers are often short, brief and unembellished
What is mood?
A prolonged prevailing state or disposition; typically associated with what the pt describes
Mood is ___________
SUBJECTIVE
What may someone with depression describe their mood as?
Low, miserable, unhappy, sad.
Can be described as ‘flat’ ‘empty’ ‘black.’
What is affect?
Basically, this is mood APPLIED to things (ie. events, people).
When taking a hx, it’s how the pt’s feelings change in relation to their surroundings and the context; it’s something that you typically observe or infer
Affect is ___________
OBJECTIVE
As a clinician, how might you describe someones affect?
Depressed (ie. low). Reduced range (stays low throughout). Limited reactivity affect doesn’t respond or react to changes in subject, context or emotion.
In depression, what is the form of thought like?
NORMAL
What is the flow of thought like in someone with depression?
Thoughts are slow and pondering.
Can almost be absent (subjectively or objectively).
What does thought content in someone with depression tend to be like?
Negative, self-accusatory, failure, guilt, low self-esteem, pessimism
Delusions can occur: guilt, poverty, nihilism, hypochondriasis
What is paranoia?
Self-referential thinking ie. ‘he’s talking about me.’
In depression, hallucinations are almost always?
AUDITORY
Describe the auditory hallucinations in someone with depression.
2nd person + USUALLY DEROGATORY ie. ‘you’re a bad person and you’re going to die’
What themes do the hallucinations in depression usually follow?
Negative and depressive themes
What is the cognition of someone with depression like?
Slow, with complaints of poor memory (probably more to do with inattention)
What do typical deficits in cognition involve?
- Working memory
- Attention
- Planning
In depression insight is typically ___________
PRESERVED
People with depression are usually aware of their symptoms
TRUE
Although patients are usually aware of their symptoms, what can be affected by depression?
Attribution
What may symptoms of depression be blamed on by the patient?
Sins, physical illness, personal failings and weakness
Describe the appearance of someone with depression during a mental state exam
- Classic furrowed brow
- Tearful
- Probably not sleeping (was up at 3am)
- Feelings of guilt, pessimism, low self-esteem, and being a burden to others
- Suicidal ideation and apparent intent
In what % of people is depression chronic?
20%
What is depression not?
Just ‘low mood.’
- everyone will have been sad, or unhappy, or gloomy, or miserable at some stage.
For something to be a depressive illness, it must be……
- Be clearly abnormal for the individual to be concerned.
- Persist.
- Interfere with normal fn to a significant degree.
What is depression often similar to?
Grief
What are the 2 general criteria for the diagnosis of criteria to be made?
A - The depressive episode should last at least 2 weeks.
B – There have been no hypomaniac or maniac sx sufficient to meet the criteria for hypomaniac or maniac episode at any time in the individual’s life.
At least 2 of what 3 symptoms should be present?
- Depressed mood
- Loss of interest or pleasure
- Decreased energy or increased fatiguability
List some additional symptoms of depression.
- Loss of confidence/self-esteem
- Unreasonable feeling of self-reproach or guilt
- Thoughts of death/suicide
- Inability to concentrate
- Change in psychomotor ability
- Sleep disturbance
- Change in appetite
How can severity of depression be rated?
Via rating scales
– Hamilton Rating Scale for Depression (HRSD, HAM-D)
– Montgomery-Asperg Depression Rating Scale (MADRS)
– Beck Depression Inventory (BDI)
How does ICD-10 rate severity?
According to the number (and to some extent, the severity) of symptoms
For something to be classified as a moderate depressive episode, what is required?
- At least 2 of the 3 main sx listed for F32.0.
- criterion B must be present.
- Additional sx from F32.0.
- criterion C must be present to give a total of at least six.
For something to be classified as a severe depressive episode, what is required?
- All 3 sx in criterion B, F32.0, must be present.
* Additional symptoms from F32.0, criterion C, must be present, to give a total of at least eight.
What are the 3 main categories of depression?
- Somatic
- Atypical
- Psychotic
What are the 5 R’s of depression?
Response. Remission. Relapse. Recovery. Recurrence.
Unipolar major depression is predicted by the WHO to be the second biggest cause of worldwide morbidity by 2020
TRUE :(
For a diagnosis of somatic syndrome depression to be made, 4 out of 8 of the following sx should be present.
- marked loss of interest or pleasure in activities that are normally pleasurable
- lack of emotional reactions to events or activities that normally produce an emotional response
- waking in the morning 2 hours or more before the usual time
- depression worse in the morning
- objective evidence of marked psychomotor retardation or agitation (remarked on or reported by other people)
- marked loss of appetite
- weight loss (5 % or more of body weight in the past month)
- marked loss of libido
What is the criteria for a diagnosis of atypical depression to be made?
A. Mood Reactivity.
ie. mood brightens in response to actual or potential positive events.
B. Two or more of the following:
- significant weight gain or increase in appetite
- hypersomnia
- leaden paralysis (that is, heavy, leaden feelings in arms or legs)
- long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment
What are the key features of psychotic depression?
- Occasionally paranoid
- Typically ‘mood-congruent’
- Hypochondriacal
Who is Cotard’s syndrome most common in?
Elderly
In people with Cotard’s they often have _________ delusions
Nihilistic
