Abnormal Mood - Depression Flashcards
What is the epidemiology of mental disorders?
Peak in late 30s and onwards
50% of all mental disorders start before age 14
50% of all mood disorders starts before age 30
What are some terms used to describe mood?
Euthymic = normal mood Cyclothymic = variable mood
What are some key terms used for symptoms of depression?
Anhedonia = lack of enjoyment or pleasure Anergia = lack of energy Amotivation = lack of motivation
What does diurnal variation mean?
Symptoms vary over the course of the day
What is psychomotor retardation?
Subjective or objective slowing of thoughts and/or movement
What is stupor?
Absence of relational features
What are some features of a depressed patient’s mood and behaviour in the mental state examination?
Reduced facial expression = classically furrowed brow
Reduced eye contact and limited gesturing
Rapport often difficult to establish
How may a depressed patient’s use of language appear in a mental state examination?
Reduced rate, volume and intonation of speech
Increased speech latencies and limited content
How is mood defined?
Prolonged/prevailing state or disposition = subjective, associated with what the patient describes
How is affect defined?
How mood is applied to things = objective, something you observe or infer from how the patient reacts
How may a patient with depression describe their mood?
Low, down, miserable, unhappy, flat, empty, numb
What is the affect of a patient with depression?
Depressed, reduced range, limited reactivity, may report emotional paralysis
What parameters are used to describe thought?
Form, flow and content
How does depression affect a patient’s though form and flow?
Form = usually normal Flow = thoughts are slowed, can be almost absent
What are the content of the thoughts of a depressed patient?
Negative, self-accusatory, failure, low self-esteem, delusions of guilt or poverty, suicidal thinking
What is Cotard’s syndrome?
Nihilistic delusions = more common in elderly
How is perception impacted by depression?
Usually no perceptual disturbance
Some people report increased self-referential thinking
Hallucinations can occur
What are some features of hallucinations that can occur in depression?
Almost always auditory
Usually second person and derogatory
Typically reflect depressive themes
How is cognition affected by depression?
Slow with poor memory = pseudo-dementia
Deficits involve working memory, attention and planning
Often compounded by anxiety
What are some features of insight in patients with depression?
Usually preserved = aware of symptoms
Attribution can be affected = blame symptoms on self
What are some observations you may make on a patient with depression?
Slightly slower movements and fiddling
Defeated posture and tearful or worrying
Reduced facial expression and speech intonation
Exhausted due to poor sleep
What are some features of major depression?
Common = 14-18% lifetime prevalence
Usually recurrent and chronic (>=20%)
Suicide rate = 6-7%
How does the ICD-10 categorise mood disorders?
Mania, bipolar disorder, dysthymia, depressive disorder
How does the DSM-5 categorise mood disorders?
Depressive disorders = major depressive disorder, persistent depressive disorder
Bipolar disorder grouped separately
How may depressive disorders be grouped in the ICD-10?
May be moderate or severe
What is a depressive illness?
Not just low mood = must be clearly abnormal for person, must be persistent and should interfere with normal function
How does grief differ from a depressive illness?
Similar in quality, but function is usually not so impaired
What is the general criteria for diagnosing depression?
Depressive episode should last at least 2 weeks
There have been no hypomanic or manic symptoms at any time in the patient’s life
What are the core features of depression?
Depressed mood
Loss of interest/pleasure in normally pleasurable activities
Decreased energy or increased fatiguability
What are the features of a depressed mood?
Abnormal for the person, present for most of the day and almost every day, largely uninfluenced by circumstance, lasts at least 2 weeks
What are the additional symptoms of depression?
Loss of confidence or self-esteem Unreasonable guilt Recurrent thoughts of death or suicide Loss of concentration Sleep disturbance Change in appetite Change in psychomotor activity
What are some scales that can be used to assess the severity of depression?
Hamilton rating scale (HAM-D)
MADRS
Beck Depression Index (BDI)
How does the ICD-10 rate severity of depression?
According to number of symptoms
Moderate = two core plus four additional symptoms
Severe = all three core plus five additional symptoms
What are some features of mild depression?
Mild depressive symptoms have weekly prevalence of 7.7% = majority of depression found in primary care
Antidepressants are no better than placebo = generally self-resolves
What are some features of psychotic depression?
Occasionally paranoid
May have Cotard’s syndrome
Typically mood-congruent or hypochondrial
