Depression Flashcards
What is the Beck’s cognitive triad in depression?
Negative views about the world
Negative views about the future
Negative views about the oneself
What are the criteria for depression diagnosis?
Diagnosis of depression requires symptoms to occur for a minimum of 2 weeks and cause a loss of functioning/signficant distress, in absence for secondary effects such as drugs, bereavement and medical disorder.
What is the epidemiology of suicide in the UK?
Most common in men aged 45 to 59 and the method via hanging or strangulation.
What is the aetiology of depression?
Multiple gene variants
Drugs which are steroids, contraceptive pills, beta blockers and digoxin.
Adverse childhood events
Recent life events such as childbirth
Low sunlight
Neurotic personality, due to hyperarousal to emotional stimuli and negative bias for attention and processing of emotional material
Social environment
Physical illness
Pre-existing mental illness such as psychosis, dementia, anxiety and addiction
What are the risk factors for suicide?
->Completed suicide is more common in men and suicide attempt is greater in women
->Middle aged
-> Previous self harm
->Single, widowed or divorced
->Insecure employment/unemployment or retired
->Occupation such as vets, farmers, pharmacists and doctors
->Lower socioeconomic status
->Recent life events such as sexual assault or war
->Poor social support such as elderly, prisoners, immigrants
->Physical or mental illness history
How is mild depression classified?
The patient fulfils 4 of the main core symptoms for depression in the ICD-10 category for over 2 weeks, where they are distressed but still able to function. This is more common in those with anxiety, premorbid personality traits or stressful life events.
This is subdivided into somatic syndrome or non-somatic syndrome.
What is the management plan for a patient with a suicide risk?
1) Carry out a mental state assessment, with particular focus to mood and excluding psychosis
2) Is the patient returning to the same situation and are there any protective factors
3) Ask about suicidal ideation
Dependant on the risk assessment and the patient’s social support network. The discharge may be managed by a crisis team to provide additional support and supervision and referral to GP or community mental health team for follow up or care co-ordination.
How is moderate depression classified?
They must fulfil 5-6 depressive symptoms of the ICD-10 where they have great difficulty continuing with daily life, subdivided into somatic and non-somatic symptoms.
This is more common in those with anxiety, premorbid personality traits or stressful life events.
What is parasuicide?
Any act which resembles suicide but does not result in death and may have been a means of expressing despair or attention rather than the sole purpose of death. Parasuicide is a form of deliberate self-harm.
How is severe depression classified?
They must fulfil at least 7 to 10 of core symptoms, where they are completely unable to work and function. This is further subdivided into psychotic and non-psychotic symptoms.
These can present with psychotic depression and somatic symptoms such as anhedonia, amenorrhoea and constipation.
What is the process of CBT for severe depression?
CBT involves three main areas:
It targets negative automatic thoughts which affect mood, behaviour and physiology.
Behavioural activation through tracking activities, goal setting and activity scheduling
It includes therapy for empathy and CBT specific skills
Negative automatic thoughts arise from early experiences that create core beliefs based on dysfunctional assumptions. There is typically a critical incident which reinforces these underlying beliefs and maintained by distorted thinking, triggering depression.
What are the symptoms of core depression?
D: depressed mood, present most of the day
E: energy loss
P: Pleasure loss (anhedonia)
R: Retardation/Agitation
E: Eating changes such as weight loss, in absence of dieting
S: Sleep changes, where early morning waking 2-3 hours than usual is common and difficulty falling asleep. Atypical depression features hypersomnia.
S: Suicidal thoughts
I: I’m a failure, ideas of guilt and unworthiness
O: Only me to blame
N: NO/Reduced concentration and self-esteem
Bleak and pessimistic views of the future
What are the levels of CBT?
Self-help materials such as books or website
Assisted self-help presented by health workers
CBT approaches for specific issues such as anxiety management, which is not adapted to the patient
Formulation driven CBT, where the patient is engaged in a therapeutic alliance to adapt a CBT technique
What are the somatic symptoms of depression?
Loss of emotional reactivity
Diurnal mood variation, where mood is worst upon first waking and improves over the course of the day
Anhedonia
Psychomotor agitation
Loss of appetite
Loss of libido
What are the key characterisitcs of formulation based CBT?
Frequent weekly sessions based on an agenda created between the patient and the therapist based on the present. Homework and rating scales are frequently used.
What is the epidemiology of depression?
More common in women
Physical illness, especially chronic pain and neurological disorders
Childhood adverse experiences
Co-morbidity with psychiatric disorders such as addiction, anxiety and personality disorder
Which behavioural techniques are used in CBT?
Activity monitoring and scheduling to encourage planning
Systematic desensitisation
Anxiety management through breathing control and imagery
What is the evidence base for CBT?
CBT is highly effective in the management of anxiety and depression equivalent to medication. There is evidence of its effectivity in schizophrenia, however this evidence is less valid.
How does brain pathology contribute to aetiology of depression?
Sevre depression is associated with ventricular enlargement and subclass prominence. There is reduced GABA function on post-morgen findings and expression of serotonin transporter in the dorsal rather nuclei.
Depression is featured by initial insomnia, frequent waking and unsatisfactory sleep, where early morning waking is common due to a reduced REM latency and total slow wave sleep.
What is the differential diagnosis for depression?
Psychosis
Seasonal affective disorder
Dementia
Anxiety
Adjustment disorder
Grief
Alcohol dependence
What are the categories of depression?
Depression with somatic symptoms
Depression without somatic symptoms
Depression with psychotic symptoms
What are the risk factors for depression?
Recent bereavement
Physical illlness
Social problem
Past history of depression
Chronic disease
What is the presentation of depression with somatic symptoms?
Patients will have psychomotor disturbances such as motor retardation, periodic agitation and impairment of cognitive function that can objectively be measured by a clinician.
What are the red flags for depression?
Feeling of hopelessness
Suicidal thoughts/ideation
Chronic pain
Disabling symptoms
Severe and prolonged symptoms
What is the common presentation of depression in absence of somatic symptoms?
Hostile depression which is more common in younger people with anxiety that have a history of hostile behaviours in response to stress like yelling, physical damage to objects and impulsivity. They have a poor response to antidepressants.
AND
Anxious depression: typically an early onset depression, where they are shy and withdrawn. There is a higher likelihood of substance dependency and self-harm and suicide, but a better response to antidepressants
What are the common presenting symptoms of depression in GP’s?
Tiredness
Low mood
Headache
Backache
Indigestion
Chest pain
Sleep disturbances
Stress
Dizziness
What is the common presentation of depression with psychosis?
Psychotic depression is a severe depressive episode accompanied by psychotic symptoms such as
Delusions, typically nihilistic in nature such as guilt, responsibility for world events and deserving of punishment
Hallucinations that may be auditory like accusatory voices, olfactory sense of rotting or visual images of torment like demons or torture.
This typically occurs within the context of schizophrenia or bipolar disorder, and presents with typical symptoms of depression. Psychotic depression typically features psychomotor changes and suicide ideation.
What is the screening tool used for depression?
PHQ-2 tool used in primary care and general hospital where patients are screened, based on the first two questions from the PHQ-9 that detects a majority of cases of depression:
“Do you struggle with feelings of depression and hopelessness?”
“Do you struggle with a loss of interest of hopelessness or loss of interest?”
What is abnormal grief reaction?
Cluster of depressive symtpoms with preoccupation with the deceased where it:
->Intense enough to be diagnosed by clinical depression
->Delayed to avoid grief
->Last longer than 6 months
What is the normal grief reaction?
Grief is the emotional response to a loss where a person may experience shock, numbness, sadness, helplessness and depression.
What are the aspects of the mental state examination:?
Appearance
Behaviour
Speech
Thoughts
Perception
Mood
Cognition
Insight
What are the positive prognostic factors for depresssion?
Acute onset, earlier age of onset, endogenous depression
What is the framework for approaching patient aetiology for depression?
3 P’s
Predisposing factors: features of patient history which puts them at risk based on the aetiology of depression
Precipitating factors: Important recent events that occurred in the patient’s life
Perpetuating factors: Which aspects of the patient’s social or biomedical history is making the depression worse
