Depression Flashcards
what are the core features of depression
depressed mood
anhedonia
anergia
elaborate on the “depressed mood” core feature of depression
must be present for most of the day almost every day for at least 2 weeks
must be to a degree that is definitely abnormal for that individual
is largely uninfluenced by circumstances
depressed mood in depression tends to be worse at what time of day
morning
what is anhedonia
loss of interest in activities they previously found pleasurable
what is needed for diagnosis of depression
2
and an additional symptom(s) should be present
what is anergia
decreased energy or increased fatiguability
what are some additional features that may be seen in depression (7)
loss of confidence/self esteem unreasonable feelings of guilt recurrent thoughts of death or suicide diminished ability to think or concentrate change in psychomotor activity sleep disturbance change in appetite with weight change
what changes in psychomotor activity might be seen in depression
agitation psychomotor retardation (slowing of thoughts/movement)
what is the most common sleep disturbance seen in depression
early morning wakening (wakening at least 2 hours before expected/normal waking time)
what are some other sleep disturbances
broken sleep
initial insomnia
is an increase or decrease in appetite more common in depression
decrease
according to ICD 10 what is moderate depression
2 core + 4 additional = at least 6
according to ICD 10 what is severe depression
3 core + 5 additional = at least 8
what is mild depression
less than 6 symptoms
what kind of depression is the majority in primary care
mild - antidepressants not indicated
what are some rating scales used to measure severity of depression
HRSD/HAM-D
MADRS
what is Beck’s Triad
hopelessness
worthlessness
excessive guilt
what is stupor
absence of relational functions i.e. actions, speech
what are some somatic symptoms of depression
amenorrhoea fatigue abdominal pain constipation indigestion
what hallucinations most commonly occur in depression
2nd person auditory derogatory hallucinations
- you are a bad person and deserve to die
is insight typically preserved or lost in depression
preserved
- attribution may be affected - blame depression on illness/personal feelings/weakness
is insight typically preserved or lost in depression
preserved
- attribution may be affected - blame depression on illness/personal feelings/weakness
50% of all mood disorders start before age
30
50% of all mental disorders start before age
14
what system is used for classification of mood disorders in the uk
International Classification of Diseases, version 10
ICD 10
what system is used for classification of mood disorders in america
Diagnostic and Statistical Manual, version 5
DSM-5
according to ICD 10 what are the classes of mood disorders
mania
depressive disorder
bipolar disorder
dysthymia
Manic episode Bipolar Affective Disorder Depressive Episode Recurrent Depressive Disorder Persistent Mood Disorders Unspecified Mood Disorder
according to ICD 10 what are the classes of depression
mild
moderate
severe
do ICD 10 outline chronic depression
no
what is the DSM - IV criteria for chronic depression
Full criteria for a Major Depressive Episode have been met continuously for at least the past 2 years
what are 3 subtypes of depression
somatic syndrome
atypical depression
psychotic depression
what is somatic syndrome
4 out of 8 of:
- anhedonia
- lack of emotional reaction to events that usually produce emotional reaction
- objective evidence of psychomotor agitation or retardation
- marked loss of appetite
- weight loss > 5% body weight in past month
- loss of libido
- EMW
- depression worse in morning
what is diurnal variation
mood varies throughout the day
what is the general criteria for depression
depressive episode should last at least 2 days and there be no hypo/manic symptoms sufficient to meet criteria for an episode at any point in individuals life
what is atypical depression
mood reactivity: mood will brighten in response to actual or potential positive event
- will also see 2 of:
weight gain or increased appetite, hypersomnia, leaden paralysis, long standing pattern of interpersonal rejection sensitivity that results in significant social or occupational impairment
psychotic depression is typically ___ _____ or ______
it is occasionally ____
mood congruent or hypochondriacal
occasionally paranoid
what is cotards syndrome and who is it common in
elderly patients
nihilistic delusions
what the 5 Rs of depression
response remission relapse recovery recurrence
what is recovery of depression
maintenance of remission for 1 year +
a relapse after recovery is called
recurrence
what is dysthymia
chronic mild depression for a minimum of 2 years in which episodes are not long enough or severe enough to meet criteria for depression
what is the biggest risk factor for suicide
history of DSH
what is a robust predictor or eventual fatal self-harm and should be included in MSE
hopelessness
who is most likely to suicide after DSH
older males
what is the 1st line treatment of depression
SSRI
what do you do if SSRI doesn’t work
dose increase, swap, combine or change
what could you combine an SSRI with
SNRI
or mirtazapine
how long should someone continue to take antidepressant after remission
6 months - reduces risk of relapse and not assoc. with addiction
