Abnormal Mood: Depression Flashcards
50% of all mental disorders start before what age?
14
50% of all mood disorders start before what age?
30
what is the definition of anhedonia?
loss of enjoyment / pleasure
what is the definition of anergia?
lack of energy
what is the definition of amotivation?
lack of motivation
what is the definition of diurnal variation?
mood varies over the day
what is definition of early morning wakening?
waking at least 2 hours before expected / normal waking time
what is definition of psychomotor retardation?
subjective or objective slowing of thoughts and / or movement
what is definition of stupor?
the absence of relational functions ie action and speech
what is definition of euthymia?
normal mood
what appearance and behaviour symptoms might you see in 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
what speech symptoms may you see in depression?
reduced rate lowered in pitch reduced in volume reduced intonation (monotone) increased speech latencies limited content
what is the definition of mood?
a prolonged prevailing state or disposition; typically associated with what the patient describes (subjective)
“how do you feel”
what is the definition of affect?
mood applied to things (events, people etc)
how the patients feelings change in relation to their surroundings and context; something you observe
how the patient reacts
what types of mood may patient describe?
low, miserable, unhappy, sad
can be describes as “flat”
often “empty”, “black”, “numb”
what types of affects may the patient experience?
depressed (ie low)
reduced range (stays low)
limited reactivity (doesn’t respond to change in subject, context or emotion)
emotional paralysis
what is the typical form of thought in depression?
normal
what is the typical flow of thought in depression?
slowed; pondering
can be almost absent (subjectively or objectively)
what is the typical content of flow in depression?
negative, self accusatory, failure, guilt, low self esteem, pessimism
delusions can occur: guilt, poverty, nihilism, hypochondriasis
what perceptual disturbances may occur in depression?
in most cases - none
some report increased self-referential thinking (people talking about me)
hallucinations can occur
what kind of hallucinations can occur in those with depression?
almost always auditory
usually second person and derogatory (you are a bad person and deserve to die)
the voices reflect depression
what cognitive symptoms could someone with depression develop?
cognition is slow with complaints of poor memory (inattention)
pseudo-dementia
involves working memory, attention and planning
do people with depression often have a problem with insight?
no (in contrast to schizophrenia and mania)
people are usually ware of their symptoms
however, attribution can be affected - symptoms blamed on sins, physical illness, personal failings and weakness
what type of posture may someone with depression have?
“defeated”
what problem with sleep may those with depression experience?
poor sleep (initial insomnia; broken sleep)
do those with depression tend to be worried and exhausted?
yes
what do UK and european psychiatrists use to classify mental / depressive disorders?
international classification of diseases, version 10
what do american psychiatrists use to classify mental / depressive disorders?
diagnostic and statistic manual, version 5
what is the general criteria for diagnosis of depression?
the depressive episode should last at least 2 weeks
there have been no sufficient hypomanic or manic symptoms at any time in individuals life
at least two of the what CORE three symptoms must be present to diagnose depression?
1) depressed mood that is abnormal, present for most of day every day and sustained for at least 2 weeks
2) loss of interest or pleasure in activities
3) decreased energy or increased fatiguability
an ADDITIONAL symptom or symptoms from which list should be present to give a total of at least four symptoms?
1) loss of confidence
2) unreasonable guilt
3) suicidal behaviour
4) diminished concentration
5) agitation or retardation (either subjective or objective)
6) sleep disturbance
7) change in appetite
ICD-10 rates severity of depression by what?
number (and to some extent, the severity) of symptoms
how many symptoms are needed for diagnosis of moderate depressive episode?
two core symptoms + four others to give total of at least SIX
how many symptoms are needed for diagnosis of severe depressive episode?
all three core symptoms + five others to give total of at least EIGHT
what is the main symptom of atypical depression?
mood reactivity (mood brightens in response to actual or potential positive events)
for mild depression, antidepressants are no better than placebo and are not indicated - true or false?
true
four of what eight symptoms should be present for a diagnosis of somatic syndrome?
1) loss of interest in activities
2) lack of emotional response to events or activities
3) waking 2 hours before usual time
4) depression worse in morning
5) marked psychomotor retardation or agitation
6) loss of appetite
7) weight loss
8) marked loss of libido
what is the main symptom of atypical depression?
mood reactivity (mood brightens in response to actual or potential positive events)
to be diagnosed with atypical depression, you must have two (or more) of what symptoms?
1) weight gain or increase appetite
2) hypersomnia
3) leaden paralysis (heavy feelings in arms or legs)
4) long standing pattern of interpersonal rejection sensitivity that results in social or occupational impairment
what is psychotic depression and what are examples of thoughts?
occasionally paranoid, typically “mood-congruent” or hypochondriacal
“people out to kill me”
“im being poisoned to punish me for my sins”
“ive got cancer because i deserve it”
what is cotard’s syndrome?
more common in elderly
nihilistic delusions - “i cant eat because my bowels have turned to dust”
may be as extreme as “im dead.. the world doesnt exist”
what are the five Rs - stages of depression?
response (acute - 12 weeks) remission (acute - 12 weeks) relapse (continuation - 4-9 months) recovery (maintenance - >1 yr) recurrent (maintenance - >1 yr)
what % of affective disorders are recurrent and what % are chronic?
10 year recurrence - >80%
chronic - 20%
