Depression Flashcards
How does someone with depression appear or behave?
Reduced facial movements - furrowed brow
Reduced eye contact
Limited gesturing
Slowed movement
How is a depressed persons speech?
Slow Low pitch Quiet Reduced intonation Increased latency Limited content Difficult to establish rapport
What is the mood of a depressed patient?
Low Miserable Unhappy irritable Flat Empty Numb
What is the affect of a depressed patient?
Limited reactivity
Reduced range
What form does a depressed persons thoughts take?
Typically normal
What Flow does a depressed persons thoughts take?
Slowed
Pondering
Almost absent
What is the content of a depressed persons thoughts?
Negative Self accusatory failure guilt pessimism
Suicidal thought is common
Delusions of guilt poverty nihilism
What is Cotards Syndrome?
Nihilistic delusion
Belief you are already dead and waiting for your body to decay away.
What is a depressed patients perception like?
Usually normal
Can report increased self referential thinking
What is self referential thinking?
“People are talking about me”
Can someone with depression present with hallucinations?
They can
Always auditory second person derogatory
Reflect negative depressive themes
What is a depressed patients cognition like?
Usually preserved
Complaints of poor memory
What cognitive defects do depressed patients complain of?
Working memory
Attention and planning deficits
Describe a depressed patients insight.
Usually Preserved
Aware of the symptoms but believe them to be down to a personal weakness of failing
IDC10 definition of depression
2 out of 3 main symptoms
>4 additional symptoms
Last more than 2 weeks
No hypomanic or manic symptoms
What are the main symptoms of depression?
Abnormally depressed mood lasting for most of the day
Loss of enjoyment
Decreased energy or increased fatiguability
What are some additional symptoms of depression?
Loss of confidence Recurrent suicidal behaviour Diminished ability to concentrate Sleep disturbances Change in appetite
ICD 10 - Moderate depression
2 core
4 additional
ICD 10 - Severe depression
3 core
>5 additional
What is Psychotic depression?
Occasional paranoia but it is mood congruent
e.g. ive got cancer because I deserve it
Describe the distribution of 5-HT receptors in depression.
Decreased in Frontal cortex, Amygdala and Temporal Cortex
Increased in Hippocampus Raphe Nuclei
Give a list of ways to ascertain level of depression in patient.
Inventory of Depressive Symptomology
Quick Inventory of Depressive Symptomology Self Report 16
Hospital Anxiety and Depression Scale
Montgomery Asberg Rating Scale
What is the Inventory of Depressive Symptomology?
IDS
Self Reported questionnaire
30 items
What is the Quick Inventory of Depressive Symptomology Self Report 16?
Shorter version of IDS
What is covered in the Quick Inventory of Depressive Symptomology Self Report 16?
Sleep Sadness Appetite Weight Concentration View of self Suicidal thoughts General interest Energy
What is the Hospital Anxiety and Depression Scale?
14 item self rated
Why would the Hospital Anxiety and Depression Scale be used over the IDS?
Requires far less reading and comprehension skills.
What is the Montgomery Asberg Rating Scale?
10 Items
Observer Rated scale
Why would the Montgomery Asberg Rating scale be used?
It is very sensitive to change - good for monitoring
In terms of medicating for depression what is the rule?
Match the drug to the patient you are treating the symptoms not the condition.
What is the best all round SSRI?
Escitalopram
What is first line treatment for depression?
SSRIs
Better tolerated and safer in overdose
Setraline Fluoxetine
Which SSRI has a good cardiac safety profile and you are able to titrate slowly?
Setraline
What is a risk associated with Escitalopram?
Prolongs QT
Why is Mirtazapine used?
Promotes sleep eating and weight gain
Less sexual dysfunction associated
Venlaxafine
Higher rate of adverse effects
Dose/ response relationship is more effective than others
What is the most common combination of Antidepressants?
SSRI/SNRI + Mirtazapine
What can Antidepressants be augmented with?
Antipsychotics
Lithium
If someone has a relapse what is the course of action?
Continue medication for at least 6 months after full recovery without reducing dose.
If someone has a second relapse what is the course of action?
Continue medication without reducing dose for 1-2 years
If someone has relapsed on medication alone what should be considered?
Consider psychological therapy or lifestyle factors
If a patient with depression presents with an acute episode of Mania or Hypomania what should you do?
Maximise Antimania drugs if already on maintenance
Discontinue antidepressants
Combination therapy
Likely to need hospital admission
If an old patient with depression present with a history of falls what drug should be considered?
Mirtazapine as less risk of postural hypertension
