Depression Flashcards
What is depression?
symptoms including low mood, reduction of energy and decreased activity
What is the prevalence of depression?
depression affects 2 - 5% of the population
What is the female to male ration of depression?
2:1 (female to male ratio of depression)
What could be the presentation of depression in the elderly population?
Somatic:
- pain
- bowel change
- weight change
- decreased energy
- lack of motivation
- poor compliance
- poor appetite
- weight loss
- debility
What is the prevalence of depression in patients with parkinson’s disease and alzheimer’s?
40% = parkinson’s
20% = Alzheimer’s
What are the symptoms of depression?
- loss of interest (anhedonia)
- Lack of emotional reactivity
- loss of energy / fatigue
- Insomina and early morning wakening
- Diurnal variation of mood
- psychomotor retardation
What is the negative cognitive triad?
1) Self : worthless
2) Future : hopeless
3) World : critical, guilt
What are the screening tools for depression?
- PHQ-9
- geriatric depression scale (GDS)
- hospital anxiety and depression scale (HAD)
What are some conditions that may present as depression?
- PTSD (post-traumatic stress disorder)
- anxiety
- other neurotic disorder
What is are the somatic presentations of depression?
- back pain
- headache
What 9 questions would you ask in a depression history?
1) Little interest
2) feeling down, depressed, hopeless
3) sleep
4) appetite (poor / overeating)
5) Tired / little energy
6) feeling bad about yourself / failure
7) lack of concentration - cant watch tv or read
8) Moving / speaking slowly or being fidgetry or restless
9) Suicide/self harm
How long must symptoms be present before a depression diagnosis be made?
at least 2 weeks
What 3 factors are part of depression risk assesment?
1) Suicide / self harm
2) Risk to self (able to cope at home)
3) Risk to others (identified targets)
What are the medical treatments for depression?
1) SSRIs e.g. fluoxetine, citalopram, sertaline
2) Tricyclics e.g. amitriptyline, nortriptyline, lofepramine
3) NaSSA e.g. mirtazapine
4) SNRI e.g. venlafaxine, duloxetine
What are the bio-psycho-social treatments for depression?
- Talking therapy
- CBT
What are the risk factors for suicide?
- drugs alcohol
- unemployement
- social isolation
- poverty
- chronic illness
- family / relationship breakdown
- previous attempt
- mental disorder
Give an example of an SSRI
- setraline
- citalopram
- fluoxetine
Give an example of an tricyclic anti depressant?
- amitriptyline
- nortriptyline
- lofepramine
Give an example of NaSSA
mirtazapine
Give an example of an SNRI
- venlafaxine
- duloxetine
what demographic is more likely to be affected by depression?
- lower socio-economic background
- live in urban areas
- unemployed
Depression can be classified as severe with psychotic symptoms. Describe the psychotic features which may present.
Delusions and/or hallucinations congruent with the low mood.
- delusions may include ideas of guilt, illness, poverty, nihilistic delusions. can develop cotard’s syndrome (belief that they are dead)
- hallucinations tend to be 2nd auditory. voices telling individual they are worthless etc.
What are the predisposing factors for depression?
1) genetic (3X increased risk if family history of depression) –> Monoamine theory of depression (decrease in brain Noradrenaline &/or 5HT (serotonin))
2) hypothyroidism and Cushing’s disease / other chronic health condition.
3) past physical, emotional, sexual abuse
4) low self esteem
5) isolation
6) drug use / alcohol abuse
7) “vulnerability” factors in working women:
- 3+ children under age of 14
- no work outside home
- no confiding relationship
What might be the precipitating and maintaining factors for depression?
Precipitating:
- adverse life event
- childbirth
Maintaining:
- chronic social difficulties ( poverty, unemployement)
- drug / alcohol abuse.