Depression Flashcards
What is Anhedonia?
loss of pleasure/enjoyment
What does it mean to have diurnal variation depression?
- mood varies over the day
- mood is worse in the Morning —gets better throughout the day
What is psychomotor retardation?
the subjective or objective SLOWING of thoughts and/or movements
What occurs in Stupor?
- pt locks down; absence of action and speech
How may one be treated if conditioned with Stupor?
- ECT (electroconvulsive therapy)
How may a depressed person appear?
- reduced facial expression
- furrowed brows
- reduced eye contact
- slow/absent movements (limited gesturing)
- hard to build rapport
How may speech change with mood depression?
- slow speech
- low pitch
- reduced VOLUME
- monotonous
- increased speech latencies (takes a while for them to reply)
- limited content (short answers, brief)
Distinguish Mood vs Affect.
Mood- how the patient feels
Affect- how the patient reacts (demeanour)
What is considered as having a “low affect”?
- means very limited reactivity to changes in CONTEXT, subject or emotion
- emotional paralysis
- —low through out the convo
How different is thought processing when one is depressed?
- slow thoughts (pondering)
- content: negative, self-accusatory
- Delusions
- suicidal thinking
What is psychosis?
- a mental health problem that cause people to perceive or interpret things differently
- involves HALLUCINATIONS and DELUSIONS
DIstinguish an Halluccination from a Illusion!
- a halluccination; perception experienced as real in the absence of an EXTERNAL stimulus
- Illusion: MISPERCEPTION of an external stimulus (shadow mistaken for a person in the room)
What form do hallucinations usually occur?
- almost always AUDITORY
- usually in second person
- most psychiatric cases
When do visual hallucinations occur?
-with “organic” problems of the brain
How is cognition impaired in Depression?
- slow with complains of POOR memory (mainly d/t inattention)
- compounded with ANXIETY
- issues with planning. working memory, attention
Are depressed patients aware of their condition?
- insight in depression is PRESERVED
- however, attribution is affected by illness (think poorly of themselves)
What is the behaviour like with depressed individuals?
- fiddling with fingers, tissues
- defeated posture
-exhausted
worrying
What is the course of depression?
- usually recurrent and often chronic
What are the 2 criterias mental illnesses?
- DSM-5 (USA)
- ICD-10 (eu)
Depression involves at least 2 of 3 symptoms. State them.
- Depressed mood (present MOST of the day, and almost every day)
- Loss of Interest and pleasure
- decreased energy
How is grief not deemed an illness?
- because it does not impair one’s functionality to the extent of how depression does
What is in the criteria for MDD to be dx?
- should last at least 2 WEEKS
- no hypomanic or manic symptoms that has ever occurred in the person’s life
M.E.E. for depressive sx ?
mood-enjoyment-energy
What are other (additional) symptoms that may be present?
- loss of confidence
- Guilt
- suicidal behaviour
- inability to concentrate
- AGITATION
- sleep disturbance
- change in appetite+ Wgt loss
How is the severity assessed for depression?
- HRSD, HAM-D
- MADRS
- BDI
When is it considered to be a moderate depressive episode?
2 core symptoms+ 4 additionals= 6
—-every symptom should be present for MOST of everyday
Severe Depressive episode SCORE
3 core symptoms+ 5 additionals = (having 7 or more)
What is the management plan intended for mild depression?
- should get better on its on
- meds are no better than placebo
What are the subtypes of Depression?
- somatic Syndrome
- Atypical Depression
- Psychotic depression
What are the distinct fts of Somatic $ Depression?
- early morning wakening (2hrs or more than usual time)
- depression in the morning (DIURNAL VARIATION of MOOD)
How is atypical depression different?
- they have MOOD REACTIVITY (mood brightens in resp. to + things)
- Two or more atypical depression symptoms
What are the additional symptoms seen in Atypical Depression?
- WGT GAIN and INCREASED appetite
- hypersomnia
- LEADEN paralysis (leaden feelings in limbs)
- interpersonal rejection
What is psychotic depression like?
- usually paranoia
- mood congruent (if you’re happy in that moment; you will remember all the happy things in your life)
- hypochondriacal
What is Cotard’s Syndrome?
- seen in ELDERLY
- nihilistic delusions
- body is rotting; organs are dead (constipation)
When may depression become chronic?
- when it is treatment refractory
- d/t POOR ADHERENCE
- INADEQUATE dose or duration
When is it accounted as chronic depression by the DSM-5?
-full criteria for MAJOR DEPRESSIVE EPISODE was met for at least 2 years
What are the 5 Rs for depression?
-response
-remission (momentary bliss)
relapse
recovery
recurrence
What is mild depression classified as having?
- just 4 symptoms
How to manage mild-moderate depression?
CBT+ Active monitoring of pt
- consider ANTIDEPRESSANTS if pt is not responding to CBT or HAS a hx of MOOD disorders
How to manage moderate-severe depression?
- Antidepressants (SSRIs) - SERTRALINE; follow-up in 2 weeks
When could you adjust the dose of Fluoxetine ?
- after 4-6 weeks
- (optimum action is only at this time period)
If 1 SSRi does not work, what next?
- another ssri (Check after 2 weeks)
- still no improvement, change class of drug (SNRI)
How long should the pt take anti-depressants, if she had only 1 depressive episode?
6 months- 1 year
How long should one take anti-depressants , if they had 2 episodes?
- 12-24 months
If very severe depressive d.o?
continue AD
psych consultation review
What is the risk of NOT tapering down SSRIs?
- SSRI DISCONTINUATION SYNDROME
- —must taper over 4-6 weeks
WHat occurs with SSRI discontinuation syndrome?
- N.V.D
- sweating
- headaches
- Sleep disturbances, Vertigo and tremors
How to prevent SSRI discontinuations syndrome?
Switch the short half-lives to LONG HALF-LIVES ( FLUOXETINE & CITALOPRAM)
—-manage symptoms symptomatically
What serotonin syndrome?
- occurs with the use of MULTIPLE serotonergic meds (COCAINE with SSRIs
What occurs with Serotonin syndrome?
- high body temp./ Agitation
- incr. REFKEXES./ TREMORS
- sweating/ DILATED pupils and diarrhea
How to manage atypical depression?
Phenelzine/ Moclobemide
—-alternatives (SSRIs and NARI–reboxetine)
