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Psychiatry > Depression > Flashcards

Depression Flashcards

1
Q

What is depression?

A

Refers to both negative affect (low mood) and/or absence of positive affect (loss of interest and pleasure in most activities)

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2
Q

Def: Euthymic

A

Normal mood

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3
Q

Def: Hyperthymic

A

Elevated mood

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4
Q

Def: Cyclothymic

A

Variable mood

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5
Q

Def: Anhedonia

A

Loss of enjoyment/pleasure

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6
Q

Def: Anergia

A

Lack of energy

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7
Q

Def: Amotivation

A

Lack of motivation

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8
Q

Def: Diurnal variation

A

Varying over the course of the day

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9
Q

Def: Early morning wakening

A

Waking at least 2 hours before expected waking time

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10
Q

Def: Psychomotor retardation

A

Subjective or objective slowing of thoughts and/or movement

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11
Q

Def: Stupor

A

Absence of relational functions (E.g. Action and speech)

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12
Q

What are some risk factors for depression?

A
  • Genetic susceptibility
  • Life factors - i.e. social situation e.g. single mums
  • Alcohol/drug dependence
  • Abuse (sexual or not) - particularly in childhood
  • Unemployed
  • Previous psychiatricdiagnosis
  • Chronic disease
  • Lack of a confiding relationship
  • Urban population
  • Post natal period
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13
Q

What are some sub-types of depression?

A

Psychotic depression
Cotard’s syndrome (Nihilistic delusion)
Somatic syndrome
Atypical depression
Late-onset depression

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14
Q

What is meant by psychotic depression?

A

A form of depression in which there are psychoses, occasionally paranoid, which are typically hypochondriacal and are congruent with mood

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15
Q

What is Cotard’s syndrome

A

A syndrome of severe depression in which the person believes they are dead or they are an empty shell with rotting innards
Most common in the elderly

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16
Q

What are some somatic symptoms of depression

A
  • 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 or more before the usual time
  • Depression worse in the morning
  • Objective evidence of marked psychomotor retardation or agitation (remarked on or reported by other people)
  • Marked loss of appetite
  • Weight loss (5 % or more of body weight in the past month)
  • Marked loss of libido
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17
Q

What are the features of atypical depression?

A
  • Mood reactivity (that is, mood brightens in response to actual or potential positive events)
  • Significant weight gain or increase in appetite
  • Hypersomnia
  • Leaden paralysis (heavy, leaden feelings in arms or legs)
  • Long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment
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18
Q

What is late-onset depression?

A

Depression occurring for the first time in later life (>65)

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19
Q

What are some risk factors for late-onset depression?

A
  • Genetic susceptibility
  • Life events (i.e. loss of spouse)
  • Social factors (i.e. Loneliness, financial hardship)
  • Poor physical health (especially vascular disease)
20
Q

What are some symptoms of depression?

A
  • Classic triad:
    • Anhdonia - loss of enjoyment/pleasure
    • Anergia - lack of energy
    • Amotivation
  • Diurnal variation - typically worse earleier in the day
  • Early morning wakening - waking at least 2 hours before the expected/normal waking time
21
Q

MSE - Depression - Appearance

A

May be signs of personal neglect

22
Q

MSE - Depression - behaviour

A
  • Rapport is often difficult to establish
  • Reduced eye contact
  • Reduced facial expression
  • Brow is classically ‘furrowed’
  • Limited gesturing - movements may be slowed, or absent
  • Psychomotor retardation - subjective or objective slowing of thoughts and/or movements
23
Q

MSE - Depression - Speech

A
  • Reduced rate of speech
  • Lower in pitch
  • Reduced volume
  • Reduced intonation
  • Increased speech latencies
  • Limited content
24
Q

MSE - Depression - Mood

A
  • ‘Low, ‘down’, ‘miserable’, ‘unhappy’, ‘sad’
  • Can be described as ‘flat’
  • Often ‘empty’, ‘black’, ‘numb’
25
Q

MSE - Depression - Affect

A
  • Depressed i.e. low
  • Reduced range (stays low throughout)
  • Limited reactivity - affect doesn’t respond or react to changes in subject, context, or emotion
  • May report emotional paralysis
26
Q

MSE - Depression - Thought

A
  • Form: typically normal
  • Flow: thoughts are slow, pondering, can be almost absent
  • Content: negative, self-accusatory, failure, guilt, low self-esteem, pessimism, delisions, suicidal thinking
    • Cotard’s syndrome (nihilistic delusions)
27
Q

MSE - Depression - Perception

A
  • In most cases there is no perceptual disturbance
  • Some people report increased self-reference thinking (‘people are talking about me’
  • Hallucinations can occur - almost always auditory, usually second person and derogatory (‘you are a bad person and deserve to die’)
28
Q

MSE - Depression - Cognition

A
  • Subjectively, cognition is slow with complaints of poor memory
  • ‘Pseudo-dementia’
  • Typical deficits involve working memory, attention, and planning
  • Often compounded by anxiety
29
Q

MSE - Depression - Insight

A
  • Insight is typically preserved
  • People are usually aware of their symptoms - recognition is commonly intact
  • However, attribution can often be affected by the illness - symptoms may be blamed on sins, physical illness, personal failings, or weakness
30
Q

What is the main diagnostic criteria used for depression in the UK and Europe?

A

ICD-11

31
Q

What are the 4 main depressive disorders recognised by ICD-11?

A
  • Single episode depressive disorders
  • Recurrent depressive disorder
  • Dysthymic disorder
  • Mixed depressive and anxiety disorder
32
Q

What are the 3 severity classifications for depression?

A

Mild
Moderate
Severe

33
Q

What is the ICD-11 criteria for classification of a depressive episode

A

A period of depressed mood or diminished interest in activities occurring most of the day, nearly every day during a period lasting at least 2 weeks, accompanied by other symptoms such as:

  • Loss of confidence or self-esteem
  • Unreasonable feeling of self-reproach or excessive and unreasonable guilt
  • Recurrent thoughts of death/suicide, or any suicidal behaviour
  • Complaints or evidence of diminished ability to think or concentrate, such as indecisiveness or vacillation
  • Change in psychomotor activity - with agitation or retardation (either subjective or objective)
  • Sleep disturbance of any type
  • Change in appetite (increase or decrease) with corresponding weight change
34
Q

Criteria for mild depression

A
  • Patient is distressed by the symptoms
  • Has some difficulty continuing to function in one or more domains (E.g. Social, occupational)
  • No delusions or hallucinations
35
Q

Criteria for moderate depression?

A
  • Several symptoms to a marked degree OR
  • A large number of symptoms to a lesser degree
  • There is usually considerable difficult functioning in multiple domains (E.g. Social, occupational)
36
Q

Criteria for moderate depression

A
  • Many or most symptoms to a marked degree OR
  • A few symptoms to an intense degree
  • Serious difficulty in most domains (E.g. Social, occupational)
37
Q

Management of mild depression

A

No anti-depressants
Watchful waiting and assessment within 2 weeks
Possible low-intensity interventions such as CBT

38
Q

Management options for moderate-severe depression

A

Anti-depressants (1st line)
High-intensity psychological treatment (CBT, interpersonal therapy)
Psychiatric referral (If required)
ECT (Severe)

39
Q

1st line pharmacological management of depression

A

SSRI

40
Q

2nd line pharmacological management of depression

A

Switch SSRI

41
Q

3rd line pharmacological management of depression

A

Add or swap antidepressant (E.g. SNRI, Tricyclic, MAOI)

42
Q

What is ECT?

A

Electroconvulsive therapy
Given under general anaesthetic twice a week
Very useful in severe depression

43
Q

Management of mild depression in children

A
  • Watchful waiting for 2 weeks
  • Group IPT/CBT, non-directive supportive therapy for 2-3 weeks
44
Q

Management of unresponsive or moderate-severe depression in children

A
  1. Individual CBT, IPT, family therapy, psychodynamic psychotherapy 4-6 sessions
  2. Fluoxetine
  3. Sertraline or citalopram
45
Q

How is response to management in depression monitored?

A

There are 2 main symptomatology questionnaires used for monitoring response in depression treatment:

  • IDS-30-SR (30 item patient-rated scale)
  • QIDS (Quick version)
46
Q
A

Psychiatry (20 decks)

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