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Psychiatry > Depression > Flashcards

Depression Flashcards

1
Q

What are the different causes of depression?

A 
Genetic
Negative childhood experiences 
Personality traits
Social Circumstances
Marital status
Adverse life events in vulnerable individuals
Low socioeconomic status
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2
Q

What are the social circumstances that can contribute to depression?

A

Martial Status - separation
ACEs
Low socioeconomic status

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3
Q

what personality traits are associated with depression?

A

anxiety, impulsivity, obsessionally

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4
Q

what are the structural brain changes associated with depression?

A

ventricular enlargement and sulcal prominence
White matter lesions
Reduced grey matter in left hippocampus, basal ganglia, thalamus
Reduced cortical volumes in left parietal and frontal

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5
Q

what are the brain post-mortem findings in depression?

A

Reduced GABA function, abnormal synaptic density, or neuronal plasticity in the hippocampus; glial cell abnormalities; reduced expression of SERT mRNA in dorsal raphe nucleus

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6
Q

what are the results of functional brain imaging in depression?

A

hypoperfusion in frontal, temporal, and parietal areas (esp. older patients) and increased perfusion in frontal and cingulate cortex

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7
Q

what are the neurotransmitter abnormalities seen in depression?

A

reduced monoamine function may cause depression (i.e. 5-HT, NE, DA).

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8
Q

what are the results of neuroendocrine challenge tests show in depression?

A

increased cholinergic functioning, increased cortisol associated with adrenal hypertrophy and dexamethasone

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9
Q

what are the thyroid abnormalities in depression?

A

abnormalities in the thyrotropin (TSH) response to TRH

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10
Q

what are the changes in sleep pattern seen in depression?

A

reduced total SWS and shortened REM latency

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11
Q

what is the stress vulnerability model of depression?

A

neuron cell death via
Mitochondrial dropout
Glional Dropout

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12
Q

what is mitochondrial dropout?

A

increased glucocorticoids (i.e. cortisol) in response to stress leads to excessive mitochondrial activity, cell burnout and cell death

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13
Q

what is glional?

A

Brain-derived neurotrophin factor (BDNF) is a protein in the brain that protects neurons from damage, neurotransmitters 5-HT, NA and DA increase levels, in depression reduced levels lead to cell death

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14
Q

what is the pathophysiology of the hypothalamus in depression?

A

5-HT suppresses hypothalamus, inhibits releases CRH to release ACTH, in depression hypothalamus altered response to serotonin? Raised cortisol

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15
Q

what are the core symptoms associated with depression?

A 
o	Depressed mood 
o	Anhedonia 
o	Weight change 
o	Disturbed sleep 
o	Psychomotor agitation or retardation 
o	Fatigue or loss of energy 
o	Feelings of worthlessness or excessive or inappropriate guilt
o	Diminished ability to think or concentrate or indecisiveness
o	Recurrent thoughts of death or suicide
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16
Q

what are the features of depressed mood in depression?

A

present all day, everyday, lack of responsiveness to change, diurnal variation

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17
Q

what weight changes can occur in depression?

A

loss of weight or gain, decreased or increased appetite

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18
Q

what are the sleep disturbances in depression?

A

insomnia with early morning wakening, or hypersomnia

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19
Q

what are the somatic symptoms of depression?

A 
o	Loss of emotional reactivity.
o	Diurnal mood variation. 
o	Anhedonia. 
o	Early morning wakening. 
o	Psychomotor agitation or retardation. 
o	Loss of appetite and weight. 
o	Loss of libido
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20
Q

what are the psychotic symptoms of depression?

A

o Delusions
o Hallucinations
o Catatonic symptoms

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21
Q

what are the different parts of a mental state examination?

A

appearance, attitude, behaviour, mood, affect, speech, thought process, thought content, perception, cognition, insight and judgement.

22
Q

what are the features of appearance and behaviour in an MSE in depression?

A

reduced facial expression, furrowed brow, reduced eye contact
Limited gesturing – movements may be slowed, or absent
Difficult to establish rapport

23
Q

what are the features of speech in an MSE in depression?

A

Reduced rate of speech, lower pitch, quiet, monotonous, increased speech latencies, limited content

24
Q

what are the features of mood in an MSE in depression?

A

low, miserable, unhappy, sad, flat, empty, numb

25
Q

what are the features of affect in an MSE in depression?

A

depressed, reduced range, limited reactivity, emotional paralysis

26
Q

what are the features of thought in an MSE in depression?

A

form typically normal, flow – slow, almost absent, content

27
Q

what is the minimum DSM-V criteria for depression?

A

o At least FIVE of the core symptoms almost every day for the last 2 weeks (at least one of which must be depressed mood or anhedonia)
o PLUS ALL of the following:
1. Symptoms cause significant distress or impair functioning
2. Symptoms not due to a medication, other substance or other underlying illness
3. Symptoms are not better explained by a schizophrenia spectrum disorder or psychotic disorder
4. No history of a manic or hypomanic episode (if present – consider bipolar disorder)

28
Q

how many core symptoms must be present to meet DSM-5 criteria in depression?

A

at least 5

29
Q

what is the additional criteria in DSM-5 for depression?

A
  1. Symptoms cause significant distress or impair functioning
  2. Symptoms not due to a medication, other substance or other underlying illness
  3. Symptoms are not better explained by a schizophrenia spectrum disorder or psychotic disorder
  4. No history of a manic or hypomanic episode (if present – consider bipolar disorder)
30
Q

what is the minimum ICD-10 criteria for depression?

A

presence of at least 2 typical symptoms (depressed mood, anhedonia, or fatigue)
plus at least 2 others from the core symptoms list.

31
Q

what is the ICD-10 criteria for mild depression?

A

2 typical symptoms + 2

other core symptoms

32
Q

what is the ICD-10 criteria for moderate depression?

A

2 typical symptoms + 3+ other core symptoms

33
Q

what is the ICD-10 criteria for severe depression?

A

3 typical symptoms + 4+ other core symptoms

34
Q

what is the DSM-IV criteria for mild depression?

A

5 core symptoms + minor social/occupational impairment

35
Q

what is the DSM-IV criteria for moderate depression?

A

5+ core symptoms + variable degree of social/occupational

impairment

36
Q

what is the DSM-IV criteria for mild depression?

A

5+ core symptoms + significant social/occupational impairment

37
Q

What is the 1st line management of depression?

A

SSRI

Plus CBT and interpersonal psychotherapy/problem solving therapy

38
Q

what are examples SSRIs?

A

fluoxetine, sertraline, citalopram, escitalopram, paroxetine

39
Q

what is the 2nd line management of depression?

A

SNRI
Tricyclic
MAOI
Combo therapy

40
Q

What is the management of resistant depression?

A

Referral to psychiatry

ECT

41
Q

how can depression management be monitored?

A

scales e.g. IDS-30-SR, QIDs, MADRs

42
Q

what is the mechanism of tricyclic antidepressants?

A

Block NA and 5-HT re-uptake

43
Q

what is the mechanism of MAO inhibitors?

A

Increase stores of NA and 5-HT

44
Q

what is the mechanism of reserpine?

A

Increase NA and 5-HT storage

45
Q

what is the mechanism of α Methotyrosie?

A

Inhibits NA synthesis

46
Q

what is the mechanism of Methyldopa?

A

Inhibits NA synthesis

47
Q

what is the mechanism of ECT?

A

Increases CNS responsiveness to 5-HT and NA

48
Q

what is the mechanism of Tryptophan?

A

Increases 5-HT synthesis

49
Q

what is the definition of chronic depression?

A

“Full criteria for a Major Depressive Episode have been met continuously for at least the past 2 years”

50
Q

what are the 5Rs in depression progression?

A

Response, Remission, Relapse, Recovery, Recurrence

51
Q

what are the different subtypes of depression?

A
  • Somatic syndrome
  • Atypical
  • Psychotic
  • Melancholy
  • Non-melancholy
  • Dysthymia
  • Seasonal Affective Disorder
  • Post-Partum Depression

Psychiatry (11 decks)

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