Depressive Disorder

Question 1

What is the definition of depressive disorder?

Answer 1

Mood disorder characterised by pervasive low mood.

Accompanied by social and biological symptoms. Episodes descriobe din terms of core symptoms and additional ICD10 features. Further classified dependingon severity and psychotic feature presence.

Question 2

What is the aetiology of depressive disorder?

Answer 2

Genetic theories. Biochemical model of 5HT dyfcuntion, perso. Cognitive distortions present (overgeneralisation, personalisation, minimisation) and negative view triad: self, the world, the future.

Question 3

What is the epidemiology of depressive disorder?

Answer 3

Associated with chronic ilness, divorce, unemployment, lack of confiding relationship, poor support, low SES. Comorbidity with other psych issues common. Lifetime risk 10%.

Question 4

What are the core symptoms of depressive disorder?

Answer 4

Anergia
Anhedonia
Low mood

Question 5

What additional symptoms may occur in depressive disorder?

Answer 5

· Low concentraiton and attention

· Low self esteem

· Thoughts of self harm or suicide

· Pseeimistic view of future

· Disturbed sleep

· Disturbed appetite

· Guilt and worthlessness

Question 6

What are the biological symptoms of depressive disorder?

Answer 6

· Lack of emotional reactivity

· Early morning wakening >2h

· Diurnal variation in mood

· Psychomotor retardation or agitation

· Loss of appetite

· Weight loss

· Low libido

Question 7

What is the classification of depression?

Answer 7

Mild depression: 2 core + 2 additonal

Moderate depression: 2 core + 3 additional

Severe depression: 3 core + 4 additional

Severe with psychosis: Severe + hallucination/delusion/stupor

Question 8

What may you find on examination of someone with depressive disorder?

Answer 8

· Appearance: neglect, slumped

· Behaviour: poor communication eye contact,

· Speech: slow, slurred, reduced volume

· Mood: low

· Thought: pessimistic

· Perception: ? hallucinations

· Cognition: poor concentration

· Insight: generally good.

Question 9

What investigations may you do for depressive disorder?

Answer 9

Blood tests: FBC, UE, Ca, LFT, tox screen, TFT, glucose.

Question 10

What is the conservative management of depressive disorder?

Answer 10

Risk assess for suicide and self harm, risk to others. Minimise adverse life events.

Primary care if mild. Psychiatric intervention if severe., hospitalise if psychotic/suicidal.

Question 11

What drug treatments exist for depressive disorder?

Answer 11

· Antidepressant medication: TCA, SSRI

· Li if refractory.

· AD continue for 6 months after symptom resolution.

· Antipsychotic if psychosis too.

· ECT if severe resistant to tx.

Question 12

What are the complications and prognosis of depressive disorder?

Answer 12

Social isolation, aggraation, unemployment, self harm, suicide, substance abuse.

Lifetime suicide risk 15%. After initial episode 10% recover but almost all have recurrence within 10y.