Depression

Question 1

ICD-10 core symptoms of depression

Answer 1

Depressed mood
Anhedonia
Anergia

At least two must be present for at least two weeks

Question 2

Minor ICD-10 symptoms for depression (7)

Answer 2

Reduced concentration 
Reduced self-esteem
Ideas of guilt
Pessimistic views of the future
Ideas/acts of self-harm or suicide
Disturbed sleep (early morning wakening)
Diminished appetite (loss of 5% body weight in last month)

At least two must be present

Question 3

Mild depression (ICD-10)

Answer 3

Total of four or more symptoms, most normal activities continued

Question 4

Moderate depression (ICD-10)

Answer 4

Total of five or more symptoms, great difficulty in continuing normal activities

Question 5

Severe depression (ICD-10)

Answer 5

Total of seven or more symptoms including all three core symptoms, unable to continue normal activities

Question 6

Biological symptoms of depression (5)

Answer 6

Early morning wakening
Depression worse in the morning
Loss of appetite 
Psychomotor retardation/agitation
Loss of libido

Question 7

Cognitive symptoms of depression (5)

Answer 7

Reduced concentration/memory
Poor self-esteem
Disproportionate guilt
Hopelessness for future
Suicide/self harm

Question 8

Dysthymia

Answer 8

Low mood begins in young adulthood and continues throughout life - not severe enough to classify as depressive episode

Question 9

Ddx for patient with a depressed mood

Answer 9

Depression
Recurrent depressive disorder (80% of those with depression)
Dysthymia
BPAD
Schizoaffective disorder
Adjustment disorder
Comorbid: psychiatric conditions, gen medical conditions, prescribed and illicit drugs

Question 10

Drugs that can cause depression

Answer 10

Alcohol
Beta blockers
Steroids
Oral contraceptives 
Carbamazepine
Opiates
Antipsychotics 
Interferon

Question 11

Investigations for depression

Answer 11

Social: collaterals, home visit

Psycho: mood diary, depression scores e.g. Beck Depression Inventory, HADS

Bio: to exclude medical causes, establish baseline before treatment and screen for consequences of neglect
FBC (anaemia, infection, alcohol)
U&Es, LFTs, TFTs, calcium
CRP, ESR, Vit B12, folate
Urine drug screen