Depression Flashcards
Describe the differences between normal sadness and depression.
Sadness
- healthy emotional reaction, signal of loss
- lasts for short period of time
- usually does not impact a person’s ability to function productively
- often realistic in thought pattern
Depression
- feelings of hopelessness and helplessness
- complex pattern of physiological/psychological symptoms
- negatively biased thoughts
- mental illness
Discuss the criteria of Major Depressive Disorder.
A - 5 or more of the following symptoms present in a 2 week period; 1 or more of symptoms (1) or (2):
1 - depressed mood
2 - loss of interest/pleasure in almost all activities
3 - significant weight loss/weight gain/decrease appetite/increased appetite
4 - insomnia/hypersomnia
5 - psychomotor agitation or retardation
6 - fatigue/loss of energy
7 - feelings of worthlessness/excessive or inappropriate guilt
8 - difficulty to think/concentrate, indecisiveness
9 - recurrent thoughts of death, recurrent suicidal intention without specific plan or a suicide attempt or a specific plan for committing suicide
B - clinically significant distress in social, occupational or other important areas of functioning
C - episode is not attributable to the physiological effects of a substance or to another medical condition
D - Not better explained by different forms of schizophrenia spectrum disorders
E - NEVER been a manic/hypomanic episode (bipolar disorder)
What does the acronym MOOD DSM AIDES stand for?
Mood Decisiveness concentration Sleep Motor symptoms Appetite, weight Interest, pleasure Dysfunctional thinking Energy, fatigue Suicidality
What is the 1-2 month prevalence of MDD in NZ?
5.7%
Which gender is at most risk of MDD?
Women
What is the median onset age of MDD?
25 years
What family factors lead to MDD?
Marital dissatisfaction/discord & negative parenting behaviours
What physical health problems are strongly associated with MDD?
Chronic physical disorders (arthritis, asthma, cancer, diabetes, cardiovascular disease and pain)
How is finances associated with MDD?
Personal earnings and household incomes of people with MDD are lower
How does MDD affect work performance?
Those with MDD have the highest number of days away from work of any physical or mental disorder.
What physical/social aspects are affected by MDD?
Family
Physical Health
Finances
Work Performance
Discuss the global burden of depression.
About 300 million people suffer from depression
Leading disorder contributing to global YLDs and DALYs.
List the screening questions used for depression.
During the past month, have you often been bothered by feeling down, depressed or hopeless?
During the past month, have you often been bothered by little interest or pleasure in doing things?
Name examples of information found in screening for MDD.
Patient history Family history Maori/Pacific : roles & responsibilities within whanau and wider community Physical examination Medications taking Alcohol/recreational drugs
List more examples of information needed in screening for MDD.
Duration of symptoms Previous interventions Functional impairment Precipitating factors Perpetuating factors Protective resources Suicidal ideation or attempts
Which sociodemographic groups show increased risk of suicide?
Males Maori Aged 15-24 Socioeconomically deprived ^^ Same risk groups for attempted suicide
List medications with depressogenic effects.
Analgesics Anticonvulsants Antidepressants Anxiolytics, hypnotics, sedatives GI agents Hormones/hormone modifiers Respiratory agents
Name medical conditions that can mimic depression.
Thyroid condition Cardiac condition Certain pancreatic conditions Anaemia B12 or Folic acid deficiency Viral infections (e.g. Lyme disease, influenza post viral infection) Dementia
What are the etiological causes of MDD?
Biological
Genetic
Psychosocial
How do you treat persistent subthreshold depression/mild to moderate MDD?
Low intensity psychosocial interventions
Antidepressants only if specific NICE criteria met
Describe how you would treat moderate/severe MDD.(no chronic physical health problem)
Antidepressant & high intensity CBT/interpersonal therapy
How would you treat moderate MDD with a chronic physical health problem?
High intensity psychological intervention
How would you treat severe MDD with a chronic physical health problem?
Antidepressant
Individual CBT
List the prevention strategies for MDD.
Strengthening protective factors
Reducing prodromal symptoms
Reducing comorbid disorders
