Affective Disorders - Depression Flashcards
What are mood disorders?
- They are disorders of mental staus and function where altered mood is a core feature.
- It is a term that refers to states of depression and of mania.
Give two examples of classification systems.
- ICD10
- DSM5
When does depression become abnormal?
Not clear cut but psychiatry places emphasis on:
- Persistence of symptoms
- Pervasiveness of symptoms
- Degree of impairment
- Presence of specific symptoms or signs
What are the three spheres that depressive illness symptoms occur in?
- Psychological
- Physical
- Social
What changes can occur in the psychological sphere of depression?
- Changes in mood
- Changes in thought content
What changes in mood can occur in depression?
- Depression (can have diurnal variation)
- Anxiety
- Perplexity
- Anhedonia
What changes in thought content can occur with depression?
- Undue guilt
- Hopelessness
- Worthlessness
- Any neurotic symptoms
- Ideas of reference
- Dellusions and hallucinations
What changes can occur in the physical sphere with depression?
- Change in bodily function
- Change in psychomotor functioning
What changes in bodily function can occur with depression?
- Energy decline (fatigue)
- Sleep disturbance
- Apetite changes (most often results in weight loss)
- Low libido
- Contipation
- Pain
What changes with psychomotor functioning occur with depression?
- Agitation
- Retardation
What changes occur in the social sphere of depression?
- Anhedonia
- Irritability
- Apathy
- Withdrawal, loss of confidence, indeciseive
- Loss of concentration, registration and memory
Define Agitation
A state of restless over anxiety, aimles or ineffective.
Define Anhedonia
Loss of ability to derive pleasure from experience.
Define Anxiety
An unpleasant emotion in which thoughts of apprehension or fear predominate.
Define Apathy
Loss of intrest in own surroundings.
Define Retardation
A slowing of motor responses including speech.
Define Stupor
A state of extreme retardation in which conciousness is intact. The patient stops moving, speaking, eating and drinking. On recovering, the pateint can describe clearly the events which occured while they were stuporose.
What is the ICD10 criteria for depression?
- At least a 2 week history
- No history of hypomanic/manic episodes ever
- Not attributable to substance abuse or organic mental disorder
- Must exclude other diagnosis if presenting with psychosis
Symptoms of somatic syndrome
- 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 2 hrs before the normal time
- Depression worse in the morning
- Objective evidence of psychomotor agitation or retardation
- Marked loss of appetite
- Weight loss (5%+ of body weight in a month)
- Marked loss of libido
What is the general criteria for depression?
- Depressed mood that is abnormal for most of the day almost everyday for the past two weeks, largely uninfluenced by circumstances
- Loss of interest or pleasure
- Decreased energy or increased fatigability
What is the additional criteria for depression?
- Loss of confidence or self esteem
- Unreasonable feelings of guilt or self reproach
- Recurrent thoughts of death by suicide or any suicidal behaviour
- Decreased concentration
- Agitation or retardation
- Sleep disturbance of any sort
- Change in appetite
According to ICD 10, what is the criteria for mild depression?
- At least 2 general criteria
- Additional criteria to give score of at least 4
According to ICD 10, what is the criteria for moderate depression?
- At least 2 general criteria
- Additional criteria to give total score of at least 6
According to ICD 10, what is the criteria for severe depression?
- All of the general criteria
- Additional criteria to give score of at least 8
- If psychotic symptoms or stupor then severe depression
How does childbirth affect women’s mental health?
- increased risk of psychiatric admission in the 30 days following childbirth
- 75% of women experience ‘blues’ within 2 weeks
- 10% of women develop depression within 3-6 months
- ‘puerperal psychosis’ - 1 in 500 deliveries
Differential diagnosis.
- Normal reaction to life event
- SAD
- Dysthymia
- Cyclothymia
- Bipolar
- Stroke, tumour, dementia
- Endocrine - Hypothyroidism, Addison’s, Hyperparathyroidism
- Infections - Influenza, infectious mononucleosis, hepatitis, HIV/AIDS
- Drugs
Treatments for depression.
- Antidepressants
- Psychological treatments
- CBT
- Physical treatments
- ECT, psychosurgery
