Depression Flashcards
what ages are mood disorders most common
2nd
3rd
4th
5th decades
50% start before the age of 30
what age do 50% of all mental disorders start
14
what is anhedonia
loss of enjoyment/ pleasure
what is anergia
lack of energy
what is amotivation
lack of motivation
what is the typical diurnal variation of depression
worse in the morning
in atypical depression gets worse as day goes on
what is psychomotor retardation
subjective/ objective slowing of thoughts and/ or movements
what is stupor
absence of relational functions i.e. action and speech
what is early morning wakening
waking at least 2 hours before the expected/ normal waking time
what is ethymia
normal mood
what are the features of appearance and behaviour in depression
reduced facial expression furrowed brow reduced eye contact limited gesturing, movements may be slowed or absent rapport is often difficult to establish
what are common qualities of speech in depression
reduced rate
lowered pitch and volume
reduce intonation (monotonous)
increased speech latencies (longer time between end of a question and them starting to speak)
limited content (answers are often short, brief, and un-embellished)
define mood
a prolonged prevailing state or disposition, typically associated with what the patient describes= subjective (how you you feel?)
define affect
how the patient reacts in relation to their surroundings and the context
something you observed or infer = objective
what is mood like in depression
low, miserable, unhappy, sad
flat
when extreme- empty, black, numb
what is affect like in depression
depressed (low)
reduced range
limited reactivity
may report emotional paralysis (shutting down their emotions)
what is the form, flow and content of thought like in depression
form usually normal
flow- slowed, pondering, can be almost absent
content- negative, self accusatory, failure, guilt, low self esteem, pessimism
delusions can occur: guilt, poverty, nihilism, hypochondriasis
how does depression affect perception
in most cases there is no perceptual disturbance
some people report increased self referential thinking (people are talking about me)
hallucinations can occur- almost always auditory, usually 2nd person and derogatory. reflect negative and depressive themes
how is cognition affected in depression
slow with complaints of poor memory (due to inattention not information recall)
‘pseudo-dementia’
defects in working memory, attention and planning
often worsened by anxiety
how is insight affected in depression
typically preserved
usually aware of symptoms however attribution can often be affected- blamed on patients sins, physical illness, personal failings and weakness
what form of paranoia can you get in depression
increased sensitivity to criticisms of others
much more self conscious/ self aware
feel under scrutiny
how much of depression is chronic
20%- usually recurrent
what is the suicide rate in depression
6-7%
7% in males
what is the lifetime prevalence of depression
14-18%
what are the current diagnostic schemes for depression
ICD-10 and DSM-5
what form of depression is not considered in ICD-10
mild
what must symptoms be for a patient to truly have depression
must be abnormal for the patient
it must persist
should interfere with normal function to a significant degree
what is the general diagnostic criteria for depression
-episode should last a least 2 weeks
-no hypomanic or manic episodes at any time during the patient life (if yes to this -> bi polar)
at least 2 of:
-depressed mood (definitely abnormal for patient, present for most of day, almost every day, largely uninfluenced by circumstances, sustained for >2 weeks)
-loss of interest or please in activity that are normally pleasurable
-decreased energy or increased fatiguability
(remember by MEE: mood, energy, enjoyment -> MEE people become egocentric)
plus an additional symptom
what are the additional symptoms of depression
- loss of confidence/ self esteem
- feelings of self reproach/ excessive and unreasonable guilt
- recurrent thoughts of death or suicide/ any suicidal behaviour
- complaints/ evidence of diminished ability to think or concentrate (indecisiveness/ vacillation)
- change in psychomotor activity with agitation or retardation (either subjective or objective)
- sleep disturbance (increase/ decrease)
- change in appetite with corresponding weight change (increase/ decrease)
what defines a moderate depressive episode
two core symptoms + four additional symptoms
= total of at least 6
what defines a severe depressive episode
all 3 core symptoms + 5 others
= total of at least 8
what are the core symptoms of depression
depressed mood
reduced enjoyment/ interest
decreased energy
when do you give anti depressants for mild depression
not indicated unless patient has recurrent episodes of mild to severe, then can give to prevent it become severe
what is psychotic depression
occasionally paranoid: typically mood congruent or hypochondriacal
“People are out to get me and kill me”
“I’m being poisoned to punish me for my sins”
“I’ve got cancer…I know I have…It’s because I
deserve it”
can have cotards syndrome- often nihilistic delusions, more common in the elderly
what is the 10 year recurrence rate for depression
> 80%
how long until depression becomes classed as chornic
2 years
what are the features of a typical depression
Mood reactivity (that is, mood brightens in response to actual or potential positive events)
Two (or more) of the following:
significant weight gain or increase in appetite
hypersomnia
leaden paralysis (that is, heavy, leaden feelings in arms or legs)
long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment
what features are present in somatic syndrome (a subtype of depression)
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 morning
objective evidence of marked psychomotor retardation or
agitation (remarked on or reported by other people)
marked loss of appetite
weight loss (5 % or more of body weight in the past month)
marked loss of libido
