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Psychiatry > Depression - General > Flashcards

Depression - General Flashcards

1
Q

What are three points which are not stated in ICD criteria but must be the case for a diagnosis of depression to be made?

A

Symptoms must be clearly abnormal for the individual, they must persist and they must interfere with normal functioning to some degree.

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2
Q

What are the 2 general ICD-10 criteria which MUST be present for the patient to be diagnosed as having depression?

A

The depressive episode should last at least two weeks, and there should be no evidence of previous manic or hypomanic episodes.

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3
Q

What are the three features under ICD-10 criteria B (core features) for the diagnosis of depression? How many of these must be present for a diagnosis of depression to be made?

A

Low mood, anhedonia and lack of energy/fatigue. At least 2/3 of these features must be present for a diagnosis to be made.

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4
Q

In criteria B of the ICD-10 depression features, when should low mood be present?

A

Present for most of the day, almost every day, largely uninfluenced by circumstances.

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5
Q

What are the 7 features listed under criteria C for the ICD-10 diagnosis of depression?

A

Loss of confidence/self-esteem, unreasonable guilt, suicidal thoughts/behaviours, decreased concentration, psychomotor agitation/retardation, sleep disturbance, change in appetite.

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6
Q

What is the most common sleep disturbance to be seen in depression?

A

Early morning wakening

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7
Q

What are somatic symptoms?

A

Various bodily sensations that a depressed individual perceives as unpleasant or worrisome.

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8
Q

Briefly describe mild depression?

A

A few symptoms of depression are usually present. The patient is often distressed by these but will probably be able to continue with most activities.

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9
Q

How is mild depression usually managed?

A

Normally managed in primary care only, and often with no treatment as the episodes will get better by themselves.

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10
Q

According to ICD-10, what defines moderate depression?

A

2/3 of criteria B must be present, and some additional features from criteria C to make at least 6 features from criteria B and C together.

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11
Q

According to ICD-10, what defines severe depression?

A

3/3 of criteria B must be present, and some additional features from criteria C to make at least 8 features from criteria B and C together.

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12
Q

Severe depression can be further divided depending on the presence or absence of what?

A

Psychotic symptoms

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13
Q

Describe some features of a patient with psychotic depression?

A

These patients will typically be paranoid, have ‘mood congruent’ i.e. depressive, delusions or hallucinations and can sometimes by hypochondriacal.

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14
Q

What is Cotard’s syndrome? Who is it mostly seen in?

A

A subtype of psychotic depression where people deny their own existence or believe that a part of them does not exist. It is more common in the elderly.

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15
Q

How may the mood in depression be?

A

Depressed, miserable or irritable

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16
Q

How may a person with depression’s speech be?

A

Impoverished, slow, monotonous

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17
Q

How would you describe a person with depression’s energy?

A

Reduced, lethargic, lacking motivation

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18
Q

What are some ideas that a person with depression might have?

A

Feelings of futility/guilt/unworthiness, hypochondriacal preoccupations, suicidal thoughts

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19
Q

What are some cognitive features of depression?

A

Impaired learning and concentration, pseudodementia in older patients

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20
Q

What are some physical features of depression?

A

Insomnia, poor appetite and weight loss, constipation, sexual dysfunction, bodily pains

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21
Q

What are some behavioural features of depression?

A

Psychomotor retardation or agitation, poverty of movement and expression

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22
Q

In more severe forms of depression, diurnal variation can occur. What is the usual pattern of this?

A

Patients feel worse in the morning and gradually get a little better throughout the day

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23
Q

What type of hallucinations are most commonly seen in depression?

A

2nd person auditory (often insulting them or suggesting suicide)

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24
Q

What are the 3 main groups of people who are at an increased risk of depression?

A

Females, the unemployed and those who are separated/divorced

25
Q

What are some social factors which often coincide with depression?

A

Physical illness, excessive/chronic alcohol use, loss events, interpersonal difficulties, lack of social support

26
Q

What are some differential diagnoses of depression?

A

Other psychiatric disorders, Cushing’s disease or excessive steroid treatment, thyroid disease, hyperparathyroidism, brain tumour (rare)

27
Q

What are some physical treatments for depression?

A

Stopping depressing drugs, regular exercise, anti-depressants and adjunctive drugs, ECT

28
Q

When should ECT be used as a treatment for depression?

A

If the depression is life threatening (e.g. not eating or drinking) or non-responsive

29
Q

What are are psychological treatments for depression?

A

Education and regular follow up, CBT, other psychotherapies e.g. couples, family, interpersonal

30
Q

What are some social treatments for depression?

A

Sort finances, acquiring or changing job, good housing, child support

31
Q

What is the most effective treatment (generally) for depression?

A

A mixture of CBT and an anti-depressant

32
Q

How would you describe CBT?

A

It involves the identification of negative automatic thoughts that maintain the negative perceptions which feed depression. It then tests the logic of these thoughts

33
Q

What are some examples of the negative automatic thoughts which occur in depression which get tested by CBT?

A

Catastrophising, over-generalising and categorical thinking

34
Q

What is the evidence for CBT?

A

Good evidence that it is as effective as anti-depressants for the treatment of mild-moderate depression and should be offered as a 1st choice treatment. It is also effective at reducing the risk of relapses.

35
Q

What is interpersonal therapy?

A

Focuses on interpersonal relationships involved in or affected by the depression and uses problem solving techniques to find solutions.

36
Q

According to NICE, what is the management for mild-moderate depression?

A

Low intensity psychological interventions

37
Q

According to NICE, if there is no response to low intensity psychological therapy OR there has been a past history of moderate-severe depression OR the depression has been present for more than two years, what are the next steps?

A

High intensity psychological interventions OR an anti-depressant (usually SSRI)

38
Q

According to NICE, if high intensity psychological interventions OR an anti-depressant (usually SSRI) is tried to no effect, what is the next step?

A

Combine the two

39
Q

According to NICE, what are the treatment options for a complex/severe depression?

A

ECT, augment with anti-psychotic, inpatient care

40
Q

When should patients with depression be treated as inpatients?

A

When they are at risk of suicide, self-harm or neglect

41
Q

If a medication for depression does not seem to be working, what could be some causes for this?

A

Non-concordance, incorrect diagnosis, substance misuse, physical illness, social factors need sorted first

42
Q

If a medication is not working for a patient and you have addressed all likely causes and think the treatment needs to be altered, what are some options?

A

Increase dose, change drug, combine drugs, augment with anti-psychotic or lithium

43
Q

What are the most common combinations of drugs to be used in depression?

A

SSRI or SNRI + mirtazapine

44
Q

What are the 3 things which should be done before starting anti-depressants?

A

Get ratings of depressive symptoms so you can compare the effect later, warn patients about side effects and that they will likely be transient, arrange follow-up for 1-2 weeks later

45
Q

What should you tell a patient about continuing their anti-depressant for the recommended length of time?

A

This will greatly reduce the risk of relapse and will not result in addiction

46
Q

Why is it important to look out for elderly people with depression presenting with ‘dementia’?

A

This can just be caused by the depression or certain medications and is treatable

47
Q

Cognitive impairment in depression occurs as a result of what?

A

Underlying brain dysfunction

48
Q

What are some cognitive deficits which can be seen in depression?

A

Poor attention, poor memory, slowed reaction time, impairments in planning

49
Q

What is the main neuroendocrine change in depression? What does this lead to?

A

Chronically raised cortisol levels which leads to disturbances in noradrenaline and serotonin transmission

50
Q

What happens to hippocampal volume as depression continues?

A

It decreases

51
Q

On mental state examination, what are some features of depression that you may list under ‘appearance and behaviour’?

A

Reduced facial expressions, furrowed brow, decreased eye contact, limited gesturing, difficult to establish rapport

52
Q

On mental state examination, what are some features of depression that you may list under ‘speech’?

A

Reduced rate, pitch, volume and intonation, increased speech latencies, limited content

53
Q

On mental state examination, what are some features of depression that you may list under ‘mood’?

A

Low/miserable/unhappy

54
Q

On mental state examination, what are some features of depression that you may list under ‘affect’?

A

Depressed mood, limited reactivity, reduced range (i.e. stays low throughout)

55
Q

On mental state examination, what are some features of depression that you may list under ‘thought’?

A

Normal form, can be slow and sometimes absent, can be of negative content (e.g. failure, guilt), delusions and paranoia can occur

56
Q

What are some examples of self-referential thinking which can be seen in depression?

A

Increased sensitivity to criticism, self-conscious in busy places, feeling under scrutiny

57
Q

On mental state examination, what is a feature which doesn’t always occur in depression but could be listed under ‘perception’?

A

Hallucinations

58
Q

On mental state examination, what are some features of depression that you may list under ‘cognition’?

A

Typically slow, may complain of poor memory, planning and attention

59
Q

What will a person with depression’s insight be like?

A

Typically preserved, but may attribute depression to other things e.g. sins, personal failings

Psychiatry (20 decks)

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