Depressive Disorder Flashcards
What is depressive disorder?
Disorder where symptoms of unhappiness become qualitatively different and pervasive or interfere with normal functioning
Who gets depressive disorder?
- More than 50% of cases before age 30
- Onset usually late 20s-30s
Criteria for depressive disorder?
- Depressive episode should last at least 2 weeks
- No hypomanic or manic episodes in individual’s life
- At least 2 of the following symptoms:
- Depressed mood
- Loss of interest or pleasure
- Decreased energy
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Additional symptom or symptoms to make at least 4 (eg guilt, poor concentration etc)
Acronym to help assess depressive episode?
MEE
- Mood
- Energy
- Enjoyment
Additional symptom list in depressive episodes?
- Loss of confidence
- Guilt
- Suicidal ideas or behaviours
- Poor concentration
- Agitation/retardation
- Sleep in disturbance
- Changes in appetite
What is dysthymia?
Mild or moderate depressive illness that lasts intermittently for 2 years or more
What is psychotic depression?
Occurs in those with severe depression where thinking becomes psychotic
What usually occurs in psychotic depression?
Hallucinations within the theme of depression
-Voices telling them that they are a failure
What syndrome can occur in psychotic depression?
Cotard syndrome
-Nihilistic delusions can occur where it is believed by the patient that a part of them us dead or decomposed or annihilated or they don’t exist entirely as a human being
Mental state exam in depressive disorder?
Appearance: Slouching, tired, unkempt, dishevelled
Behaviour: Upset or teary
Speech: Slowed down speech, monotonal, low volume, poverty of speech
Mood: low
Affect: Blunted, flattened, not responding much
Thoughts: Suicidal thoughts/self harm, guilt, shame, thought blocking
Perception: Probably normal unless psychotic
Cognition: Poor concentration and memory, but most likely orientated
Insight: Generally aware of how they are feeling
Initial screening for depressive disorder?
2 screening questions: If answer to one or both is yes then person should be assessed for depressive illness
What are the 2 initial screening questions?
- During the last month have they been feeling down, depressed or helpless
- During the last month, have you been bothered by having little interest or pleasure in doing things
Other screening tools for depressive disorders?
- PHQ-9 (patient health questionnaire)
- Hospital anxiety and depression scale
Possible physical causes of depression?
- Thyroid disease
- Cushing’s
- Hyperparathyroidism
- Corticosteroid treatment
- Brain tumours
Management of depression patients who are actively suicidal?
Admission to hospital
