Depression Flashcards
What are the steps in conducting an assessment of suicide?
Rapport, therapeutic alliance, active listening, empathy, directed questions
Collateral information (with patient’s consent) – get information from people around the patient
Conduct a suicide enquiry
→ Ideation – frequency, intensity, duration (in the past 48h, past month and the worst ever)
→ Suicide plan – timing, location, lethality, access to means, preparatory acts
→ Intent – extent pt expects to carry out the plan, and believes the plan to be lethal or self-injurious
→ Explore ambivalence – reasons to die vs to live
Consultation w specialist whenever in doubt
What are the risk management strategies for suicide risk?
Identify and manage the underlying disorders (if any)
Identify risk factors
→ Prior attempts of suicide/self-harm
→ Past/current psychiatric diagnosis – mood/psychosis, alcohol/substance use, ADHD, PTSD (Key symptoms: anhedonia, hopelessness, anxiety, impulsivity, aggression, delusions)
→ Family history of suicide, child maltreatment
→ Stressors – triggering events leading to humiliation, shame or despair
Identify protective factors (or the lack thereof)
Removing the means
Activating support system
What are the possible causes of depression?
Biological – neuroendocrine theories
- Hormonal influences – inc secretion of cortisol (major stress hormone)
- Monoamine hypothesis – dec neurotransmitters in brain (NE, 5-HT, DA)
Psychological – loss, negative self-evaluation
Psychosocial – isolation, lack of social support
Genetics - 5-HTT, HTR2A, BDNF, TPH12
Medical disorders
→ Endocrine disorders: Hypothyroidism, Cushing’s, T2DM (bidirectional association in women)
→ Deficiency states: anemia, Wernicke’s encephalopathy
→ Infections: CNS infections, STD/HIV, TB
→ Metabolic disorders: electrolyte imbalance (↓K, Na), hepatic encephalopathy
→ CV: CAD, HF, MI
→ Neurological: Alzheimer’s, epilepsy, pain, Parkinson’s, post-stroke
→ Malignancy
Psychiatric disorders – alcoholism, anxiety disorders, eating disorders, schizophrenia
Drug-induced
→ Psychotropics: CNS depressants, anticonvulsants, tetrabenazine
→ Lipid soluble beta blockers
→ Withdrawal from alcohol, stimulants
→ Systemic corticosteroids
→ Isotretinoin
→ Interferon-β-1a
What are the DSM-5 criteria for depression?
≥5 Sx present during 2-week period and represent a change from previous functioning (In.SAD.CAGES)
- Interest: Decreased interest and pleasure in normal activities (anhedonia)
- Sleep: Insomnia or hypersomnia
- Appetite: Decreased appetite, weight loss
- Depressed: Depressed mood (adults) – may present as irritable mood in children
- Concentration: Impaired concentration and decision making
- Activity: psychomotor retardation or agitation
- Guilt: Feelings of guilt or worthlessness
- Energy: Decreased energy or fatigue – note socially introverted vs dec energy; focus on change in level
- Suicidal thoughts or attempt
Symptoms cause significant distress or impairment in social, occupational or other impt areas of functioning
Symptoms are not caused by an underlying medical condition or substance
What are the classifications of depression?
- Major Depressive Disorder
- Persistent Depressive Disorder
- Disruptive Mood Dysregulation Disorder
- Premenstrual Dysphoric Disorder
- Substance/Medication-Induced Depressive Disorder
- Depressive Disorder secondary to another medical condition (eg hypothyroidism)
- Other specified/unspecified depressive disorder
What is the definition of Major Depressive Disorder?
Single and recurrent episodes of ≥5 Sx, incl depressed mood or loss of interest
What are the differential diagnoses of depression?
Adjustment Disorder: Sx occur within 3 months of onset of a stressor, but once the stressor is terminated, Sx do not persist for more than an additional 6 months
Acute Stress Disorder: Sx occur within 1 month of a traumatic event and lasts 3 days – 1 month (intense fear, helplessness, horror, dissociation, re-experiencing, avoidance, inc arousal)
Seasonal Affective Disorder
Substance-Induced Mood Disorder
