Abnormal Mood - Depression Flashcards

1
Q

What is the epidemiology of mental disorders?

A

Peak in late 30s and onwards
50% of all mental disorders start before age 14
50% of all mood disorders starts before age 30

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2
Q

What are some terms used to describe mood?

A
Euthymic = normal mood
Cyclothymic = variable mood
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3
Q

What are some key terms used for symptoms of depression?

A
Anhedonia = lack of enjoyment or pleasure
Anergia = lack of energy
Amotivation = lack of motivation
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4
Q

What does diurnal variation mean?

A

Symptoms vary over the course of the day

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5
Q

What is psychomotor retardation?

A

Subjective or objective slowing of thoughts and/or movement

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6
Q

What is stupor?

A

Absence of relational features

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7
Q

What are some features of a depressed patient’s mood and behaviour in the mental state examination?

A

Reduced facial expression = classically furrowed brow
Reduced eye contact and limited gesturing
Rapport often difficult to establish

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8
Q

How may a depressed patient’s use of language appear in a mental state examination?

A

Reduced rate, volume and intonation of speech

Increased speech latencies and limited content

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9
Q

How is mood defined?

A

Prolonged/prevailing state or disposition = subjective, associated with what the patient describes

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10
Q

How is affect defined?

A

How mood is applied to things = objective, something you observe or infer from how the patient reacts

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11
Q

How may a patient with depression describe their mood?

A

Low, down, miserable, unhappy, flat, empty, numb

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12
Q

What is the affect of a patient with depression?

A

Depressed, reduced range, limited reactivity, may report emotional paralysis

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13
Q

What parameters are used to describe thought?

A

Form, flow and content

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14
Q

How does depression affect a patient’s though form and flow?

A
Form = usually normal
Flow = thoughts are slowed, can be almost absent
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15
Q

What are the content of the thoughts of a depressed patient?

A

Negative, self-accusatory, failure, low self-esteem, delusions of guilt or poverty, suicidal thinking

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16
Q

What is Cotard’s syndrome?

A

Nihilistic delusions = more common in elderly

17
Q

How is perception impacted by depression?

A

Usually no perceptual disturbance
Some people report increased self-referential thinking
Hallucinations can occur

18
Q

What are some features of hallucinations that can occur in depression?

A

Almost always auditory
Usually second person and derogatory
Typically reflect depressive themes

19
Q

How is cognition affected by depression?

A

Slow with poor memory = pseudo-dementia
Deficits involve working memory, attention and planning
Often compounded by anxiety

20
Q

What are some features of insight in patients with depression?

A

Usually preserved = aware of symptoms

Attribution can be affected = blame symptoms on self

21
Q

What are some observations you may make on a patient with depression?

A

Slightly slower movements and fiddling
Defeated posture and tearful or worrying
Reduced facial expression and speech intonation
Exhausted due to poor sleep

22
Q

What are some features of major depression?

A

Common = 14-18% lifetime prevalence
Usually recurrent and chronic (>=20%)
Suicide rate = 6-7%

23
Q

How does the ICD-10 categorise mood disorders?

A

Mania, bipolar disorder, dysthymia, depressive disorder

24
Q

How does the DSM-5 categorise mood disorders?

A

Depressive disorders = major depressive disorder, persistent depressive disorder
Bipolar disorder grouped separately

25
Q

How may depressive disorders be grouped in the ICD-10?

A

May be moderate or severe

26
Q

What is a depressive illness?

A

Not just low mood = must be clearly abnormal for person, must be persistent and should interfere with normal function

27
Q

How does grief differ from a depressive illness?

A

Similar in quality, but function is usually not so impaired

28
Q

What is the general criteria for diagnosing depression?

A

Depressive episode should last at least 2 weeks

There have been no hypomanic or manic symptoms at any time in the patient’s life

29
Q

What are the core features of depression?

A

Depressed mood
Loss of interest/pleasure in normally pleasurable activities
Decreased energy or increased fatiguability

30
Q

What are the features of a depressed mood?

A

Abnormal for the person, present for most of the day and almost every day, largely uninfluenced by circumstance, lasts at least 2 weeks

31
Q

What are the additional symptoms of depression?

A
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
32
Q

What are some scales that can be used to assess the severity of depression?

A

Hamilton rating scale (HAM-D)
MADRS
Beck Depression Index (BDI)

33
Q

How does the ICD-10 rate severity of depression?

A

According to number of symptoms
Moderate = two core plus four additional symptoms
Severe = all three core plus five additional symptoms

34
Q

What are some features of mild depression?

A

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

35
Q

What are some features of psychotic depression?

A

Occasionally paranoid
May have Cotard’s syndrome
Typically mood-congruent or hypochondrial