Depression Flashcards
Peak of depression in terms of life span?
2nd,3rd and 4th decade
What is anhedonia?
Loss of enjoyment/ pleasure
What is anergia?
Lack of energy
Describe the diurnal variation of depression?
Worse in the morning and gets worse as the days go on
What is stupor in terms of depression?
The absence of relational functions i.e. action and speech
What is psychomotor retardation in terms of depression?
Subjective or objective slowing of thoughts and/or movement
What is euthymia?
Normal mood
What is the phenomenology of depression in terms of appearance and behaviour?
Reduced facial expression Brow is classically furrowed Reduced eye contact Limiting gesturing; movement may be slowed, or absent Rapport is often difficult to establish
What can be seen in the speech category of the MSE in depression?
Reduced rate of speech Lowered in pitch Reduced in volume Reduced intonation Increased speech latencies Limited content
What encompasses mood as part of the MSE?
Prolonged prevailing state or deposition; typically associated with what the patient describes; subjective
“How do you feel”
What encompasses affect as part of the MSE?
Mood applied to things; events, people etc
Objective observation
How patient reacts to event changes
What is the mood like in an MSE for depression?
Low, miserable, unhappy, sad Flat Empty Black Numb
Describe the affect in depression in an MSE?
Depressed; low
Reduced range; stays low throughout
Limited reactivity; affect doesn’t respond or react to changes in subject, context, or emotion
May report emotional paralysis
Describe the form of thought seen in depression
Normal
Describe the flow of thought in depression?
Thoughts are slowed, pondering
Can be absent; subjectively or objectively
Describe the content of thought in depression?
Negative, self accusatory Failure Guilt Low-self esteem Pessimism Delusions; guilt, poverty, nihilism, hypochondriasis
Is there commonly a perceptual disturbance in depression?
No
What hallucinations can occurs in depression?
Almost always auditory
Usually 2nd person and derogatory
Typically are mood congruent and reflect the negative and depressive themes
Is there paranoia in depression?
Increased sensitivity to criticism of others; often tied to guilt/ self blame
More self-conscious and self-aware
Feeling of being under scrutiny
Is there paranoia in psychosis?
May have a bizarre quality
Other symptoms; persecutory ideas/delusions, altered perceptions
Insight lost
What is the cognition like in depression?
Cognition is slow with complaints of poor memory
Pseudo-dementia
Deficits in working memory, attention and planning
Compounded by anxiety
Is insight preserved in depression?
Yes
Aware of symptoms however attribution can often be affected by the illness; symptoms may be blamed on sins, physical illness, personal failings and weakness
What systems are used to classify depression?
ICD-10
DSM-5
How does the DSM-5 classify depression?
Depressive disorders; major depressive disorder
Persistent depressive disorder
How does ICD-10 classify depression?
Mania
Bipolar
Depressive disorder
Dysthymia
What is the general criteria for the diagnosis of depression?
A; depressive episode should last at least 2 weeks
B; no hypomanic or manic symptoms sufficient to meet criteria (this would classify it as bipolar disorder)
What are the core features of depression?
At least 2 out of 3:
- Depressed mood to a degree that is definitely abnormal for the individual, present for most of the day and almost every day largely uninfluenced by circumstances and sustained for at least 2 weeks
- Loss of interest or pleasure in activities that are normally pleasurable
- Decreased energy or increased fatigability
What are common additional symptoms of depression?
Loss of confidence or self-esteem Guilt Suicidal behaviour Lack of concentration Agitation or retardation Sleep disturbance Change in appetite
How can the severity of depression be assessed?
Rating scales e.g.:
Hamilton rating scale for depression
Montgomery-Asberg depression rating scale
Beck depression inventory
ICD-10 rates severity according to the number of symptoms
How is a moderate depressive episode defined?
2 core symptoms + 4 others = score of at least 6
How is a severe depressive episode defined?
All 3 core symptoms + 5 other = total of at least 8
Are mild depressive episodes treated?
NO; antidepressants no better than placebo and generally is self-limiting
What needs to be present to diagnose somatic syndrome depression?
4 of the following:
Marked loss of interest or pleasure in activities that are normally pleasurable
Lack of emotional reactions to events or activities that normally produce an emotional response
Waking in the morning 2 hours or more before the usual time
Depression worse in the mornings
Retardation or agitation
Marked loss of appetite
Weight loss
Marked loss of libido
What is atypical depression?
A; mood reactivity (mood brightens in response to actual or positive events)
B; two or more:
Significant weight gain
Hypersomnia
Leaden paralysis
Long-standing pattern of interpersonal rejection sensitivity
What is cotards syndrome?
Subtype of psychotic depression;
More common in elderly
Nihilistic delusions
Is chronic treatment treatment-refractory?
No, not necessarily
What is the criteria for the diagnosis of chronic depression?
MDD for at least 2 years
What are the 5 R’s of depression?
Response Remission Relapse Recovery Recurrence
What is dysthymia?
Chronic depression of mood lasting at least several years, which is not sufficiently severe to justify a diagnosis of severe, moderate or mild recurrent depressive disorder
