Depression- Melancholia & Psychotic Depression

Question 1

Melancholia

DR, recovery

Answer 1

• severe psychiatric experience (worst), high death rate (suicide, alcohol, eating).
• f you get depress tend completely recover.
• higher than normal chance of getting it again (amygdala hyperactivity).

Question 2

Types of depression

Answer 2

both included in major depress disorder- MDD
–commonly diagnosed.
-only 1% MDD have melancholia.
99% various other types of depress.

Question 3

Melancholia

Answer 3

rare v severe treat hospital.
patients debilitated by it - can’t look after themselves.
-emergency seen right away.
-ppl kill family as favor cus world is cruel.
-Melancholia same as Endogenous Depress.

Question 4

Features

Answer 4

• depressed mood, diff from normal misery, feel numb/dead.
• also feel pain indescribable.
• -Anhedonia- inability experience pleasure .
• loss libido. can’t react to surroundings.
• early morning waking- makes them feel worse, have diurnal rhythm.
• generally blame themselves, guilt, plans suicide- frequent thoughts.
• psychometric retardation. -loss appetite & thirst.

Question 5

Vital Symps of Depress

Answer 5

Malaise symps -“feeling ill”.
-washed out, heavy, dull aches.
Phy body symps- similar immune activation to viral infections- flu/arthritis
- cancer disseminated- spread to sites.

Question 6

Main treatment Melancholia

Answer 6

TCAs- trycylic anti-d- imipramine.

• if don’t work 2nd line drugs- MAOIs- phenelzine.
• ECT- don’t like but accepted to work v well.

SSRIs- don’t work.

Ketamine- intravenous infusion, v quick & effective.

Question 7

Psychotic Depress (PD)

Answer 7

melancholia & psychotic feats.
-such as hallu, delusions, catatonia.
psychotic feats are mood congruent.
-neg voices, rotten food smells. -delusions often blame- believe causes suffering or have sinned. 
-they are dead (rotting inside).
-agitated, rep gestures & comments.
-no insight.

Question 8

Stupor

Answer 8

severe melancholia & PD can progress to stupor.

• unresponsive state- semi-coma- would respond to pain.
• don’t eat, drink use toilet.
• death quick if untreated- dehydration, starvation- need intensive therapy support- IV food/liquid.

ECT treatment is necessary.
Ketamine- promising new drug.

Question 9

Aetiology (causes)

Epidemiology

Answer 9

unknown, probs many. Like disease would occur out of the blue. -happen to almost anyone.

100 new cases per million population a year.
-MDD 100,000 per million.