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Phase 2 5. People and Illness > Depression > Flashcards

Depression Flashcards

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1
Q

What is psychiatry?

A

medical speciality concerned with the diagnosis, treatment and prevention of mental health disorders

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2
Q

What is the different between a psychiatrist and a psychologist?

A
  • psychiatrist = medical degree, assess, diagnose, treat
  • psychologist = pyschology degree, postgrad clinical psycology, asses, formulate, treat

work together and very similar

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3
Q

what is the incidence of psychiatric conditions in the UK?

A

1 in 4 per year in UK

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4
Q

How many people worldwide are estimated to have a psychiatric condition?

A

500 million people globally

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5
Q

What is the diagnostic hierarchy in psychiatry?

A

the order in which disorders need to be excluded before reaching a diagnosis

  • organic
  • schizophrenia and related disorders
  • bipolar spectrum disorders
  • depressive disorders
  • anxiety and somatoform disorders
  • personality disorders
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6
Q

What is an organic disorder in psychiatry?

A

change in mental function that is secondary to physical processes rather than a psychiatric illness

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7
Q

Why are organic disorders assessed for first?

A
  • mimic psychiatric disorders
  • usually life-threatening that need immediate treatment
  • usually reversible
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8
Q

How are anxiety disorders and personality disorders diagnosed?

A
  • usually a diagnosis of exclusion
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9
Q

What is psychosis?

A

altered relationship with reality

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10
Q

What is a delusion?

A
  • fixed false belief
  • held despite evidence to the contrary
  • outwith sociocultural norms
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11
Q

What is a hallucination?

A

sensory perception in the absence of external stimuli

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12
Q

What is an illusion?

A

misperception of real external stimuli

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13
Q

What is depression?

A

pathologically low mood that impacts on function

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14
Q

What is mood?

A

subject feeling of sustained emotion

patient will report

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15
Q

What is affect?

A

Objective immediate conveyance of emotion

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16
Q

What is euthymia?

A

Normal mood state

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17
Q

What is mania?

A

elevated mood

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18
Q

What is hypomania?

A

mildly elevated mood

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19
Q

What is subsyndromal depression?

A

mild depression

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20
Q

What is bipolar disorder?

A

more than 2 mood disturbances one of which is mania

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21
Q

What causes depression?

A
  • biological
  • psychological
  • social
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22
Q

What are the biological causes of depression?

A
  • Genetic link
  • medical comorbidities (hypothyroid, heart failure, MS, CVA)
  • psychiatric comorbidities (schizophrenia)
  • medications (steroids in cushings)
  • neurochemical ( low serotonin, noradrenalin, dopamine)
  • neuroendocrine (low t3, tsh, high cortisol)
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23
Q

Describe the pathogenesis of depression from a biological point of view

A

neurochemical theory - monoamine hypothesis

+ serotonin cant be measured in the brain, but metabolites can be measured in the CSF = decreased
+ antidepressants work
+ neurochemical blockers induce depression

  • antidepressants dont work immediately
  • antidepressants dont always work
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24
Q

What are monoamines?

A
  • serotonin
  • dopamine
  • neoradrenaline
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25
Q

What are the psychological causes of depression?

A
  • personality traits (anxious, obsessive)
  • personality disorders
  • maladaptive coping skills
  • adverse life events (losses)
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26
Q

What are the social causes of depression?

A
  • poor social support
  • socioeconomic disadvantage
  • northernization = the more north of the equator, the more likely to be depressed
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27
Q

Describe the epidemiology of depression

A
  • point prevelance = 4-6%
  • lifetime incidence = 20%
  • any age (mean 30)
  • female:male = 2:1

5 mean episodes per lifetime

28
Q

What are the clinical features of depression

A

Core symptoms:
= low mood +/- anhedonia +/- fatigue

every day for >2 weeks

29
Q

How id depression diagnosed?

A

using guidelines = ICD-10 from WHO

30
Q

What is anhedonia?

A

Loss of enjoyment/pleasure in things you used to enjoy

31
Q

What are the associated symptoms of depression?

A

Biological:

  • diurnal variation
  • insomnia
  • decreased appetite
  • decreased weight
  • decreased libido
  • constipation
  • amenorrhoea

(tend to apply in more severe forms of depression)

32
Q

What are the cognitive features of depression?

A
  • decreased concentration
  • slow/negative thinking
  • guilt
  • loss of self esteem
  • hopelessness
  • suicidality

Beck’s cognitive triad (negative thinking about the world, the future and oneself)

33
Q

What cognitive distortions are linked with depression?

A
  • minimizing
  • magnifying
  • arbitrary
  • inference
  • selective abstraction
  • personalization
  • over-generalisation
  • catastrophizing
34
Q

What is psychotic depression?

A

If depression becomes severe enough it can tip over into psychosis

  • delusions: mood congruent (‘nihilistic’ - match the mood of depression)
    • guilt
    • poverty
    • hypochondriasis
    • persecutory
  • hallucinations: auditory second person “you’re stupid”
35
Q

What is cotard’s syndrome?

A

self or part of self is dead

36
Q

How is depression categorised?

A

mild: >2 core +/- 2 associated, function ok
moderate: >2 core +/- 4 associated, function decreased
severe: >2 core +/- 6 associated, function severely decreased

if psychosis present = severe

37
Q

What are outcomes of depression?

A
  • recurrent depressive disorder
  • substance misuse
  • anxiety
  • suicide (attempted/completed)
  • cardiovascular disease
38
Q

What are the differentials of depression?

A
  • dysthymia
  • atypical depression (SAD)
  • adjustment reaction
  • grief
39
Q

What is dysthymia?

A

mildly decreased mood more more than 2 years, but not enough to be classed as depression

40
Q

What is cyclothymia?

A

alternating mild depression and mild mania, but not enough to be classed as bipolar

41
Q

What is adjustment reaction?

A
  • adaptation to stressor
  • can include low mood
  • onset <1 month from stress
  • duration <6 months max
42
Q

What is the Kubler-Ross model of grief?

A
  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance
43
Q

Describe abnormal grief

A
  • intense
  • prolonged (> 6 months)
  • delayed (2 weeks)
  • absent (inhibited)
44
Q

How is depression assessed?

A
  • clinical history
  • risk assessment
  • MSE
  • physical exam
  • baseline bloods
45
Q

How is life threatening depression treated?

A

(= suicidal, self neglect)

  • may need hospitalisation
  • if refusing treatment, may need to be detained under the mental health act
46
Q

What is the biological treatment for depression?

A

Moderate depression: antidepressants

Severe: antidepressants + antipsychotics, ECT

47
Q

Name examples of SSRIs?

A

(selective serotonin reuptake inhibitors)

  • citalopram
  • fluoxetine
  • sertraline

[also: SNRI, SARI, NASSA, NRI, DRI, NRDI, SPARI]

48
Q

Name examples of TCAs

A

(tricyclics)

  • amitryptiline
  • doxepine
  • amoxapine
49
Q

Name examples of MAOIs

A

(monoamine oxidase inhibitors)

  • isocarboxid
  • phenelzine
  • moclobemide
50
Q

Describe the normal role or serotonin

A

Seortonin is produced in the neurons of the central nervous system and is released from the presynaptic cell, crossing the synapse, attaches to a receptor to induce a messenger in the postsynaptic cell. Then it gets reabsorbed in the presynaptic cell.

51
Q

How do SSRI’s work?

A

block the reuptake of serotonin, which increases the amount pr3esent in the synapse and magnifies its effects

52
Q

Which antidepressent can be used to increase alertness in someone experiencing fatigue with depression?

A

Venlafaxine (SNRI)

53
Q

Which antidepressent can be used to decrease alertness in someone experiencing insomnia with depression?

A

Mirtazepine (NASSA)

54
Q

What are the side effects of SSRIs?

A
  • nausea
  • vomiting
  • weight gain
  • dizziness
  • anxiety
  • mania
  • serotonin syndrome
  • cardiac effects

be aware of discontinuation syndrome

55
Q

What is the response rate of antidepressants?

A
  • 33% will respond immediately
  • 33% will respond after switching antidepressants
  • 33% wont respond at all
56
Q

What are first line antidepressants?

A

SSRIs

57
Q

What are second line antidepressants?

A

TCAs

58
Q

What are third line antidepressants?

A

MAOIs

59
Q

How do TCA’s work?

A

block serotonin, noradrenaline reuptake

usually more potent than SSRIs but more adverse effects

60
Q

What are the side effects of TCAs?

A
  • antiadrenergic (decrease BP)
  • anticholinergic (cant see, cant pee, cant shit, cant spit)
  • more profound ECG changes (arrythmias, QTc prolonged)
61
Q

How do MAOIs work?

A

monoamine oxidase = enzyme that breaks down serotonin, noradrenaline and dopamine in the CNS

MAOIs inhibit this enzyme

62
Q

What are the side effects of MAOIs?

A

hypertensive crisis = ‘cheese reaction’

MAO-A also in GI tract that breaks down tyramine (found in cheese and other foods)

Using MAOIs can cause this - patients on strict avoidance diet

If blocked, increases BP

63
Q

What is ECT?

A

electrotherapy

  • controlled seizure and anaesthetic
  • used in depression, mania, catatonia
  • more effective than drugs

can promote healing of certain cells and increases neurotransmitters, redirects blood flow

64
Q

What are the side effects of ECT?

A
  • anaesthetic risks
  • memory (confused)
  • in rare cases - memory loss
65
Q

What are the primary talking therapies used in the treatment of depression?

A
  • CBT
  • Psychotherapy
  • Family therapy
66
Q

What is CBT?

A

thoughts, feelings, behaviours and physical is interlinked

by working on thoughts, can improve other aspects of life

usually intensive ~12 weeks
teaches skills for life

67
Q

What are the social treatments of depression?

A
  • occupational therapy (activity scheduling)
  • social workers (housing, financial)
  • Employment

Phase 2 5. People and Illness (21 decks)

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