Case: Depression Flashcards
What are the 3 core symptoms of depression?
- Low Mood
- Anhedonia = A complete inability to feel pleasure
- Low Energy
The 3 core symptoms of depression are;
- Low Mood
- Anhedonia = A complete inability to feel pleasure
- Low Energy
What are the other symptoms of depression?
- poor appetite
- poor sleep
- poor concentration
- reduced libido
- tearfulness
- negative thoughts
- suicidal thoughts
Severely depressed patients may also experience psychotic symptoms.
What is psychosis?
a mental disorder characterized by symptoms such as delusions or hallucinations, that indicate impaired contact with reality
What are delusions?
- Usually negative or guilty in nature
- e.g. “My body is rotting”, “I have committed a great crime and am being punished
What are hallucinations?
- Usually Auditory
- Second Person (talking directly to the patient)
- e.g. A voice telling them they are ‘worthless’, that they smell bad or criticising what they are wearing
- Can also be:
- visual (e.g. spiders)
- tactile (e.g. feeling things crawling on their skin)
- olfactory (e.g. smelling rotting flesh)
- gustatory (e.g. bad taste in mouth)
Beyond the presenting complaint, what are some important things to ask a depressed patient in the history?
Medical history
- e.g. thyroid disorders (hypothyroidism can mimic depression)
- e.g. chronic illness/pain
Psychiatric history
- e.g. admissions, suicide attempts
Family history
- e.g. psychiatric disorders, suicide
Medications
- e.g. prescribed drugs such as beta-blockers can cause depression
Social history
- current social or financial difficulties
- use of alcohol/drugs
Personal history
- e.g. adverse experiences which may have affected their ways of thinking
What are the features of the Mental State Examination?
ASEPTIC
1) Appearance
* Poor self-care, Reduced range of facial expressions
Behaviour
- Psychomotor retardation or agitation
- Reduced Eye Contact
2) Speech
* Slow, Quiet, Monotonous
3) (Emotion)Mood and Affect
- Subjectively and Objectively depressed mood
- Reduced range and intensity of affects
4) Perceptions
- Possible auditory hallucinations if psychotic
- Reduced Eye Contact
5) Thought
- Form
- Thoughts may be slowed
- Content
- Negative, guilty or suicidal thoughts
- Depressive delusions if psychotic
6) Insight
* Usually present
7) Cognition
* Not usually impaired
What are the 3 broad treatment of depression?
1) Biological
- Antidepressants
- Electro-Convulsive Therapy
2) Psychological
- Cognitive Behavioural Therapy (CBT)
- Interpersonal Psychotherapy (IPT)
3) Social
- No specific treatments but modification of lifestyle factors may be helpful
Antidepressant medication should be continued for __________ months in normal circumstances
six to twelve months
Antidepressants can be continued long-term in the case of?
- Chronic depression
- Prophylaxis where depressive episodes have been
- Frequent or severe
- Psychotic
- Or involved a significant suicide attempt
What happens if we don’t treat depression?
- Untreated, depression usually lasts six to twelve months
- However it can become chronic
- Even if it resolves without treatment, the patient may be left with some symptoms e.g. insomnia
- Robust treatment is said to be protective for further episodes
What are the complications of depression?
- Suicide
- Psychosis
- Social and Occupational dysfunction
- Unemployment or problems at work
- Family and relationship problems
- Socially isolation
