Depression Flashcards
Psychosis
Altered mind and altered relationship with reality
Delusion
Fixed false belief held despite evidence to contrary outwit sociocultural norms
Hallucination
Sensory perception in the absence of external stimuli
Mood
Subjective feeling of sustained emotion (happy, sad)
Affect
Objective immediate conveyance of emotion (blunt, fat, labile)
Depression
Decreased mood (pathological) and decreased function
Bipolar disorder
>2 mood disturbance (minimum 1 hypomania, mania), depression
3 factors contributing to depression
social
psychological
biological
social eitology of depression
- Poor social support
- Socioeconomic disadvantage
- Northernization
psychological aetiology of depression
- Personality traits - anxious, obsessive
- Personality disorders
- Coping skills
- Adverse life events
epidemiology of depression
- Females
- onset at 30
- 5 episodes in lifetime
what is given for moderate depression
Antidepressants
what is given for servere depression
Antidepressants + Antipsychotics, ECT
psychological treatment of depression
- CBT
- Psychotherapy
- Family therapy
Electrotherapy to treat depression
Controlled seizure + anaesthetic
Depression, mania, catatonia
Side effect: memory (rare)
1st, 2nd and 3rd line in treatment of depression
1st: SSRI
2nd: TCAs
3rd: MAOI
SSRI
Block 5HT reuptake
4-5 weeks to have an effect
TCAs
Block 5HT
NA reuptake
MAOI
Block MAO-A
MAO-B – breaks down 5HT, NA, DA in CNS
side effects of SSRI
Nausea, vomiting, weight gain, dizziness, discontinuation syndrome, anxiety, suicidality, mania, serotonin syndrome, cardiac effects (QTc)
side effects of TCAs
Anti-adrenergic (↓BP) Anti-cholinergic
ECG changes (arrhythmia, QTc prolongation)
side effects of MAOI
Hypertensive crisis; ‘cheese reaction’
MAO-A also in GI tract; breaks down tyramine
If blocked, ↑ ↑ BP
social treatments for depression
activities
housing, financial Employment
neurochemical factors in depression
↓ 5HT serotonin
DA dopamine
NA noadrenaline
neuroendocrine factors in depression
↓T3, TSH, ↑ cortisol
discuss the monoamine hypothesis
Metabolites of 5HT ↓ in CSF
Antidepressants work
Neurochemical blockers induce depression
X Antidepressants don’t work immediately
X Antidepressants don’t always work
assessment of depression
Clinical history
Risk assessment
MSE (mental state exam)
Physical exam
Baseline blds
4 differentials for depression
- Dysthymia
- Atypical Depression
- Seasonal Affective Disorder (SAD)
- Adjustment Reaction
- Grief
what is adjustment reaction
Adaptation to stressor
Can include low mood
Onset <1 month from stress Duration <6 months max
what is dysthymia
↓mood, chronic >2yrs but not enough depression
core features of depression
↓ mood +/- anhedonia +/- fatigue
Every day >2 weeks
biological features of depression
Diurnal variation
insomnia
↓ appetite,↓ weight, ↓ libido, constipation, amenorrhoea
Cognitive features of depression
↓ concentration, slow / negative thinking, guilt, loss of self esteem, hopeless, suicidality
Cognitive distortions as feature of depression
Minimizing, magnifying, arbitrary inference, selective abstraction, personalization, overgeneralization, catastrophizin
Psychosis features of depression
Delusions – mood congruent (‘nihilistic’) - -
Hallucinations
severities of depression
Mild – >2 core + >2 associated, function ok
Mod – >2 core + >4 associated, function ↓
Sev – >2 core + >6 associated, function ↓↓ +/- psychosis
outcomes of depression
- Recurrent depressive disorder
- Substance misuse
- Anxiety
- Suicide
- Cardiovascular disease
Cyclothymia
alternating ↓mood (mild), ↑ mood (mild)
