Depression

Question 1

Definition

Answer 1

Low mood

Changes in the brain regions associated with the regulation of emotion

Question 2

Depression is the most common mood disturbance. True or false?

Answer 2

True

Question 3

Age (roughly) of onset

Answer 3

Before the age of 30

Question 4

It is common/uncommon for a patient’s first episode of mood disorder to present in later life?

Answer 4

Uncommon

Question 5

More common in males/females?

Answer 5

Females

- sudden increase in female cases during adolescence

Question 6

Pathophysiology

Answer 6

Changes in brain regions associated with regulation of emotion ->
Altered signalling ->
this alters experience ->
altered behaviour

Question 7

Common clinical features

Answer 7

Reduced enjoyment/interest 
Decreased energy
Psychomotor retardation
Sleep disturbance - early morning wakening 
Loss of confidence 
Guilt 
Diminished concentration
Agitation or retardation
Suicidal behaviour 
Change in appetite 
Weight change 
Loss of sex drive

Question 8

Depression is typically worse in the morning/evening?

Answer 8

Worse in morning

Question 9

What is psychomotor retardation?

Answer 9

When it takes much longer than normal to complete normal tasks

Question 10

MSE components

Answer 10

Appearance and behaviour 
Speech 
Mood and affect
Thought 
Perception
Cognition 
Insight

Question 11

MSE - appearance and behaviour

Answer 11

Reduced facial expression
Reduced eye contact 
Limited gesturing 
Difficult to establish rapport
Defeated posture

Question 12

MSE - speech

Answer 12

Reduced rate (slow) 
Low pitch 
Reduced volume (quiet)
Monotonous 
Increased speech latencies
- longer time between the end of a question and the patient starting to reply 
Short answers

Question 13

What is stupor when thinking about speech?

Answer 13

When people are completely shut down and do not respond to questions

Question 14

MSE - mood

Answer 14

The patients perspective:
Low 
Miserable 
Unhappy
Flat
Empty
Black
Numb

Question 15

MSE - affect

Answer 15

Clinicians perspective:
Depressed 
Limited reactivity
- doesn't respond accordingly to changes in subject/context/emotion
Emotional paralysis

Question 16

MSE - thought

Answer 16

Form: normal
Flow: slow 
Content:
- negative 
- self accusatory
- guilt

Question 17

MSE - perception

Answer 17

Not much perceptual disturbance
Sensitive to what’s going on around them
Self conscious

Hallucinations can occur
- almost always auditory

Question 18

MSE - cognition

Answer 18

If thoughts are slowed, cognition is slowed

Poor memory

Question 19

MSE - insight

Answer 19

Almost always preserved

- people are usually aware of their symptoms

Question 20

Diagnostic criteria - depressive episode must last at least ___ weeks?

Answer 20

At least 2 weeks

Question 21

Diagnostic criteria - there must be NO evidence of hypomanic or manic symptoms at any time in the individuals life. True or false?

Answer 21

True

Question 22

What are the 3 core symptoms of depression?

Answer 22

Low mood
- sustained for at least 2 weeks

Loss of interest or pleasure in activities that are normally pleasurable

Decreased energy

Question 23

According to ICD-10, what number of symptoms is classified as moderate depression?

Answer 23

At least 2 core symptoms +
4 additional symptoms
= total of (at least) 6

Question 24

According to ICD-10, what number of symptoms is classified as severe depression?

Answer 24

All 3 core symptoms +
5 additional symptoms
= total of (at least) 8

Question 25

Mild depression - management

Answer 25

Most resolve without intervention Don't do anything for 2-4 weeks Unresponsive to anti-depressants

Question 26

What is dysthymia?

Answer 26

Chronic, persistent, low grade, mild depression Patients are still able to work despite their mood disturbance

Question 27

Sub-types - somatic syndrome

Answer 27

``` 4 of the following symptoms: Marked loss of interest/pleasure Lack of emotional reactions Waking in the morning at least 2 hours before usual time Depression worse in morning Marked loss of appetite Weight loss Loss of libido Objective evidence of marked psychomotor retardation or agitation ```

Question 28

Sub-types - atypical depression

Answer 28

Must have - mood reactivity (mood brightens in response to actual or potential positive events) + 2 or more of the following: - significant weight gain or increase in appetite - hypersomnia - leaden paralysis - interpersonal rejection

Question 29

Sub-types - psychotic depression

Answer 29

Occasionally paranoid

Question 30

What is coated syndrome?

Answer 30

Most people deny their own existence Most common in the elderly Nihilistic delusions

Question 31

Management options (broad)

Answer 31

``` Pharmacological - anti-depressants Non-pharmacological - psychological therapy (CBT) - ECT ```

Question 32

Anti depressants are more effective than CBT. true or false?

Answer 32

True

Question 33

Anti-depressants should work immediately. True or false?

Answer 33

False | - they take 2-6 weeks to work

Question 34

Which anti-depressants are usually used first line?

Answer 34

SSRIs

Question 35

When would ECT be given

Answer 35

Consider when you need a quicker response than anti-depressants can offer If patient is having suicidal thoughts

Question 36

It is not possible to start ECT and anti-depressants at the same time. True or false?

Answer 36

False

Question 37

Prognosis

Answer 37

Highly recurrent | Often chronic