Depression

Question 1

What are the three defining criteria for depression, for which you must have at least 2/3?
(according to ICD-10 section A)

Answer 1

Persistent low mood
Loss of interest / pleasure
Fatigue or low energy

Question 2

Define Anhedonia

Answer 2

Loss of enjoyment

Question 3

Minor criteria for Depression (section B)

Answer 3

Suicidal thoughts
Disturbed sleep
Diminished appetite 
Reduced concentration
Reduced confidence/self esteem
Ideas of guilt and worthlessness
Hopelessness for future

Question 4

ICD-10 Criteria for Minor depression

Answer 4

A - 2/3

B - 2

Question 5

ICD-10 Criteria for moderate depression

Answer 5

2/3 from A

3+ from B

Question 6

ICD-10 Criteria for severe depression

Answer 6

3/3 from A

4+ from B

Question 7

In depression, low mood tends to be diurnal, true or false?

Answer 7

True

Tends to be worst in the morning

Question 8

Define Dysthymia

Answer 8

Longstanding mild depressive symptoms, often associated with other psychiatric or physical illness.

Question 9

Define Atypical Depression

Answer 9

Patient depressive symptoms include excess sleep, increased appetite and phobic anxiety.

Question 10

What class of drugs do atypical depression patients respond well to?

Answer 10

Monoamine Oxidase Inhibitors

Question 11

Depression occurs more in men? true/false

Answer 11

False
Ratio of depression is 1:2
M:F

Question 12

List some defining features of the appearance of a patient with depression?

Answer 12

Furrowed brow
Reduced eye contact
Reduced facial expressions
Minimal/limited gesturing
Difficult to build rapport
Potentially dishevelled and unkempt
Appearance of not sleeping

Question 13

List some defining features of speech in a patient suffering from depression

Answer 13

Reduced rate
Lowered volume
Reduced intonation
Lowered pitch
Minimal content
Increased speech latencies

Question 14

In depression, a patient’s insight tends to be impaired. True/False?

Answer 14

False

Patients suffering from depression tend to retain insight

Question 15

What is somatic syndrome?

Answer 15

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

Question 16

Define a depressive stupor:

Answer 16

When psychomotor retardation leads to the patient being motionless and mute
Can be fatal if patient suffers from dehydration
ECT is choice of treatment

Question 17

Define Cotard’s Syndrome:

Answer 17

Patient with psychotic depression thinks that a part of their body is dead

Question 18

Biological Factors which contribute to Depressive disorder

Answer 18

• Genes
• Medical conditions (organic disorders)
• Altered HPA axis function
• Monoamine Abnormalities
• Chronic Health conditions

Question 19

Psychological factors which contribute to Depressive Disorders

Answer 19

Childhood environment
Emotional deprivation / parental loss
Abnormal cognition
Personalist factors e.g. neuroticism

Question 20

Social Factors which can contribute to Depressive Disorders

Answer 20

Isolation
Unemployment
Abuse
Bereavement
Relationship problems
Drug misuse / addictions

Question 21

What is normally first line pharmacological treatment for depression?

Answer 21

SSRI’s

e.g. fluoxetine

Question 22

What must you monitor for when prescribing SSRI’s to patients <25 y/o?

Answer 22

Suicidal thoughts

SSRI’s are known to increase suicidal tendencies in patients, especially under 25 y/o

Question 23

How long must you continue anti-depressant treatment once episode has been resolved?

Answer 23

6 months to a year

Question 24

What factors can contribute to your management plan for depression?

Answer 24

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

Question 25

Up to 2/3rds of patients do not respond to initial treatment? True/False

Answer 25

True

2/3rds of patients do not respond to first line treatment in depression

Question 26

What things can be done to improve response to treatment?

Answer 26

Increase dose
Add adjunctive therapy
Change class of drugs
Check patient compliance
Check timeline - most drugs take at least 6 weeks to become effective

Question 27

What other therapies are available, besides pharmacological, for depression?

Answer 27

CBT
Talking therapy
Counselling
ECT

Question 28

What % of patients who suffer from depression will relapse?

Answer 28

> 50%

Question 29

Risk of suicide is increased in patients with depression. True/False

Answer 29

True

Risk increase 10x

Question 30

What is the mean age of onset of depression?

Answer 30

20’s

Question 31

Define psychomotor retardation?

Answer 31

When there is a subjective or objective slowing of thoughts

Question 32

What counts as “early morning wakening”?

Answer 32

When the patient wakes at least 2 hours earlier than their normal and does not return to sleep

Question 33

Define Psychotic Depression

Answer 33

Depression associated with occasional paranoia’s e.g. cotards syndrome

Question 34

List some physical (organic) diseases which can induce depression-like symptoms:

Answer 34

Hypothyroidism
Hypoglycaemia
Steroid Treatment 
Brain Tumour 
Cushing's disease

Question 35

List some physical symptoms which can be manifestations of depressive disorders?

Answer 35

Headache
Fatigue
Loss of appetite
Weight loss
constipation 
Loss of libido
Insomnia 
Muscle aches/pains