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Y3 - Psych > Depression > Flashcards

Depression Flashcards

1
Q

What are the core features of depression?

A

Depressed mood
Loss of interest (anhedonia)
Lack of energy (anergia)

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2
Q

What are additional symptoms of depression?

A

Loss of confidence/senf-esteem
Unreasonable feelings of self-reproach or excessive guilt
Recurrent thoughts of death or suicide
Decreased ability to think or concentrate, indecisiveness
Change in psychomotor activity - agitation or retardation
Bleak and pessimistic views of the future
Sleep disturbance
Change in appetite and corresponding weight change

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3
Q

What is psychomotor retardation?

A

Slowing of thoughts and reduction of physical movements, speech and affect

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4
Q

How are appearance and behaviour altered in depression?

A

Reduced eye contact
Reduced facial expression
Limited gesturing (psychomotor retardation)
Difficult to establish rapport

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5
Q

Describe speech in depression

A

Slow
Lowered in pitch
Quiet
Monotonous (reduced intonation)
Increased latencies (longer time between end of a question and them starting to speak)
Limited content (answers are often short, brief, and unembellished)

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6
Q

Describe mood in depression

A

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

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7
Q

Describe affect in depression

A

Reduced range - stays low throughout

Limited reactivity

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8
Q

Describe thoughts in depression

A

Form - normal
Flow - slow
Content
- Negative, failure, guilt, low self esteem, pessimism
- Delusions - of poverty, nihilism, hypochondriasis
- Suicidal thinking

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9
Q

Describe perception in depression

A

Most have no perceptual disturbance
Increased self-referential thinking (people are talking about me)
Hallucinations (usually auditory, second person and derogatory, negative and depression)

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10
Q

Describe cognition in depression

A

Slow
Poor memory (inattention)
‘Pseudo-dementia’
Deficits in working memory, attention and planning

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11
Q

Describe insight in depression

A

Insight preserved
Aware of their symptoms - recognition intact
Attribution not always correct - symptoms can be blamed on sins, physical illness, personal failings

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12
Q

What are the subtypes of depression?

A

Somatic syndrome
Atypical depression
Psychotic depression
Chronic depression

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13
Q

What is somatic syndrome?

A

4 of the following present:

  • 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 in the morning 2 hours before the usual time (early morning wakening)
  • Depression worse in the morning
  • Objective evidence of marked psychomotor retardation or agitation (remarked on or reported by others)
  • Marked loss of appetite
  • Weight loss (5% or more of body weight in the past month)
  • Marked loss of libido
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14
Q

What is atypical depression?

A

Mood reactivity - mood brightens in response to actual/potential positive events
Weight gain or increase in appetite
Hypersomnia
Leaden paralysis - heavy feeling in arms or legs
Long-standing pattern of interpersonal rejection sensitivity

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15
Q

What is psychotic depression?

A

Depression with psychotic features

Occasionally paranoid

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16
Q

What is chronic depression?

A

2 years of depression

Not necessarily treatment refractory

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17
Q

What is the medical differential of depression?

A 
Hypothyroidism
Cushing's
Syphilis
SLE
Drugs: steroids, isotretinoin, B blockers
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18
Q

What are the psychiatric differentials of depression?

A 
Bipolar
Schizophrenia
Generalised anxiety disorder
Substance misuse
Dementia
Dysthymia
Bereavement reaction
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19
Q

How would you differentiate depression from bipolar disorder?

A

Have you ever had periods of the opposite where your mood has been very high?

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20
Q

How would you differentiate depression from schizophrenia?

A

Have you ever experienced anything (seeing or hearing) that others haven’t or had thoughts that seemed unusual but you weren’t able to shake?

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21
Q

How would you differentiate depression from generalised anxiety disorder?

A

Do you feel yourself anxious, any physical symptoms of anxiety?

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22
Q

What is dysthymia?

A

Chronic mild depression for a minimum of 2 years in which episodes are either not long enough or severe enough to meet criteria for depression

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23
Q

What is the criteria for depression?

A

Symptoms for minimum 2 weeks

Presence of at least 2 of the core symptoms

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24
Q

What is classed as mild depression?

A

2 core symptoms + 2 additional symptoms

In distress but able to continue with activities of daily living

25
Q

What is classed as moderate depression?

A

2 core symptoms + 4 additional symptoms

Associated difficulty in carrying out activities of daily living

26
Q

What is classed as severe depression?

A

3 core symptoms + 5 additional symptoms
Associated with hopelessness, worthlessness, suicidal ideation, somatic symptoms and complete inability to carry out activities of daily living

27
Q

What is the management of depression?

A

Reassure the patient that in time, mood will get better
Self-supportive measures (self-help, talk to people, exercise, activities you used to enjoy)
CBT
Antidepressants
ECT

28
Q

How long should antidepressants be continued for? (for a first episode, and subsequent episodes)

A

First episode - at least 6 months after full recovery w/o reducing dose
Second+ episode - at least 1-2 years after full recovery w/o reducing dose
May be needed lifelong

29
Q

When is ECT used?

A

Life-saving or very treatment resistant cases

When a quicker response than anti-depressants can offer is needed

30
Q

What are the classes of antidepressants?

A

Selective Serotonin Re-uptake Inhibitors (SSRI)
Tricyclics
Serotonin and Noradrenaline Re-Uptake Inhibitors (SNRI)
Noradrenaline and Serotonin Specific Antidepressant (mirtazapine)
Monoamine oxidase inhibitors

31
Q

What is the first line class of antidepressant for depression?

A

SSRIs

32
Q

What are examples of SSRIs?

A

Fluoxetine
Sertraline
Paroxetine
Citalopram

33
Q

What is the mechanism of SSRIs?

A

Block serotonin re-uptake from the synapse

Reduce inhibitory controls of serotonin release

34
Q

What other conditions are SSRIs used for?

A

GAD
Panic disorder
Phobia
OCD

35
Q

What are the side effects of SSRIs?

A

GI upset (abdo pain, constipation, nausea) - usually settles in a couple weeks
Increased risk of GI bleeds
Increased anxiety, insomnia, agitation, sexual dysfunction
Increased suicidality in first few weeks in younger patients
Hyponatremia and falls in older patients
Withdrawal

36
Q

What are the withdrawal symptoms of SSRIs?

A 
Flu-like symptoms
Insomnia
Nausea
Imbalance
Sensory disturbance
Hyperarousal
(FINISH)
37
Q

What are examples of tricyclics?

A 
Amitriptyline
Nortriptyline
Imipramine
Lofepramine
Clomipramine
38
Q

What is the mechanism of tricyclics?

A

Block the re-uptake of noradrenaline and serotonin from the synapse by blocking their transporters

39
Q

When are tricyclics used in depression?

A

Second line after SSRIs

Effective at reducing anxiety

40
Q

When should tricyclics be avoided?

A

For patient working as driver or operating machinery - strong sedative
Recent MI or history of arrhythmia

41
Q

What are the side effects of tricyclics?

A

Sedation
Weight gain
Cardiac - long QT (arrhythmia), postural hypotension
Anticholinergic - dry mouth, constipation, blurred vision, urinary retention
sexual dysfunction

42
Q

What are examples of SNRIs?

A

Venlafaxine

Duloxetine

43
Q

What is the mechanism of SNRIs?

A

Selectively block the re-uptake of noradrenaline and serotonin from the synapse by blocking their transporters
Weak antagonists of dopamine re-uptake

44
Q

When are SNRIs used?

A

Second line to SSRI

If others not tolerated

45
Q

What are the side effects fo SNRIs?

A

GI upset

Cardiac - HTN, palpitations, dizziness

46
Q

What is the mechanism of mirtazapine?

A

Antagonizes presynaptic noradrenaline, serotonin and histamine receptors

47
Q

When is mirtazapine used?

A

Second line
For those where weight loss or sleep are issues
Used in isolation or combination with SSRI

48
Q

What are the side effects of mirtazapine?

A

Sedation
Weight gain
Can cause nausea or sexual difficulties but less likely to

49
Q

What are examples of monoamine oxidase inhibitors?

A

Moclobemide

Phenelzine

50
Q

What is the mechanism of monoamine oxidase inhibitors?

A

Block monoamine oxidase which presents the breakdown of serotonin and noradrenaline amongst other neurotransmitters

51
Q

When are monoamine oxidase inhibitors used?

A

Good in atypical depression

52
Q

What are the downsides off monoamine oxidase inhibitors?

A

Interact with tricyclics and SSRIs so need to be off them for several weeks before starting (risk of hypertensive crisis)
Penelzine requires dietary restriction - avoid cheese, red wine, soy

53
Q

What are the side effects of monoamine oxidase inhibitors?

A

Dizziness
Postural hypotension
Anticholinergic effects

54
Q

How long do antidepressants take to work?

A

4-6 weeks

55
Q

What is the general algorithm for order of antidepressants to try?

A
  1. SSRI
  2. Increase dose then try different SSRI
  3. Switch to SNRI (or tricyclic)
  4. Mirtazapine
  5. Augment with antipsychotics, lithium
56
Q

What antidepressant should be prescribed in the elderly?

A

Not SSRI due to hyponatremia/falls risk

57
Q

What antidepressant should be prescribed in teenagers?

A

SSRI or mirtazapine

58
Q

What antidepressant should be prescribed if sleep or weight loss is a major issue?

A

Mirtazapine

Y3 - Psych (12 decks)

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