Depression

Question 1

Diagnosis

Answer 1

-Core- 
Fairly constant depressed mood at least 2 wk. 
Anhedonia
Loss energy
-somatic-
EMW or hypersomnia
Poor appetite
Weight loss
Psychomotor agitation or retardation
Low libido
Flat affect
Diurnal mood variation
-depressive cognitions-
Worthless and guilt
Low self esteem
Hopeless
Loss concentration
Suicidal
Hypochondriacal
-pyschotic- mood congruent or not
Delusions- poverty, inadequacy, guilt, responsibility, deserving punishment, nihilistic.
Halucination
Catatonic

Question 2

ICD 10

And other classification

Answer 2

Mild- 2 typical plus 2 other core
Moderate- 2 typical plus 3 or more core
Severe- 3 typical plus 4 or more core
Severe with psychosis
Can be single or recurrent
-atypical dep- variable low mood, overeat and sleep, extreme fatigue and limb heaviness, anx.
-psychotic dep- often auditory third person, mood congruent delusions eg hypochond, guilt, nihilistic, persecutory.
-post natal dep- 15% of women within 6 months of birth. Worried about babies health or her adequacy. RFs eg family hx dep, old, single, unplanned, lack support.
-SAD
-premenstrual dysphoric disorder.

Question 3

Aetiology

Answer 3

• adevrse experience, personality, psychological eg rels, woman, social
• reduced monoamine function eg 5HT, NA, DA.
• low thyroid hormone.
• sleep change

Question 4

Differentials

Answer 4

Bipolar
Adjustment disorder
PTSD
Anxiety disorder
Eating disorder
Schizoaffective disorder
Schizophrenia
PD
Neuro eg dementia, parkinsons, HD, MS< stroke, epilepsy, head inj, tumour. 
Addisons, cushings, thyroid, perimenstrual, menopause, prolactinoma, hyperPTH, hypopituitary.
Hypoglycaemia, hyperCa.
Inflammation eg SLE.
Infection- syphillis, lyme disease, HIV encephalopathy. 
Sleep apnoea
Drug se
Substance

Question 5

mx

Answer 5

Mild recent and new- monitoring, self help, CCBT.
More severe- CBT, antiD, ECT.
Tx resis- different dose and type antiD, lithium or tryptophan (serotonin precursor) adjuncts, ECT, psychosurgery.
-TCA- eg amitriptyline, imipramine.
Probs- anti cholinergic and adrenergic and histaminergic. Toxic OD. Slow cardiac conduction. Seizure.
-MAOI so prevent breakdown- eg isocarboxacid
2nd line for tx resis dep or AD
Probs- HTN crisis, diet resitriction, antimuscarinic, hepatotoxic, insomnia, anxiety, weight gain, postural hypotension, oedema, sex dysfunction, reduce appetite.
-SSRI- eg citalopram, fluoxetine, certruline.
Probs- GI, insomnia, not for severe. NOT if manic.
-SNRI- eg venlafaxine, duloxetine.
-NA and specific serotonergic antiDs- eg mirtazepine. Sedation.

RTMS- repetitive trnscranial megnetic stimulation.
Increase activity in prefrontal cortex.

For first episode contin antiD for 6mnth after recovery.
For second episode contin for 2yr after recov.

Question 6

Prevalence

Answer 6

lifetime prevalence 10-20%
4th in global disease burden
2-3 times more if LTC
£7.5bn per yr
M:F 1:2

Question 7

Investigation

Answer 7

-FBC, ESR, B12, folate, UE, LFTs, TFTs, glucose, Ca.
-if indicated-
Urine or blood tox, alc, ABG, thyroid Abs, antinuclear Ab, syphillis, electrolytes, addisons, CT or MRI.

Question 8

Prognosis

Answer 8

Episodes 4-30wk, shorter for recurrent.
10-20% chronic where symtpoms over 2 yrs.
60% recurrence in 20 yrs.
suicide up to 13%.
High death rate.
-poor facs- insidious onset, neurotic, old, residual symptoms, low self confidence, comorbidity, lack support.
-good facs- acute onset, endogenous dep, early onset.
First episode- contin antiD for at least 6 month.
Multiple episodes- continue antiD for 2 yr.
80% have further dep episodes.
10% sev unremitting.

Question 9

ECT

Answer 9

Indics- sev dep, other tx not work. Life threatening. Prolonged and sev mania. Catatonia. High suicide risk. Stipor. Sev psychomotor retardation.

Question 10

Dysthymia

Answer 10

Chronic dep of mood that is not recurrent dep.

complain, poor sleep, feel inadeq, but can suually function.