Depression Flashcards
What are the three defining criteria for depression, for which you must have at least 2/3?
(according to ICD-10 section A)
Persistent low mood
Loss of interest / pleasure
Fatigue or low energy
Define Anhedonia
Loss of enjoyment
Minor criteria for Depression (section B)
Suicidal thoughts Disturbed sleep Diminished appetite Reduced concentration Reduced confidence/self esteem Ideas of guilt and worthlessness Hopelessness for future
ICD-10 Criteria for Minor depression
A - 2/3
B - 2
ICD-10 Criteria for moderate depression
2/3 from A
3+ from B
ICD-10 Criteria for severe depression
3/3 from A
4+ from B
In depression, low mood tends to be diurnal, true or false?
True
Tends to be worst in the morning
Define Dysthymia
Longstanding mild depressive symptoms, often associated with other psychiatric or physical illness.
Define Atypical Depression
Patient depressive symptoms include excess sleep, increased appetite and phobic anxiety.
What class of drugs do atypical depression patients respond well to?
Monoamine Oxidase Inhibitors
Depression occurs more in men? true/false
False
Ratio of depression is 1:2
M:F
List some defining features of the appearance of a patient with depression?
Furrowed brow Reduced eye contact Reduced facial expressions Minimal/limited gesturing Difficult to build rapport Potentially dishevelled and unkempt Appearance of not sleeping
List some defining features of speech in a patient suffering from depression
Reduced rate Lowered volume Reduced intonation Lowered pitch Minimal content Increased speech latencies
In depression, a patient’s insight tends to be impaired. True/False?
False
Patients suffering from depression tend to retain insight
What is somatic syndrome?
When a patient experiences at least 4/6 of the following:
- Loss of libido
- weight loss
- loss o appetite
- Diurnal variation
- Early wakening
- Psychomotor retardation
- Marked loss of interest
- Lack of emotional reactions
Define a depressive stupor:
When psychomotor retardation leads to the patient being motionless and mute
Can be fatal if patient suffers from dehydration
ECT is choice of treatment
Define Cotard’s Syndrome:
Patient with psychotic depression thinks that a part of their body is dead
Biological Factors which contribute to Depressive disorder
- Genes
- Medical conditions (organic disorders)
- Altered HPA axis function
- Monoamine Abnormalities
- Chronic Health conditions
Psychological factors which contribute to Depressive Disorders
Childhood environment
Emotional deprivation / parental loss
Abnormal cognition
Personalist factors e.g. neuroticism
Social Factors which can contribute to Depressive Disorders
Isolation Unemployment Abuse Bereavement Relationship problems Drug misuse / addictions
What is normally first line pharmacological treatment for depression?
SSRI’s
e.g. fluoxetine
What must you monitor for when prescribing SSRI’s to patients <25 y/o?
Suicidal thoughts
SSRI’s are known to increase suicidal tendencies in patients, especially under 25 y/o
How long must you continue anti-depressant treatment once episode has been resolved?
6 months to a year
What factors can contribute to your management plan for depression?
Previous treatments and response to them?
Family history of depression/use of anti-depressants
Patient’s preference
Suicide risk in patient - some are more toxic
Sedative effects - required or not
Up to 2/3rds of patients do not respond to initial treatment? True/False
True
2/3rds of patients do not respond to first line treatment in depression
What things can be done to improve response to treatment?
Increase dose Add adjunctive therapy Change class of drugs Check patient compliance Check timeline - most drugs take at least 6 weeks to become effective
What other therapies are available, besides pharmacological, for depression?
CBT
Talking therapy
Counselling
ECT
What % of patients who suffer from depression will relapse?
> 50%
Risk of suicide is increased in patients with depression. True/False
True
Risk increase 10x
What is the mean age of onset of depression?
20’s
Define psychomotor retardation?
When there is a subjective or objective slowing of thoughts
What counts as “early morning wakening”?
When the patient wakes at least 2 hours earlier than their normal and does not return to sleep
Define Psychotic Depression
Depression associated with occasional paranoia’s e.g. cotards syndrome
List some physical (organic) diseases which can induce depression-like symptoms:
Hypothyroidism Hypoglycaemia Steroid Treatment Brain Tumour Cushing's disease
List some physical symptoms which can be manifestations of depressive disorders?
Headache Fatigue Loss of appetite Weight loss constipation Loss of libido Insomnia Muscle aches/pains
