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NEUROLOGY > Depression > Flashcards

Depression Flashcards

1
Q

What is Anhedonia?

A

loss of pleasure/enjoyment

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2
Q

What does it mean to have diurnal variation depression?

A
  • mood varies over the day

- mood is worse in the Morning —gets better throughout the day

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3
Q

What is psychomotor retardation?

A

the subjective or objective SLOWING of thoughts and/or movements

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4
Q

What occurs in Stupor?

A
  • pt locks down; absence of action and speech
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5
Q

How may one be treated if conditioned with Stupor?

A
  • ECT (electroconvulsive therapy)
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6
Q

How may a depressed person appear?

A
  • reduced facial expression
  • furrowed brows
  • reduced eye contact
  • slow/absent movements (limited gesturing)
  • hard to build rapport
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7
Q

How may speech change with mood depression?

A
  • slow speech
  • low pitch
  • reduced VOLUME
  • monotonous
  • increased speech latencies (takes a while for them to reply)
  • limited content (short answers, brief)
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8
Q

Distinguish Mood vs Affect.

A

Mood- how the patient feels

Affect- how the patient reacts (demeanour)

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9
Q

What is considered as having a “low affect”?

A
  • means very limited reactivity to changes in CONTEXT, subject or emotion
  • emotional paralysis
  • —low through out the convo
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10
Q

How different is thought processing when one is depressed?

A
  • slow thoughts (pondering)
  • content: negative, self-accusatory
  • Delusions
  • suicidal thinking
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11
Q

What is psychosis?

A
  • a mental health problem that cause people to perceive or interpret things differently
  • involves HALLUCINATIONS and DELUSIONS
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12
Q

DIstinguish an Halluccination from a Illusion!

A
  • 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)
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13
Q

What form do hallucinations usually occur?

A
  • almost always AUDITORY
  • usually in second person
  • most psychiatric cases
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14
Q

When do visual hallucinations occur?

A

-with “organic” problems of the brain

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15
Q

How is cognition impaired in Depression?

A
  • slow with complains of POOR memory (mainly d/t inattention)
  • compounded with ANXIETY
  • issues with planning. working memory, attention
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16
Q

Are depressed patients aware of their condition?

A
  • insight in depression is PRESERVED

- however, attribution is affected by illness (think poorly of themselves)

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17
Q

What is the behaviour like with depressed individuals?

A
  • fiddling with fingers, tissues
  • defeated posture
    -exhausted
    worrying
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18
Q

What is the course of depression?

A
  • usually recurrent and often chronic
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19
Q

What are the 2 criterias mental illnesses?

A
  • DSM-5 (USA)

- ICD-10 (eu)

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20
Q

Depression involves at least 2 of 3 symptoms. State them.

A
  1. Depressed mood (present MOST of the day, and almost every day)
  2. Loss of Interest and pleasure
  3. decreased energy
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21
Q

How is grief not deemed an illness?

A
  • because it does not impair one’s functionality to the extent of how depression does
22
Q

What is in the criteria for MDD to be dx?

A
  • should last at least 2 WEEKS

- no hypomanic or manic symptoms that has ever occurred in the person’s life

23
Q

M.E.E. for depressive sx ?

A

mood-enjoyment-energy

24
Q

What are other (additional) symptoms that may be present?

A
  • loss of confidence
  • Guilt
  • suicidal behaviour
  • inability to concentrate
  • AGITATION
  • sleep disturbance
  • change in appetite+ Wgt loss
25
Q

How is the severity assessed for depression?

A
  • HRSD, HAM-D
  • MADRS
  • BDI
26
Q

When is it considered to be a moderate depressive episode?

A

2 core symptoms+ 4 additionals= 6

—-every symptom should be present for MOST of everyday

27
Q

Severe Depressive episode SCORE

A

3 core symptoms+ 5 additionals = (having 7 or more)

28
Q

What is the management plan intended for mild depression?

A
  • should get better on its on

- meds are no better than placebo

29
Q

What are the subtypes of Depression?

A
  1. somatic Syndrome
  2. Atypical Depression
  3. Psychotic depression
30
Q

What are the distinct fts of Somatic $ Depression?

A
  • early morning wakening (2hrs or more than usual time)

- depression in the morning (DIURNAL VARIATION of MOOD)

31
Q

How is atypical depression different?

A
  1. they have MOOD REACTIVITY (mood brightens in resp. to + things)
  2. Two or more atypical depression symptoms
32
Q

What are the additional symptoms seen in Atypical Depression?

A
  • WGT GAIN and INCREASED appetite
  • hypersomnia
  • LEADEN paralysis (leaden feelings in limbs)
  • interpersonal rejection
33
Q

What is psychotic depression like?

A
  • usually paranoia
  • mood congruent (if you’re happy in that moment; you will remember all the happy things in your life)
  • hypochondriacal
34
Q

What is Cotard’s Syndrome?

A
  • seen in ELDERLY
  • nihilistic delusions
  • body is rotting; organs are dead (constipation)
35
Q

When may depression become chronic?

A
  • when it is treatment refractory
  • d/t POOR ADHERENCE
  • INADEQUATE dose or duration
36
Q

When is it accounted as chronic depression by the DSM-5?

A

-full criteria for MAJOR DEPRESSIVE EPISODE was met for at least 2 years

37
Q

What are the 5 Rs for depression?

A

-response
-remission (momentary bliss)
relapse
recovery
recurrence

38
Q

What is mild depression classified as having?

A
  • just 4 symptoms
39
Q

How to manage mild-moderate depression?

A

CBT+ Active monitoring of pt

- consider ANTIDEPRESSANTS if pt is not responding to CBT or HAS a hx of MOOD disorders

40
Q

How to manage moderate-severe depression?

A
  1. Antidepressants (SSRIs) - SERTRALINE; follow-up in 2 weeks
41
Q

When could you adjust the dose of Fluoxetine ?

A
  • after 4-6 weeks

- (optimum action is only at this time period)

42
Q

If 1 SSRi does not work, what next?

A
  • another ssri (Check after 2 weeks)

- still no improvement, change class of drug (SNRI)

43
Q

How long should the pt take anti-depressants, if she had only 1 depressive episode?

A

6 months- 1 year

44
Q

How long should one take anti-depressants , if they had 2 episodes?

A
  • 12-24 months
45
Q

If very severe depressive d.o?

A

continue AD

psych consultation review

46
Q

What is the risk of NOT tapering down SSRIs?

A
  • SSRI DISCONTINUATION SYNDROME

- —must taper over 4-6 weeks

47
Q

WHat occurs with SSRI discontinuation syndrome?

A
  • N.V.D
  • sweating
  • headaches
  • Sleep disturbances, Vertigo and tremors
48
Q

How to prevent SSRI discontinuations syndrome?

A

Switch the short half-lives to LONG HALF-LIVES ( FLUOXETINE & CITALOPRAM)
—-manage symptoms symptomatically

49
Q

What serotonin syndrome?

A
  • occurs with the use of MULTIPLE serotonergic meds (COCAINE with SSRIs
50
Q

What occurs with Serotonin syndrome?

A
  1. high body temp./ Agitation
  2. incr. REFKEXES./ TREMORS
  3. sweating/ DILATED pupils and diarrhea
51
Q

How to manage atypical depression?

A

Phenelzine/ Moclobemide

—-alternatives (SSRIs and NARI–reboxetine)

NEUROLOGY (36 decks)

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