Depression - 1 Flashcards
what are depression types recognised by ICD11?
Single depressive Episode
Recurrent Depressive Disorder
Dysthymic Disorder
Mixed depressive and anxiety disorder
What are depression types recognised by DSM-5?
Disruptive mood dysregulation disorder (temper outburst)
Major Depressive disorder
Persistent depressive disorder (dysthymia)
Premenstrual Dysphoric disorder
Where is “Mixed depression with anxiety disorder is located in DSM-5?
It is coded by the ‘with anxious distress’ qualifier.
Biological Symptoms of depression?
Neurovegetative
Somatic
Vital
Melancholic
Endogenomorphic
what is difference between dsm5- and icd 11 when it comes to psychotic symptoms of depression?
In ICD-11, only moderative and severe can have psychotic symptoms
In DSM-5 psychotic symptoms are independent of severity
How long ICD-11 requires Depressive episodes and DSM 5 requires MDD to last?
2 weeks at least
Symptom clusters in ICD-11 depressive episodes
Affective
Cognitive behavioural
Neurovegetative
Symptoms in affective cluster of ICD 11 depressive episode
Depressed mood
Lack of interest or inability to experience pleasure ( including sex)
Symptoms in cognitive behavioural cluster of the ICD 11 depressive episode
Self worthless ness
Lack of concentration
Hopelessness
Suicidal ideation and thoughts of dying
Symptoms in neurovegetative cluster of the ICD 11 depressive episode
sleep disturbance
appetite disturbance
aggitation/irritability
lack of energy
how many symptoms are required in total to qualify in icd 11 depressive disorder
5 at least
one must be from affective
Difference between DSM 5 and ICD 11 for MDD/Depressive episodes?
Almost the same, although ICD 11 uses clusters for the same nine symptoms on DSM 5.
Difference between DSM 5 and ICD 11 for recurrent depressive disorder
ICD 11 requires at least 2 episode of depressive episodes separated by several months (not specified) without significant mood disturbance
DSM -5 requires at least two episodes separated by precisely two consecutive months without meeting criteria for MDD
Dysthymic disorder in ICD11
- Recurrent depressive mood (feeling down) for at least 2 years with individual 9 symptoms of depressive episode without having 2 weeks of sufficient symptoms to meet depressive episode criteria.
- No longer than 2 consecutive months of symptom-free reported.
Dysthymic disorder difference between ICD 11 - DSM 5
DSM 5 - specifies 1 year for children and adolescents (both say it this group there is more irritability for mood)
Mixed depressive and anxiety disorder
at least 2 weeks of several symptoms of depression and anxiety, but none meet the criteria for depressive episodes or anxiety or fear-related disorders.
How does NICE guidlines (ng222) grades derpession?
MOre severe and less severe
should you offer antidepressant for less severe cases routinely?
no, unless preferred by patient
what are first line of antidepressants for less severe cases who request medication?
SSRIs
for less severe depression what antidepressant should be avoided and why?
TCA (except lofepramine) because they’re easy to overdose
which TCA is not easy to overdose?
Lofepramine
what if there was no response to first SSRI?
1st - switch to another medication in the same class or another like SNRI ( or TCA and MAOIs in 2ndary care)
2nd - vortioxetine
or
3rd- antipsychotic + SSRI, Or Mirtazapine + SSRI or Lithium + SSRI
4th- Consider augmentation of SSRI with ECT or lamotrigine
when can a clinician consider vortioxetine?
when two antidepressant did not work at all or properly
Treatment based on PHQ- 9 <16 (Less severe; Mild and subthreshold)
- Self-help (Guided)
-Group or indie CBT
-Group or indie Behavioural activation
-Group Exercise
-Group Mindfulness and meditation
-IPT
-SSRI
-Counselling
-STPP (short term psychodynamic psychotherapy)
-Combined CBT + Antidepressant
