Depression Flashcards

1
Q

What is depression?

A

A mood disorder causing a persistent feeling of sadness and loss of interest

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2
Q

How is depression divided?

A

Mild - core symptoms + 2/3 other symptoms
Moderate - core symptoms + 4 other symptoms
Severe - suicidal, marked loss of functioning
Severe divided into with/without psychotic symptoms

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3
Q

What is dysthymia?

A

Mild/moderate depressive illness lasting intermittently for 2 years or more
Mood relapses and remits with several weeks of feeling well and then followed by longer periods of being unwell

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4
Q

What is seasonal affective disorder?

A

Recurrent episodes of depressive illness occurring in winter months in northern hemisphere

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5
Q

What are puerperal affective disorders?

A

Depression related to pregnancy

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6
Q

Name 4 risk factors for developing depression

A

Family history of depression
Death or loss in your life
Conflict - personal disputes or disputes with family/friends
Abuse - physical, sexual, or emotional
Other illnesses - sleep problems, chronic pain, anxiety, ADD
Medications
Substance abuse
Social isolation due to illness or separation from family or social groups
Emotional or perfectionist personality

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7
Q

How common is depression?

A

1/3 of population will feel unhappy at any one time
Middle-aged people feel the least happy
5% prevalence in the community
More common in women
No difference in ethnic group or socioeconomic class
Similar prevalence in married and non-married people
Divorced people have 2-3x the prevalence
Becoming more common
Associated with increased mortality in those with physical illness

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8
Q

What are the psychiatric differential diagnoses for depression?

A
Alcohol misuse
Amphetamine misuse and withdrawal
EUPD
Dementia
Delirium
Schizophrenia
Normal and pathological grief
Bipolar disorder!!!
Seasonal affective disorder!!!
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9
Q

What are the organic differential diagnoses for depression?

A
Cushing's syndrome
Hypothyroidism!!!
Hyperparathyroidism
Corticosteroid treatment
Brain tumour
MS
Vit B12 deficiency
Addison's disease
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10
Q

What are the biological symptoms of depression?

A
Lack of sleep
Lack of appetite
Anergia 
Lack of motivation
Change in libido and erectile dysfunction
Impoverished, slow, monotonous speech - psychomotor retardation
Weight loss
Constipation
Bodily pains
Psychomotor agitation
Menstrual cycle changes
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11
Q

What are the psychological symptoms of depression?

A
Anhedonia
Diurnal mood variation
Depressed, miserable, or irritable
Thoughts of hopelessness
Guilt
Suicidal thoughts
Persistent low mood
Feelings of unworthiness
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12
Q

What are the cognitive symptoms of depression?

A
Struggling with concentration
Memory difficulties
Agitation
Loss of confidence
Indecisive
Difficulty problem solving
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13
Q

What is the criteria for depression diagnossi?

A

Symptoms every day, most of the day for 2 weeks or more

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14
Q

What is the monoamine deficiency theory?

A

Unbalance of monoamines eg serotonin, dopamine, noradrenaline is what causes depression

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15
Q

What is the hypothalamo-pituitary-adrenal axis theory?

A

Steroids cause depression

Administration of exogenous steroids and Cushing’s disease cause the onset of depression

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16
Q

What changes occur in the brain that seems to be related to depression?

A

Non-specific changes involving regions that are associated with emotional and cognitive abnormalities, increased brain ventricle volume and orbito-frontal, dorsolateral frontal and anterior cingulate cortex altered activation implicated

17
Q

What could cause depression and why?

A

Stress

Triggers brain changes in stress hormones and neurotransmitters

18
Q

What investigations should you do in a depressed patient to rule out differentials?

A
FBC, U&E, serum creatinine, eGFR
Liver biochemistry
Serum calcium
ESR/CRP
TSH
Serum cortisol
ANA
CXR
EEG/brain scan
19
Q

What is the physical management of depression?

A
Cessation of depressing drugs
Regular exercise
Antidepressants
Adjunctive drugs eg lithium if no response to 2 different antidepressants
ECT
20
Q

What is the psychological management of depression?

A

Education and regular follow-up by same professional
CBT
Other indicated psychotherapies (couple, family, interpersonal)

21
Q

What is the social management of depression?

A

Financial - eligible benefits, debt counselling
Employment - acquiring or changing a job or career
Housing - adequate, secure tenancy, safe social neighbours
Young children - childcare support

22
Q

What is the prognosis of depression?

A

With treatment, episodes last 3-6 months
Likelihood of recurrence is high
Less favourable outcome the lower the age of onset
Prognosis worse with psychotic features, prominent anxiety, personality disorders, and severe symptoms
Persistent symptoms in around 10%

23
Q

What are the common co-morbidities of depression?

A
Anxiety!!
OCD
Drug dependence!!
Alcohol dependence!!
PTSD
Personality disorder
24
Q

What antidepressants might you prescribe?

A

MAO
SSRIs
SNRIs
TCAs