Depression Flashcards
what are some of the affective disorders
major depression
subthreshold depressive symptoms
dysthymia
bipolar disorder (manic depressive illness)
what are subthreshold depressive symptoms
the criteria fall below major depression.
there is at least one key symptom of depression but with insufficient other symptoms and/or functional impairment
what is dysthymia
symptoms that are subthreshold for depression but lasts at least 2 years
what are three broad diagnoses
- loss of interest and enjoyment in ordinary things
- low/ depressed mood
- emotional, cognitive, behavioural symptoms
what is somatization
the manifestation of psychological distress by the presentation of physical symptoms
what is the DSM-IV
it is the criteria that depression assessment should include:
1. number and severity of symptoms
2. duration of the current episode
3. course of illness
stands for DIAGNOSTIC AND STATISTICAL MANUAL for mental disorders
what are the nice guidelines CG90
Appendix assessing depression and its severity for ages 18 and up
depression is a broad and heterogenous diagnosis?
yes
what are the key symptoms of depression
persistent sadness or low mood
and/or
marked loss of interest or pleasure
at least one of these, most days, most of the time for at least 2 weeks
what associated symptoms should you ask if a patient presents with the key symptoms
disturbed sleep
change in appetite/ weight
fatigue/ loss of energy
agitation/ slowing of movements
poor concentration/ indecisiveness
feeling worthlessness/ excessive guilt
suicidal thoughts/ acts
also ask:
duration
associated disability
fam and past history
availability of social support
name some emotional symptoms
loss of interest/ pleasure that were once enjoyed- ANHEDONIA
persistent sadness/ unresponsive to circumstances
irritability
tearfulness
what is anhedonia
inability to feel pleasure
what are some cognitive symptoms
negative view of self
-lowered self esteem/ confidence
-guilt/worthlessness
-hopelessness/helplessness
-pessimistic
poor concentration
reduced attention
difficulty making decisions
mental slowing
suicidal intention
what are behavioural symptoms
lowered appetite/ weight change
insomnia
low energy
loss of libido
social withdrawal
why be aware of chronic physical health
major cause of depression
what are some risk factors for depression
genetic/ family factors
early life experiences
stressful life events
social support
gender
does a genetic component mean you will become depressed
no
about a three fold increased risk for major depression in the first-degree relatives with major depression > general population
what are some early life experiences that have an affect and increase vulnerability
poor parent- child relationship
marital discord
neglect
abuse
what did brown and harris (1978) find when interviewing women in Camberwell
15-20% mod-severely depressed and NOT receiving treatment
rate of depression was 3 times higher among women who lost their mum before 11 and experienced a severe recent loss
what did brown (2002) find about early loss of mother and that affect on neglect
early loss of mother increased risk of neglect and abuse
-marked parental neglect
-physical abuse
-sexual
in 2002 brown discussed the importance of humiliation and entrapment in the development of depression
true
name some stressful events that can precede depression
failure
marital separation
rejection from a loved one
death of a child
fam ill
physical illness
why is social support important in regards to depression
it offers protection to the individual in dealing with stressors
lack of intimate relationships can increase the risk of depression
discuss gene-by-environment interaction
genetic factors influence overall risk of illness but also influence the SENSITIVITY of individuals to the depressogenic effects of environmental difficulty
do genes on their own cause depression?
no
discuss depression and gender and the factors around this
major depression more common in women
women may express and report symptoms more
hormones
early life stress (more likely to be sexually abused)
stressors like single mum, aging parents, responsibilities at home and work
discuss issues around chronic illness and depression
depression is approximately 2-3 times more common in patients with a chronic physical health problem.
occurs in 20% of people with a chronic problem
depression can also exacerbate the pain and distress and can shorten life expectancy
discuss depression and physical illness
many signs of depression can also be signs of the disease itself (fatigue, insomnia, weight loss)
drugs can also cause depression (hypertensives, corticosteroids and chemotherapy, oral combined pill)
discuss depression and coronary heart disease
2-4 fold increase risk for cardiac mortality (hospitalised MI patients)
depressed people without cardiac disease have an increased risk of cardiac mortality
also less lilely to adhere to meds, interventions, rehab programmes
may also promote bad health practices (smoking)
trigger dysregulation of neurohormonal systems responsible to cortisol and catecholamine secretion
describe the relationship between depression and CV (Elderon and Whooley 2013)
depression->behavioral factors->bio factors->CV disease->manifestations->depression
what are the treatments options for depression
pharmacological
psychological
physical activity
electroconvulsive treatment
describe CBT
short term psychological treatment
role of thinking in how we feel and what we do
identify unhealthy modes of thinking and CHALLENGE it
1-1 or group
describe the cbt chain
thoughts->behaviour->emotion->thoughts
when should individual CBT be offered
if relapsed despite meds
if there is a significant history of depression
use mindfulness if:
currently healthy but have experienced 3+ previous episodes of depression
describe some risks of suicide
- health system- access, stigma
- Community/ relationships- war/ disaster, discrimination, abuse, violence, isolation
- individual factors- previous attempts, mental disorders, alcohol abuse, financial loss, chronic pain, fam history of suicide
personality
cognitive factors
social factors
negative life events
how to assess suicide risk
ask about depression directly and about intent
assess whether there is adequate social support
arrange help
advise them to seek further help if situ gets worse
what to do is patient is assess to be at suicidal risk
more support (contact with primary care/ telephone and setting up appointments)
find out social support
specialists
