Depression

Question 1

Name of the three core symptoms of depression

Answer 1

– Low mood

• Anhedonia
• low energy

Question 2

Name overall the nine symptoms of depression

Answer 2

• low mood
• anhedonia
• low energy
• sleep problems
• difficulty concentrating
• weight loss
• pschomotor retardation
• suicidal ideation
• Guilt / worthlessness

Question 3

Describe the epidemiology of depression

Answer 3

– Females more than males

• 5% of adults affected each year
• Lifetime rate of 20%
• 1/4 of women and 1/10 men receive treatment in a lifetime

Question 4

Name some genetic causes of depression

Answer 4

• family history
• polygenic inheritance
• Piccolo PCLO
• Neuroligin-1

Question 5

Name some psychological causes of depression

Answer 5

– Personality
– chronic illness
– mental health problems
– failure of adaptive mechanisms to stress
- Bowlybys theory 
-Freuds theory
-Becks theory

Question 6

Name some social causes of depression

Answer 6

• adverse life events (unemployment, finances, poverty, divorce, abuse)

Question 7

Describe the neurochemical theory of depression

Answer 7

The monoamine hypothesis:

There is depletion or a change in the receptor function of monoamine neurotransmitters (serotonin, noradrenaline, and dopamine)

Support comes from the fact that when given antidepressants these monoamine levels increase and mood improves.
Illicit drugs such as amphetamine also increased these neurotransmitters and improve mood
Resprine, a hypertensive drug, decreases monoamines and depressive mood

Question 8

Describe the 4 P’s

Answer 8

Predisposing
Precipitating
Perpetuating
Protective

Question 9

How would you screen for mood in a depression history

Answer 9

• During the last month have you been bothered by feeling down, depressed or hopeless?
  Do you experience pleasure in doing things you would’ve previously enjoyed?
  Do you have Motivation for every day activities?
  Do you feel motivated to do things?
  How was your sleep been?

Question 10

What questions would you ask if doing a risk assessment for suicide? ( or self harm)

Answer 10

Do you ever feel that life is not worth living?
Have you had thoughts about harming yourself/ending your life? What has stopped you from acting on these thoughts? Have you attempted to end your life before?
Have you thought about harming anyone else/think anyone else wants to harm you?
Any criminal activity in the past?

Question 11

What investigations would you want to do in a patient he thought might have depression

Answer 11

Mainly based on symptoms and investigations are not normally required
However can use the following tests:
– blood glucose
– U+E
– creatinine
– LFT
– TFT
– calcium levels
– F BC
– ESR

Question 12

In depression are symptoms more likely to be worse in the morning or the evening?

Answer 12

More likely to be worse in the morning

Question 13

How many symptoms would a patient neee to have to diagnose depression?

Answer 13

2 core + 2 other = mild
2 core + 3 other= moderate
3 core + 4 other= Severe

Question 14

How would you treat mild- moderate depression

Answer 14

Low intensity psychological interventions IAPT

Self help
CCBT
Peer support programme
Group exercise

Question 15

How would you treat moderate to severe depression?

Answer 15

High integrity psychological intervention and antidepressants

CBT, behavioural activation, interpersonal therapy, couples therapy

SSRI first like- fluoxetine,paroxetine, citalopram, surrealism

Question 16

When would you consider CBT IN depression?

Answer 16

In severe symptoms- psychosis/ suicidal ideation/ psychomotor retardation

Question 17

Name some general side effects of antidepressants

Answer 17

• suicidal thoughts
• anxiety, Agitation and insomnia
  – sexual dysfunction
  – hyponatraemia
  – mild transient adverse effects such as nausea

Question 18

How long do symptoms of depression need to last for a diagnosis?

Answer 18

2 weeks