Depressive disorder Flashcards
Define depressive disorder.
Mood disorder characterised by pervasive low mood.
Accompanied by social and biological symptoms. Episodes described in terms of core symptoms and additional ICD10 features. Further classified dependingon severity and psychotic feature presence.
Explain the aetiology/risk factors for depressive disorder.
Genetic theories
Biochemical model of 5HT dysfunction
Cognitive distortions present (overgeneralisation, personalisation, minimisation) and negative view triad: self, the world, the future.
Summarise the epidemiology of depressive disorder.
Associated with chronic ilness, divorce, unemployment, lack of confiding relationship, poor support, low SES. Comorbidity with other psych issues common. Lifetime risk 10%.
What are the core symptoms of depressive disorder?
Low mood
Low energy and anhedonia
Fatigue
What are the behavioural (somatisation) signs of depressive disorder?
Anhedonia
Lack of emotional reactivity
Early moening wakening >2h
Diurnal variaiton in mood
Psychomotor retardation or agitation
Loss of appeite
Weight loss
Low libido
What are the additional symptoms of depression?
Low concentration and attention
Low self esteem
Thoughts of self harm or suicide
Pessimistic view of future
Disturbed sleep
Disturbed appetite
Guilt and worthlessness
How are the symptoms used to characterise depressive disorder?
- 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
How would a patient with depressive disorder appear on examination?
Appearance: Neglect, slumped
Behavior: Poor communication eye contact
Speech: Slow, slurred, reduced volume
Mood: Low
Thought: Pessimistic
Perception: ?Hallucinations
Cognition: Poor concentration
Insight: Generally good
What are the investigations for depressive disorder?
FBC
U+Es
Ca2+
LFTs
Tox screen
TFTs
Glucose
What is the management for depressive disorder?
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.
Drug treatment:
Antidepressant medication: TCA, SSRI, Lithium if refractory
Continue for 6 months after symptom resolution
Antipsychotic if psychosis too
ECT if severe and resistant to treatment
What are complications associated with depressive disorder?
Social isolation
Aggravation
Unemployment
Self harm
Suicide
Substance abuse
What is the prognosis of depressive disorder?
Lifetime suicide risk 15%.
After initial episode 10% recover but almost all have recurrence within 10y.
