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Mind: Sem 3 > Depression Epidemiology and Biological Basis > Flashcards

Depression Epidemiology and Biological Basis Flashcards

1
Q

what are the core features of depression?

A
  • low mood
  • loss of interest and enjoyment (anhedonia)
  • reduced energy
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2
Q

what is anhedonia?

A

loss of interest and enjoyment

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3
Q

what are the associated features of depression?

A

biological and cognitive

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4
Q

biological symptoms of depression?

A
  • poor sleep
  • loss of appetite
  • loss of libido
  • reduced concentration and attention
  • fluctuating mood
  • easily agitated
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5
Q

cognitive symptoms of depression?

A
  • low self esteem/ reduced concentration
  • guilt and worthlessness
  • hopeless
  • helplessness
  • ideas of self harm/suicide
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6
Q

what are the key symptoms in diagnosis of depression?

A
  • persistent sadness/low mood

- marked loss of interest or pleasure

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7
Q

what are the associated symptoms of depression?

A
  • disturbed sleep
  • decreased/increased appetite
  • poor concentration
  • feeling worthless/guilt
  • suicidal thoughts and intentions
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8
Q

how are the key symptoms involved in diagnosis of depression?

A

at least one must be present most days most of the time for at least two weeks

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9
Q

when would general advice and active monitoring be appropriate?

A
  • 4 or less symptoms with not much disability
  • intermittent symptoms, less than two weeks
  • no past or family history of depression
  • good social support
  • no suicidal thoughts
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10
Q

when would active treatment in primary care be appropriate?

A
  • 5+ symptoms with associated disability
  • persistent symptoms
  • past or family history of depression
  • low social support
  • occasional suicidal thoughts
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11
Q

when would referral to mental health professionals be appropriate?

A
  • inadequate response to 2+ interventions
  • recurrent episode within 1 year
  • suggestive history of bipolar disorder
  • patient or relative request referral
  • more persistent suicidal thoughts
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12
Q

when would urgent referral to specialist mental health services be appropriate?

A
  • actively suicidal ideas/plans
  • severely agitated
  • severe self-neglect
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13
Q

how many severities of depression are there?

A

mild, moderate, severse

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14
Q

what is mild depression?

A
  • two core symptoms
  • two associated symptoms

none of them are intense, might be distressed, some difficulty continuing with normal life and social activity

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15
Q

what is moderate depression?

A
  • two core symptoms
  • 3/4 associated symptoms

difficulty continuing with normal life and social/domestic activity

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16
Q

what is severe depression?

A
  • three core symptoms
  • 4 associated symptoms with severe intensity

cannot continue with normal social/domestic/work activities, includes psychotic depression

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17
Q

less obvious ways that depression can present?

A
  • headaches
  • chest pain
  • low back pain
  • atypical facial pain
  • fatigue
  • poor memory
  • weight loss
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18
Q

what is most important cause of misdiagnosis of depression?

A

somatisation

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19
Q

why is depression more common in women? (1:2 ratio)

A

men more likely to find maladaptive coping mechanisms like alcohol

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20
Q

suicide deaths in 15-29 year olds?

A

2nd leading cause of death

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21
Q

which has higher lifetime prevalence: bipolar or unipolar disorder?

A

unipolar depressive disorder (4-30%)

bipolar = 0.3-1.5%

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22
Q

bipolar male:female?

A

equal

23
Q

internalising risk factors

A 
genetics
low self-esteem
history of depression
early onset anxiety disorder
neuroticism/perfectionism
24
Q

externalising risk factors

A

substance misuse
conduct disorder
genetics

25
Q

adversity

A 
trauma in childhood
stressful life events
parental loss
low parental warmth
history of divorce
marital problems 
low social support 
low education
26
Q

1st degree relative with unipolar depression, risk of unipolar is?

A

17%

27
Q

1st degree relative with unipolar depression, risk of bipolar is?

A

3%

28
Q

1st degree relative with bipolar depression, risk of unipolar is?

A

8%

29
Q

1st degree relative with bipolar depression, risk of bipolar is?

A

15%

30
Q

how does CRH affect risk of depression?

A

reduced as CRH causes stress steroid release

31
Q

which chromosomes are associated with MH disorders?

A

3 and 10

32
Q

what might account for twins having high concordance rates of MH disorders?

A

same psychosocial environments

33
Q

which neurotransmitters are involved with depression?

A

serotonin, noradrenaline and dopamine

34
Q

what may increase BDNF (brain derived neurotrophic factor)?

A

antidepressant use and electroconculsive therapy (ECT) reduces stress

35
Q

what do MAOIs and tricyclics do?

A

treat depression

36
Q

how is cortisol linked to depression?

A

high cortisol (e.g. cushings disease) linked to depression

37
Q

what is the MA hypothesis?

A

that pathophysiologic basis of depression is a depletion in the levels of serotonin, norepinephrine, and/or dopamine

38
Q

what plasma concentrations of precursors to serotonin were found in depressed patients?

A

reduced

39
Q

what levels of serotonin did suicide victims show at night?

A

reduced, relted to impulsivity

40
Q

what do depelating levels of tryptophan lead to?

A

relapse of depression as its a precursor to serotonin

41
Q

what is a serotonin precursor?

A

tryptophan

42
Q

what do drugs that deplete NA induce?

A

depressive symptoms in recovered patients

43
Q

what do depressed people show in their CSF?

A

decreased dopamine and increased CRH

44
Q

what does increased BDNF mean?

A

less stress

45
Q

how does cortisol affect BDNF expression

A

it decreases the expression

46
Q

what does CRH act as in the limbic system?

A

a neurotransmitter

47
Q

how does depression affect t3?

A

decreases

48
Q

what happens to TSH response in depressed patients?

A

TSH response to TRH decresaes

49
Q

what is becks cognitive triad?

A
  • the self (i am to blame)
  • the world (the world is unfair)
  • the future (the future is hopeless)
50
Q

what are three cognitive biases?

A
  • polar reasoning (all or nothing)
  • abstraction (successes are ignored)
  • overgeneralisation (if this went badly so will everything else)
51
Q

personality influences on depression

A

needing to be in control
perfectionism
tendency to blame self

52
Q

early environment and depression

A
  • parental seperation and discord
  • parental style: overprotection and lack of care
  • recalled abuse
53
Q

Vulnerability factors which increase the risk of depression if a provoking agent is present (Brown and Harris)

A
  • 3 or more children under 14
    • Not working outside the home
    • Lack of confiding relationship

Mind: Sem 3 (3 decks)

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