Depression Flashcards
What is depression?
Describes a state of sadness, not just absence of happiness, that can range from normal experience to severe, life-threatening illness
What is dysthymia?
Below threshold level of depression, can go about daily life but with depressive qualities
What sex is depression more common?
F>M
What age of onset does depression most commonly occur?
Mid 20s
What can cause depression?
Genetic/FH
Psychosocial stressors/adverse life event
- Onset/first episode associated with adverse life events, but can also occur without obvious trigger
Physical Illness/organic disease
- Endocrine disorder
- Viruses
- Chronic pain
How does ICD-10 define depression?
Lasts for at least 2 weeks
No hypomanic or manic episodes in lifetime, if had would consider bipolar
Not attributable to psychoactive substance or organic mental disorder
If psychotic symptoms or stupor, exclude psychotic illness
What 3 spheres do depressive symptoms occur in?
Psychological
Physical
Social
What are the two aspects of the psychological sphere?
Change in mood
Change in thought context
What are the change in mood symptoms?
Depression: Presence of sadness often worse in the morning
Anxiety
Perplexity
Anhedonia
What is perplexity?
Feeling of being overwhelmed
What is anhedonia?
Loss of ability to derive pleasure from experience
What are the change in thought context symptoms?
Guilt
Hopelessness
Neurotic symptoms: Hypochondriasis, agoraphobia, obsessions, compulsions and panic attacks
Delusions
Hallucinations
Ideas of Reference: Feel that everything is about you
What are the two aspects of the physical sphere?
Change in bodily function
Change in psychomotor functioning
What are the change in bodily functioning symptoms?
Fatigue
Disturbed sleep
Weight loss
Loss of libido
Constipation
Pain
What are the change in psychomotor functioning symptoms?
Agitation
Retardation
Stupor
What is agitation?
State of restless overactivity, aimless or ineffective
What is retardation?
Slowing of motor responses
What is stupor?
State of extreme retardation in which consciousness is intact and patient stops moving, speaking, eating and drinking
What are the social sphere symptoms?
Loss of Interests
Irritability
Apathy
Withdrawal, Loss of Confidence, Indecisive
Loss of Concentration, Registration and Memory
What is apathy?
Loss of interest in own surroundings
What are the general depressive symptoms, according to ICD-10?
Depressed mood, abnormal for most of the day almost every day for the past 2 weeks
Anhedonia
Fatigue
What are the additional depressive symptoms, according to ICD-10?
Guilt
Loss of confidence
Loss of concentration
Sleep disturbance
Suicidal thoughts or behaviour
Change in appetite
Agitation or retardation
Define mild depression
At least 2 of the general criteria, and additional list to give at least 4
Define moderate depression
At least 2 of general criteria, and additional list to give at least 6
Define severe depression
All of general criteria and additional list to give at least 8
What investigations can be used to rule out other causes of depression?
Vitamin B12
FBC: Anaemia
U&Es
Glucose
TFT: Hypothyroidism
What is the lifestyle management of depression?
Meditation
Exercise
Self-guided help
Self hygiene and sleep disturbance
What is the first line anti-depressant class?
Selective Serotonin Reuptake Inhibitors (SSRI’s)
What psychological interventions are used in depression?
CBT
Interpersonal therapy
Family therapy
What is used in treatment resistant severe depression?
Electroconvulsive therapy
What is ECT?
Small and controlled amount of electro-current is passed through the brain, inducing a brief seizure
What is somatic syndrome?
Depression but characterised by a cluster of specific, mostly physical, symptoms
How does somatic syndrome present?
Anhedonia
Lack of emotional reactions to events that normally produce an emotional response
Waking 2 hours before normal time
Depression worse in morning
Psychomotor agitation or retardation
Loss of appetite
Weight loss
Loss of libido
Give differential diagnoses for depression
Normal reaction to life event
Seasonal affective disorder
Dysthymia
Cyclothymia
Bipolar disorder
Stroke
Tumour
Dementia
Hypothyroidism
Addison’s
Drugs
Infection: Influenza, Hepatitis, HIV/AIDS
Give examples of suicide red flags
FH of suicide attempt
Co-morbid substance use
Previous suicide attempts
Unemployed
Aggressive methods
Pre-planning
No protective factor : ‘I could never go through with it and do that to my partner/child
Male: More likely to attempt aggressive methods and more likely to attempt whereas female more likely to self harm
How long does normal grief reaction last?
up to 6 months
Give side effects of electroconvulsion therapy?
Headache
Nausea
Short term memory impairment
Memory loss of events prior to ECT
Arrhythmia
Give a contraindication for electroconvulsion therapy
Raised ICP
What time of year is suicide more common?
Spring/Summer
What age is self harm common between?
15-25
What age is suicide more common in?
Over 40 years
What is the time frame for post natal depression occurance?
2-6 weeks
When is depression automatically classed as severe?
Psychotic symptoms
What is the fatality rate of overdose?
Very low, 0.4%
What medications are more dangerous in terms of over-dose
Typically, drugs that suppress the respiratory system
Benzodiazepines
TCA
