Depression Flashcards
50% of all mental/mood disorders start before the age of 14 and 50% of all mental/mood disorders start before the age of 30.
Mental disorders before age of 14
Mood disorders before age of 30
Define anhedonia
Loss of enjoyment/pleasure
What is early morning wakening?
Waking at least 2 hours before the expected/normal waking time
What is psychomotor retardation?
Subjective or objective slowing of thoughts and or movement
Define stupor
The absence of relational functions i.e. action and speech
List presentation of depression in appearance and behaviour?
Reduced facial expression Brow furrowed Reduced eye contact Limited gesturing Difficult to get rapport
List speech presentation in depression
Reduced rate Lower in pitch Reduced in volume Reduced intonation (monotonous) Increased speech latencies (time between speaking) Short answers
Define mood vs affect?
Mood is prolonged prevailing state (subjective) - how patient feels
Affect is mood in moment (objective) - how patient reacts
Depressed, reduced range, limited reactivity and emotional paralysis are all used to describe patients mood/affect?
Affect
Describe presentation in terms of thought in patient with depression
Form: normal
Flow: thoughts are slowed, almost absent
Content: negative, self-accusatory, failure, guilt, pessimism, delusions can occur, suicidal thinking, paranoia (self-referential thinking)
What is Cotard’s syndrome?
A nihilistic delusion in which patient believes they are already dead and body needs to catch up
What may be different in paranoia in psychosis and paranoia in depression?
In psychosis paranoia may have a bizarre element to it whereas depression paranoia will often be tied to guilt/self-blame and sensitivity of criticism by others
What is the presentation of depression in terms of perception?
No perceptual disturbance
Maybe some self-referential thinking (he’s talking about me)
Hallucinations can occur - usually 2nd person and derogatory
WHat is presentation of depression in terms of cognition?
Cognition is slow - called
Pseudo-dementia
What is presentation of depression in terms of insight?
Patients typically have insight
What is the approximate lifetime prevalence of major depression?
14-18%
List 6 mood disorders as defined by ICD-10.
Manic episode Bipolar affective disorder Depressive episode Recurrent depressive disorder Persistent mood disorders Unspecified mood disorder
What is dysthymia another name for?
Persistent depressive disorder
What is dysthymia mean?
Mild to moderate persistent depressive disorder
What are general criteria for depression?
A. Depressive episode should last at least 2 weeks
B. No hypomanic or manic symptoms sufficient to meet hypomanic or manic criteria at any time in the individuals life
At least 2 of 3 CORE symptoms must be present for depression to be diagnosed. What are these 3 symptoms? (MEE)
- Depressed mood - abnormal for individual, present for most/all day, largely uninfluenced by circumstance for at least 2 weeks (MOOD)
- Loss of interest/pleasure in normally pleasurable activities (ENJOYMENT)
- Decreased energy or increased fatiguability (ENERGY)
An additional symptom(s) from another 7 should be present to give a total of at least 4 for depression to be diagnosed. What are these 7 symptoms?
- Loss of confidence
- Guilt
- Suicidal ideas/behaviours
- Diminished concentration
- Agitation/retardation which is subjective or objective (psychomotor change)
- Sleep disturbance
- Changes in appetite
How does ICD-10 rate severity of depression?
According to the number of symptoms (and to a lesser extent, the severity)
What is the criteria for a diagnosis of moderate depression?
Two core symptoms + four others to give 6
What is the criteria for a diagnosis of severe depression?
All 3 core symptoms & 5 others to give 8 in totally
Antidepressants are indicated for mild depression. True/false?
False - not indicated, usually gets better by itself
For diagnosis of somatic syndrome, 4 of what 8 symptoms should be present?
- Loss of interest in activities
- Lack of emotional reactions
- Early morning wakening (2hours or more before usual time)
- Diurnal variation of mood (worse in morning)
- psychomotor retardation/agitation
- loss of appetite
- Weight loss
- Loss of libido
What is a atypical depression?
Mood reactivity - mood brightens in response to actual or potential positive events
2 or more of 4 symptoms must be present for a diagnosis of atypical depression. What are these 4 symptoms?
- Significant weight gain/increase in appetite
- Hypersomnia
- Leaden paralysis
- Long-standing pattern of interpersonal rejection sensitivity that results in significant social/occupational impairment
What are two presentations of psychotic depression?
- paranoid
- cotard’s syndrome
Chronic depression is always treatment-refractory and so all treatment-refractory depression is chronic. True/false?
False - chronic depression is not necessarily treatment-refractory however treatment-refractory depression is usually chronic
What is the criteria for chronic depression?
Full criteria for a major depressive episode met for at least the past 2 years
What are the 5 R’s of depression?
Response to treatment Remission Relapse Recovery Recurrence
Affective disorders are common, are usually recurrent (10 year recurrence >80%) and often chronic (20% of cases). True/false?
True
Unipolar depression has been predicted by the WHO to be the second biggest cause of worldwide morbidity by 2020. Suicide rate in males is 3%. True/false?
False!! First part true but suicide rate is 7%
