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Psychiatry SOH > Depression > Flashcards

Depression Flashcards

1
Q

Definition

A

Low mood

Changes in the brain regions associated with the regulation of emotion

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2
Q

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

A

True

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3
Q

Age (roughly) of onset

A

Before the age of 30

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4
Q

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

A

Uncommon

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5
Q

More common in males/females?

A

Females

- sudden increase in female cases during adolescence

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6
Q

Pathophysiology

A

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

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7
Q

Common clinical features

A 
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
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8
Q

Depression is typically worse in the morning/evening?

A

Worse in morning

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9
Q

What is psychomotor retardation?

A

When it takes much longer than normal to complete normal tasks

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10
Q

MSE components

A 
Appearance and behaviour 
Speech 
Mood and affect
Thought 
Perception
Cognition 
Insight
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11
Q

MSE - appearance and behaviour

A 
Reduced facial expression
Reduced eye contact 
Limited gesturing 
Difficult to establish rapport
Defeated posture
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12
Q

MSE - speech

A 
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
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13
Q

What is stupor when thinking about speech?

A

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

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14
Q

MSE - mood

A 
The patients perspective:
Low 
Miserable 
Unhappy
Flat
Empty
Black
Numb
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15
Q

MSE - affect

A 
Clinicians perspective:
Depressed 
Limited reactivity
- doesn't respond accordingly to changes in subject/context/emotion
Emotional paralysis
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16
Q

MSE - thought

A 
Form: normal
Flow: slow 
Content:
- negative 
- self accusatory
- guilt
17
Q

MSE - perception

A

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

Hallucinations can occur
- almost always auditory

18
Q

MSE - cognition

A

If thoughts are slowed, cognition is slowed

Poor memory

19
Q

MSE - insight

A

Almost always preserved

- people are usually aware of their symptoms

20
Q

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

A

At least 2 weeks

21
Q

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

A

True

22
Q

What are the 3 core symptoms of depression?

A

Low mood
- sustained for at least 2 weeks

Loss of interest or pleasure in activities that are normally pleasurable

Decreased energy

23
Q

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

A

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

24
Q

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

A

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

25
Q

Mild depression - management

A

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

26
Q

What is dysthymia?

A

Chronic, persistent, low grade, mild depression

Patients are still able to work despite their mood disturbance

27
Q

Sub-types - somatic syndrome

A 
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
28
Q

Sub-types - atypical depression

A

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

29
Q

Sub-types - psychotic depression

A

Occasionally paranoid

30
Q

What is coated syndrome?

A

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

31
Q

Management options (broad)

A 
Pharmacological 
- anti-depressants 
Non-pharmacological 
- psychological therapy (CBT)
- ECT
32
Q

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

A

True

33
Q

Anti-depressants should work immediately. True or false?

A

False

- they take 2-6 weeks to work

34
Q

Which anti-depressants are usually used first line?

A

SSRIs

35
Q

When would ECT be given

A

Consider when you need a quicker response than anti-depressants can offer

If patient is having suicidal thoughts

36
Q

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

A

False

37
Q

Prognosis

A

Highly recurrent

Often chronic

Psychiatry SOH (19 decks)

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