depression (clinical) Flashcards
what neurotransmitters can depression be associated with
serotonin mainly
also dopamine and noradrenaline
structural brain changes linked with depression
ventricular enlargement
raised sucal prominence
can depression be inherited
major depression inheritability is 37%
psychological risk factor for depression
adverse childhood experiences
social factors linked to depression
events (job loss, divorce)
stress
social isolation
poor social environment/class
how long must symptoms be present for before you can call it depression
2 weeks
no alcohol, drugs, medical disorders or bereavement
what are the 3 core features of depression
AAD
anhedonia (loss of pleasure)
anergia (lack of energy)
depressed mood
features of the ‘depressed mood’
abnormal for the individual
most of the day, almost every day
uninfluenced by circumstances
what are the additional symptoms that could be present in
loss of confidence/elf-esteem
unreasonable feelings of self-reproach/guilt
recurrent thoughts of death/suicide/suicidal behaviour
diminished concentration (symptom or sign)
psychomotor retardation/agitation
sleep disturbance of any type
increase or decrease in appetite
diagnostic criteria for mild depression
2/3 core symptoms
2-3 additional symptoms
diagnostic criteria for moderate depression
2/3 core symptoms
up to 4 additional symptoms
diagnostic criteria for severe depression
3/3 core symptoms
5+ additional symptoms
what are the subtypes of depression
somatic syndrome
atypical
psychotic
cotard’s syndrome
what is somatic syndrome
clinical manifestation of depressive symptoms
Diagnostic criteria of somatic syndrome that must be present
4 should be present of: anhedonia lack of emotional reactions early morning wakening depression worse in the morning psychomotor retardation/agitation loss of appetite weight loss loss of libido
key feature of atypical depression
mood reactivity - mood brightens in response to actual or potential positive events
what are the additional features of atypical depression and how many should be present to diagnose
2 or more of:
significant weight gain/increase in appetite
hypersomnia
leaden paralysis (heavy limbs)
interpersonal rejection sensitivity resulting in social/occupational impairment
how psychotic depression differs from other forms of psychosis
related to depressive themes
typically mood congruent or hypochondrical
what is cotard’s syndrome and who gets it
elderly nihilistic delusions (sensation of being partially/completely dead)
MSE appearance
reduced facial expression
furrowed brow
unkempt
MSE behaviour
reduced eye contact
limited gesturing
rapport difficult to establish
often tearful
MSE speech
slow
low pitch and volume
monotonous
increased latencies (end of question and start of answer)
limited content - short and brief answers
MSE mood and affect
low for both
flat affect
limited reactivity
MSE thought (form)
slow/absent
MSE thought (content)
negative/suicidal failure/guilt burden low self esteem paranoid
MSE perception
2nd person auditory hallucinations
MSE cognition
slow thinking
poor concentration/attention (leading to poor memory)
MSE insight
usually preserved
can sometimes blame symptoms on personal weakness/actions
common manifestation of depression in elderly
‘pseudo-dementia’
depression mimics dementia
