Depression Flashcards
Definition
Low mood
Changes in the brain regions associated with the regulation of emotion
Depression is the most common mood disturbance. True or false?
True
Age (roughly) of onset
Before the age of 30
It is common/uncommon for a patient’s first episode of mood disorder to present in later life?
Uncommon
More common in males/females?
Females
- sudden increase in female cases during adolescence
Pathophysiology
Changes in brain regions associated with regulation of emotion ->
Altered signalling ->
this alters experience ->
altered behaviour
Common clinical features
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
Depression is typically worse in the morning/evening?
Worse in morning
What is psychomotor retardation?
When it takes much longer than normal to complete normal tasks
MSE components
Appearance and behaviour Speech Mood and affect Thought Perception Cognition Insight
MSE - appearance and behaviour
Reduced facial expression Reduced eye contact Limited gesturing Difficult to establish rapport Defeated posture
MSE - speech
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
What is stupor when thinking about speech?
When people are completely shut down and do not respond to questions
MSE - mood
The patients perspective: Low Miserable Unhappy Flat Empty Black Numb
MSE - affect
Clinicians perspective: Depressed Limited reactivity - doesn't respond accordingly to changes in subject/context/emotion Emotional paralysis
MSE - thought
Form: normal Flow: slow Content: - negative - self accusatory - guilt
MSE - perception
Not much perceptual disturbance
Sensitive to what’s going on around them
Self conscious
Hallucinations can occur
- almost always auditory
MSE - cognition
If thoughts are slowed, cognition is slowed
Poor memory
MSE - insight
Almost always preserved
- people are usually aware of their symptoms
Diagnostic criteria - depressive episode must last at least ___ weeks?
At least 2 weeks
Diagnostic criteria - there must be NO evidence of hypomanic or manic symptoms at any time in the individuals life. True or false?
True
What are the 3 core symptoms of depression?
Low mood
- sustained for at least 2 weeks
Loss of interest or pleasure in activities that are normally pleasurable
Decreased energy
According to ICD-10, what number of symptoms is classified as moderate depression?
At least 2 core symptoms +
4 additional symptoms
= total of (at least) 6
According to ICD-10, what number of symptoms is classified as severe depression?
All 3 core symptoms +
5 additional symptoms
= total of (at least) 8
Mild depression - management
Most resolve without intervention
Don’t do anything for 2-4 weeks
Unresponsive to anti-depressants
What is dysthymia?
Chronic, persistent, low grade, mild depression
Patients are still able to work despite their mood disturbance
Sub-types - somatic syndrome
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
Sub-types - atypical depression
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
Sub-types - psychotic depression
Occasionally paranoid
What is coated syndrome?
Most people deny their own existence
Most common in the elderly
Nihilistic delusions
Management options (broad)
Pharmacological - anti-depressants Non-pharmacological - psychological therapy (CBT) - ECT
Anti depressants are more effective than CBT. true or false?
True
Anti-depressants should work immediately. True or false?
False
- they take 2-6 weeks to work
Which anti-depressants are usually used first line?
SSRIs
When would ECT be given
Consider when you need a quicker response than anti-depressants can offer
If patient is having suicidal thoughts
It is not possible to start ECT and anti-depressants at the same time. True or false?
False
Prognosis
Highly recurrent
Often chronic
