Depression and Medical Illness Flashcards
When do you become concerned about mental illness?
Impacts on roles
Sick > exaggerated experience/dysfunction related to injury
What are high prevalence mental illnesses?
Major depression
Anxiety disorders
What are the different types of anxiety disorders?
Panic disorder
Agoraphobia
Generalised anxiety disorder
How are mental illnesses diagnosed?
Syndrome identification > patterns in history, symptoms, and signs
What does “threshold of diagnosis” mean?
Many common mental illnesses on continuum with normal emotions
- Diagnosis based on study of threshold
Other mental illnesses like schizophrenia and delirium - clear separation from continuum
What are some examples of physical factors causing low mood?
Medications
Alcohol
Recreational drugs
Hormonal changes
What is major depression?
Abnormal sadness/clinical depression
- Persistent lowering of mood
- Interferes with person’s ability to function
- Substantial distress
- At least 2 weeks for most of day on most days
What are some questions that you can ask to elicit the symptoms of major depression?
Low energy?
Loss of interest?
Lost confidence in yourself?
Felt hopeless?
What are the DSM-V criteria for major depression?
At least 5 of following, of which must include 1st/2nd
- Depressed mood
- Markedly diminished interest/pleasure in all/most activities
- Significant weight/appetite change
- Insomnia/hypersomnia
- Psychomotor agitation/retardation
- Fatigue/loss of energy
- Feeling worthless/excessively guilty
- Diminished concentration/ability to think clearly
- Recurrent thoughts of death/suicidal ideation/plans
Symptoms present on most days for most of day, for at least 2 weeks
What factors should be excluded when considering a diagnosis of major depression?
Direct physiological effect
Exclude bereavement
Psychotic disorder
What does a mental state examination involve, briefly?
Appearance Behaviour and attitude to interview Speech and language Mood and affect Thought process and thought content Perception Cognition Insight
In an MSE, what features should you look out for in appearance and behaviour?
Downcast demeanor and furrowed brow Stooped posture Slowed activity Reduced spontaneity of movement and gesture Tearfulness if milder
In an MSE, what features should you look out for in affect?
Little modulation
Flattened if severe
In an MSE, what features should you look out for in speech?
Monotone voice
Slow responses
In an MSE, what features should you look out for in thought content?
Negative and pessimistic themes Suicidal ideas/plans Poor concentration Lack of motivation Guilt Hopelessness Helplessness Worthlessness
What is the relevance of depression as a risk factor for cardiovascular disease?
Major depressive episode independent risk factor post AMI
Equivalent to smoking/raised cholesterol/hypertension
Increased risk of further heart-related incident, AMI, and sudden death
How does physical illness impact recognising major depression?
Harder to interpret symptoms
Cognitive symptoms more reliable indicators
Which sorts of disorders are depression and anxiety common in?
Nutritional disorders
Endocrine disorders
Neurological disorders
Any disorders causing disability
What is anxiety?
Diffuse, unpleasant, vague sense of apprehension
Physical discomfort
What are some of the cognitive symptoms of anxiety?
Fear
Embarrassment
Impending doom
Doubt
What are some of the physical symptoms of anxiety?
Heart rate
Respiratory rate
Tremor
Sweating
What are some of the behavioural symptoms of anxiety?
Avoidance
What does the Yerkes-Dodson law state?
Relationship between arousal and performance
Some anxiety enhances performance, however too much impairs performance
What is an anxiety disorder?
Anxiety out of proportion to danger in intensity and/or duration
Significant distress and/or impairs functioning
What are the cognitive symptoms of panic attacks?
Feeling of impending death
What are the cognitive symptoms of generalised anxiety disorder?
Global apprehensive expectation
What are the somatic symptoms of anxiety?
Dizziness Light-headedness Tachycardia Sweating Hyper-reflexia Hypertension Palpitations Pupillary mydriasis Restlessness Tingling in extremities Tremors Upset stomach Diarrhoea Urinary frequency/hesitancy/urgency
What are some questions you can ask to elicit a possible generalised anxiety disorder?
Have you felt keyed-up, and on edge?
Have you been worrying a lot?
Have you been irritable?
Have you had difficulty relaxing?
