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Old age psychiatry > Depression > Flashcards

Depression Flashcards

1
Q

prevalence

A

-aged over 65- 10-15%

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2
Q

Depressive disorders in hospitalised patients

A

-2-3x more common in hospitalised patients, nursing home residents or outpatients with chronic medical disorders

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3
Q

Medical disorders

A
  • Cardiovascular disease
  • CNS disease
  • Cancer
  • all associated with high risk for depression
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4
Q

Depression in dementia

A

-25%

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5
Q

Racial differences

A
  • elderly african americans have been noted to have less depression than elderly caucasians
  • may be due to communities
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6
Q

Clinical features

A
  • low mood is less prominent in depression affecting patients in old age
  • hypochondriasis or deluisons are common
  • poor memory
  • late onset neurotic symptoms
  • apathy and poor motivation may predominate
  • anorexia, weightloss and anergia
  • paranoia and delusions
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7
Q

Risk factors for late life depression

A
  • female sex
  • poor health
  • disability
  • poor perceived social support
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8
Q

Neuroimaging studies in late onset depression

A
  • includes ischemic changes, reduction in grey matter volume in frontal and temporal lobes
  • sulcal widening
  • reduction in the volume of the caudate nucleus
  • ventricular enlargement
  • reduction in volume of the hippocampus
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9
Q

CT

A

-cortical atrophy and ventricular enlargement

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10
Q

MRI

A
  • atrophy
  • ventricular enlargement
  • lesions in basal ganglia
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11
Q

SPECT

A

-reduced cerebral blood flow, sparing the posterior parietal cortex

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12
Q

Antidepressants

A
  • response rate is comparable to younger adults
  • NNT=4
  • lower doses should be used initially
  • needs long maintenance period
  • SSRI is first line
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13
Q

SSRIs

A
  • can cause GI haemorrhage
  • can induce hyponatraemia
  • takes 6-8 weeks to respond to antidepressants
  • 30% do not respond
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14
Q

ECT

A
  • remains the most effective treatment available for severe depression
  • recovery rate is 80%
  • well tolerated in the elderly
  • memory impairment is worse with bilateral electrode lacement
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15
Q

Psychological intervention

A
  • rarely offered
  • but may be as effective as medication
  • combination of antidepressants and psychotherapy is more effective than the single use of either
  • CBT is very good
  • interpersonal therapy is good for relapse prevention
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16
Q

Prognosis

A
  • older adults are thought to be at greater risk for chronicity of depression than younger persons
  • may not actually be any different in rate of remission but relapse rates are higher
17
Q

Mortality

A
  • higher in older patients with depression because of concurrent physical disorders
  • depression exacerbates the poor outcome of medical illnesses
  • 4x more likely to die within 4 months of an MI than those without depression
18
Q

Risk of CV disease

A
  • platelet aggregation is raised in depressed patients

- depression may increase the risk of CV disease

19
Q

Inflammatory markers in depression

A
  • poor T-cell responses to mitogens
  • high concentrations of plasma interleukin 6
  • these increase risk for bone resporption and predispose for fractures
20
Q

Geriatric depression scale

A
  • 15 items

- score of over 5 suggests depression

21
Q

BASDEC

A
  • brief assessment schedule depression cards
  • true or false answers
  • designed for liaison psychiatry
22
Q

Hamilton rating scale

A
  • has a number of somatic items

- less appropriate for older subjects

23
Q

MADRS

A
  • sensitive to change in depressive illness

- not reliably answered by patients with dementia

24
Q

Depressive sign scale

A

-nine items to help detect depression in people with dementia

25
Q

CSDD

A
  • cornell scale for depression in dementia

- best valadated scale for detecting depression in dementing patients

26
Q

Patient health questionnaire

A
  • PHQ-9
  • 9 item self-report scale widely used in UK primary care
  • easy use has demonstrated sensitivity to change
  • less validated among older older subjects
27
Q

Cognitive impairment in depression

A
  • deficits in attention and executive dunctions seen in late onset depression
  • pseudodementia occurs
  • 40% develop true dementia within 3 years of follow up
28
Q

Vascular depression

A
  • cerebral ischemic damage to the frontal subcortical circuits could predispose, precipitate and perpetuate late onset depression
  • vascular risk factors were found to be highly significantly associated with late onset depression
  • affected individuals have more apathy, retardation and lack of insight with less agitation
29
Q

Deep white matter lesions

A
  • more common in depressed than non-depressed older people
  • more common in late onset than early onset depression
  • seen on MRI

Old age psychiatry (18 decks)

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