Depression

Question 1

What is an organic disorder?

Answer 1

A change in mental function secondary to a physical process other than psychiatric illness e.g. confusion due to a UTI.

Question 2

Define psychosis?

Answer 2

Altered relationship with reality

Question 3

Deine delusion?

Answer 3

Fixed false belief eld despite evidence to disprove it, outwith socio-cultural norms.

Question 4

Define hallucination?

Answer 4

A sensory perception in the absence of external stimuli.

Question 5

Define illusion?

Answer 5

Misperception of real external stimuli.

Question 6

Define mood?

Answer 6

Subjective feeling of sustained emotion.

Question 7

Define affect?

Answer 7

Objective immediate conveyance of emotion.

Question 8

Define depression?

Answer 8

Pathological low mood that impacts on daily functioning.

Question 9

Define Euthymia?

Answer 9

normal mood

Question 10

Define mania?

Answer 10

Excessively elevated mood

Question 11

Define hypomania?

Answer 11

Slightly elevated mood.

Question 12

How is bipolar disorder determined?

Answer 12

> 2 mood disturbances with at least one being of elevated mood.

Question 13

Describe biological factors in the aeitiology of depression?

Answer 13

Genetics
Medical conditions - thyroid, stroke
Psychiatric conditions - anxiety, alcohol, drugs
Medications - Steroids (can cause mania, but in cushings causes depression).
Neurochemical changes - Decreased 5HT, NA and DA
Neuroendocrine - low thyroid hormones, or increased cortisol.

Question 14

Describe the ‘monoamine hypothesis’? How can it be measured?

Answer 14

That a decrease in 5HT, NA and DA are seen in depression.
Only a hypothesis as it cant be measured directly, although metabolites can be measured in CSF (these are reduced).
Also anti-depressions which increase levels of neurotransmitters work in most patients.

Question 15

Describe psychological factors in the aeitiology of depression?

Answer 15

Vunerable personality traits - anxious or obsessive
Personality disorders
Coping skills
Adverse life events

Question 16

Describe social factors in the aetiology of depression?

Answer 16

Poor social support
Socioeconomic disadvantage
Northernisation - low UV exposure?

Question 17

Describe the epidemiology of depression

Answer 17

mean age - 30
2:1 female to male
Lifetime incidence 20% with and average of 5 depressive episodes (6 months)
1/3rd dont seek help

Question 18

Describe the diagnostic criteria of depression?

Answer 18

2 out of low mood, anhedonia and fatigue every day for > 2 weeks.

Question 19

Give examples of clinical features of depression?
Biological 
Cognitive 
Cognitive distortions 
Psychosis?

Answer 19

Anhedonia, fatigue, low mood.
Decreased appetite, weight, libido, insomnia, constipation.

Decreased concentration, guilt, low self esteem, suicidality.

Minimising (good things), Magnifying (negative events), Selective abstraction (small bit of evidence blown out of proportion), catastophising.

Delusions - including Cotards syndrome (think they or part of them is dead). Hallucinations - often auditory in 2nd (youre stupid) or 3rd person (Catherines stupid).

Question 20

How is depression graded?

Answer 20

Mild: 2 core + 2 associated (have ok function)
Moderate: 2 core + 4 associated (decreased function)
Severe: 2 core + 6 associated +/- psychosis (really decreased function).

Question 21

Define dysthymia?

Answer 21

Chronic low mood >2 years, but not enough to be depression.

Question 22

Define Seasonal Affective Disorder?

Answer 22

Symptoms around winter time. Possibly due to lack of UV. Must happen for 3 consecutive years.

Question 23

Outline the stages of grief?

Answer 23

Denial 
Anger 
Bargaining 
Depression 
Acceptance

Question 24

Describe assesment for depression?

Answer 24

Clinical history 
Risk assesment - harm to self or others?
Mental State Exam 
Physical exam - ensure no organic causes. 
Baseline bloods

Question 25

Outline treatment for mild, moderate and severe depression?

Answer 25

Mild - Behavioural therapy
Moderate - Behavioural therapy and anti-depressants
Severe - Behavioural therapy, antidepressants, antipsychotics, ECT.

Question 26

Describe first line drug treatment for depression?

Answer 26

SSRI-like Drugs e.g. Fluoxetine or Sertrilline
Block seratonin reuptake - magnify effects on post-synaptic cell.
Takes 4-5 weeks to have an effect.
Side effects: Nausea, weight gain, dizziness, cardiac (prolonged QTc) suicidality (may have motivation to act on negative thoughts).

Question 27

Describe 2nd line drug treatment of depression?

Answer 27

Tricyclic Antidepressants e.g. Amitryptyline.
Blocks seratonin and NA reuptake.
More profound effect than SSRI’s, but more side effects.
Side Effects : Antiadrenergic - decreased BP.
Anticholinergic: Cant see, cant pee, cant shit, can spit. More prolonged QTc.

Question 28

Describe 3rd line drug treatment for depression?

Answer 28

Monoamine Oxidase Inhibitors e.g. Moclobamide or Selegiline.

Block monoamine oxidase so it cant break down monoamines.

Question 29

What must be avoided in monoamine oxidase inhibitor therapies? Why?

Answer 29

Cheese as it contains tyramine which is normally broken down in GI tract. If it cant be broken down get hypertensive crisis.

Question 30

Describe ECT?

Answer 30

Electroconvulsive therapy.
Under anaesthesia, an electrical current is administered to cause a controlled seizure.
This increases NT’s in the brain, and redirects blood flow and promotes cellular healing.
May suffer a memory deficit and there is anaesthetic risk.

Question 31

Outline types of behavioural therapy?

Answer 31

CBT - looks at thoughts and behaviours. Do ‘homework’ in a stepped approach.
Lasts 12-24 weeks.
Learn skills for life.

Psychotherapy - talking to a therapist

Family therapy

Question 32

Outline social therapy for depression?

Answer 32

Occupational therapy - look at activity scheduling.
Social work - housing or financial help.
Employment aids.