Depression Flashcards
What are the different causes of depression?
Genetic Negative childhood experiences Personality traits Social Circumstances Marital status Adverse life events in vulnerable individuals Low socioeconomic status
What are the social circumstances that can contribute to depression?
Martial Status - separation
ACEs
Low socioeconomic status
what personality traits are associated with depression?
anxiety, impulsivity, obsessionally
what are the structural brain changes associated with depression?
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
what are the brain post-mortem findings in depression?
Reduced GABA function, abnormal synaptic density, or neuronal plasticity in the hippocampus; glial cell abnormalities; reduced expression of SERT mRNA in dorsal raphe nucleus
what are the results of functional brain imaging in depression?
hypoperfusion in frontal, temporal, and parietal areas (esp. older patients) and increased perfusion in frontal and cingulate cortex
what are the neurotransmitter abnormalities seen in depression?
reduced monoamine function may cause depression (i.e. 5-HT, NE, DA).
what are the results of neuroendocrine challenge tests show in depression?
increased cholinergic functioning, increased cortisol associated with adrenal hypertrophy and dexamethasone
what are the thyroid abnormalities in depression?
abnormalities in the thyrotropin (TSH) response to TRH
what are the changes in sleep pattern seen in depression?
reduced total SWS and shortened REM latency
what is the stress vulnerability model of depression?
neuron cell death via
Mitochondrial dropout
Glional Dropout
what is mitochondrial dropout?
increased glucocorticoids (i.e. cortisol) in response to stress leads to excessive mitochondrial activity, cell burnout and cell death
what is glional?
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
what is the pathophysiology of the hypothalamus in depression?
5-HT suppresses hypothalamus, inhibits releases CRH to release ACTH, in depression hypothalamus altered response to serotonin? Raised cortisol
what are the core symptoms associated with depression?
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
what are the features of depressed mood in depression?
present all day, everyday, lack of responsiveness to change, diurnal variation
what weight changes can occur in depression?
loss of weight or gain, decreased or increased appetite
what are the sleep disturbances in depression?
insomnia with early morning wakening, or hypersomnia
what are the somatic symptoms of depression?
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
what are the psychotic symptoms of depression?
o Delusions
o Hallucinations
o Catatonic symptoms
what are the different parts of a mental state examination?
appearance, attitude, behaviour, mood, affect, speech, thought process, thought content, perception, cognition, insight and judgement.
what are the features of appearance and behaviour in an MSE in depression?
reduced facial expression, furrowed brow, reduced eye contact
Limited gesturing – movements may be slowed, or absent
Difficult to establish rapport
what are the features of speech in an MSE in depression?
Reduced rate of speech, lower pitch, quiet, monotonous, increased speech latencies, limited content
what are the features of mood in an MSE in depression?
low, miserable, unhappy, sad, flat, empty, numb
