Depression and Medical Illness

Question 1

What is the lifetime prevalence of any mental illness in Aus?

Answer 1

45%

Question 2

What is the depression rate in general hospital admissions vs. community prevalence?

Answer 2

6-15% in general hospital admissions

2-5% in community

Question 3

Is depression or anxiety more common in the GP setting? Which is more common in the community?

Answer 3

Depression (5-10%)

Anxiety more common in the community (14% vs 4% depression)

Question 4

List 4 important diagnostic features of major depression

Answer 4

Lowering of mood is persistent
Interferes with function
And/or leads to substantial distress
At least 2 weeks lowered mood for most of the day on most days

Question 5

3 main symptoms of major depression

Answer 5

Depressed mood
Anhedonia
Fatiguability

Question 6

Describe the melancholic features of major depression

Answer 6

Anhedonia
Worse in morning
Early morning wakening (for 2 hours or more)
Psychomotor retardation/agitation
Significant weight loss/anorexia
Excessive guilt
Distinct quality to depressed mood

Question 7

Important aspects when assessing for possible suicidal ideation

Answer 7

Presence/absence of suicidal ideation
Intention to pursue
Specific plans?
Any similar previous episodes

Question 8

List 9 important questions to ask to elicit the symptoms of major depression. How do you assess the patient’s answers?

Answer 8

Energy
Loss of interest
Loss of confidence
Hopelessness
IF YES TO ANY GO ON TO:
Concentration
Loss of weight (and appetite)
Early waking
Feeling "slowed up"
Feeling worse in the morning
(1 point for each +ive answer; score >3 suggests MDD)

Question 9

What aspect of the history is most predictive of a suicide attempt?

Answer 9

Sense of hopelessness (also worthlessness, helplessness, excessive guilt)

Question 10

What are the 8 important features of MSE?

Answer 10

Appearance
Behaviour and attitude to interview
Speech and language
Mood and affect
Thought process and thought content
Perception
Cognition
Insight

Question 11

What is the relationship between MDD and CVD?

Answer 11

Independent risk factor equivalent to smoking, hyperlipidaemia or hypertension

Question 12

How does major depression impact on CV health?

Answer 12

Alters the HPA axis, notably cortisol
Increases platelet aggregation
Increases HR variability

Question 13

List 5 more reliable indicators of a clinical depressive state in medically ill pts

Answer 13

Cognitive symptoms including:
Depressed mood
Anhedonia
Feelings of worthlessness and guilt
Decreased concentration or ability to think clearly
Recurrent thoughts of death (not just fear of dying), suicidal ideas or plans

Question 14

List 11 medical conditions associated with symptoms of depression

Answer 14

Stroke
PD
Hypothyroidism
Hypomagnesaemia
Cushing's syndrome
Addison's disease
Hypocalcaemia
Viral infections
Delirium in apathetic form
Dementias
Vitamin B deficiencies

Question 15

List 4 cognitive symptoms of anxiety

Answer 15

Fear
Embarrassment
Doubt
Sense of impending doom

Question 16

List 4 physical symptoms of anxiety

Answer 16

Tachycardia
Tachypnoea
Tremor
Sweating

Question 17

What is the main behavioural symptom of anxiety?

Answer 17

Avoidance

Question 18

What does the Yerkes-Dodson curve illustrate?

Answer 18

The relationship between arousal and performance (some anxiety enhances performance, too much impairs performance)

Question 19

What are the 2 main diagnostic factors for an anxiety disorder?

Answer 19

Disproportionate intensity and/or duration of anxiety

Significant distress and/or functional impairment

Question 20

List some somatic symptoms of pathological anxiety

Answer 20

Dizziness or light-headedness
Tachycardia
Sweating
Hyperreflexia
HTN
Palpitations
Pupillary mydriasis
Restlessness
Tingling the extremities
Tremors
Upset stomach ("butterflies")
Diarrhoea
Urinary frequency, hesitancy, urgency

Question 21

What are the 9 key questions to ask in suspected GAD?

Answer 21

Felt keyed-up and on edge
Worrying a lot
Irritability
Difficulty relaxing
IF YES TO ANY 2, GO ON TO:
Poor sleep
Headaches, neckaches or tightness in the head
Dizziness, trembling, sweating, diarrhoea, etc
Worry about health
Difficulty falling asleep
1 point for each +ive answer, anxiety states usually score at least 5

Question 22

What is the annual prevalence of mental illness?

Answer 22

1 in 5

Question 23

Give examples of abnormal laboratory findings associated with MDD in the research setting

Answer 23

Dexamethasone non-suppression
Elevated cortisol
Alterations in sleep EEG profiles (tyramine challenge tests)
Asymmetry on dichotic listening tests

Question 24

Outline the DSM-IV criteria for major depressive episode

Answer 24

At least 5 of the following symptoms (must include either 1 or 2), present on most days for most of the day over at least 2 weeks:
1. Depressed mood
2. Ahedonia
3. Significant weight/appetite loss or gain
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feeling worthless or excessively guilty
8. Diminished concentration or ability to think clearly
9. Recurrent thoughts of death (not just fear of dying), suicidal ideas or plans
Symptoms associated with distress or impaired function

Question 25

What conditions must be excluded when considering a diagnosis of major depressive episode?

Answer 25

Direct physiological effect (e.g. of physical disease, medication, substance abuse)
Bereavement
Psychotic disorder

Question 26

What 6 features suggest bereavement can be excluded when considering a diagnosis of major depressive episode?

Answer 26

Symptoms longer than 2/12
Marked impairment
Morbid preoccupation with worthlessness
Suicidality
Psychosis
Psychomotor retardation

Question 27

Give an example of a medication which can mimic MDD

Answer 27

Steroids

Question 28

What is the difference between cognitive symptoms of panic disorder and GAD?

Answer 28

Panic disorder: typical cognition is of impending death or doom
GAD: “free-floating” anxiety, typical cognitions are of global apprehensive expectation (rather than specific threat)