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YR5 Psychiatry > Depressive disorder > Flashcards

Depressive disorder Flashcards

1
Q

Define depressive disorder.

A

Pervasive low mood, loss of interest + enjoyment, neurovegetative disturbance, + reduced energy, causing varying levels of social + occupational dysfunction

Accompanied by social, biological Sx.

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2
Q

Give 6 risk factors for depression

A

Chronic comorbidities

Other MH problems e.g. schizophrenia or dementia.

Older age.

Psychosocial issues: divorce, unemployment, poverty, homelessness.

FH of depressive illness.

Adverse childhood experiences (poor parent-child relationship, physical or sexual abuse)

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3
Q

What are the core symptoms of depressive disorder?

A

Low mood

Low energy

Anhedonia

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4
Q

What are 4 biological signs of depressive disorder?

A

Poor sleep/ Early morning wakening >2h

Loss of appetite + weight loss

Poor concentration

Low libido

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5
Q

What negative cognitions may be experienced in depression?

A

Hopelessness
Helplessness
Worthlessness
Guilt

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6
Q

What psychotic symptoms may be experienced in depression?

A

Mood congruent delusions e.g. Nihilistic
Hallucinations
Catatonia

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7
Q

What are 2 additional symptoms of depression?

A

Low self esteem

Thoughts of self harm or suicide

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8
Q

How are the symptoms used to characterise depressive disorder?

A
  • Mild: 2 core + 2 additonal
  • Moderate: 2 core + 3 additional
  • Severe: 3 core + 4 additional
  • Severe with psychosis: 3 core + hallucination/ delusion/ stupor
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9
Q

What are the investigations for depressive disorder?

A

FBC: R/O anaemia

TFTs: R/O hypothyroidism

Vit D/ B12: R/O deficiency

Glucose: diabetes causes fatigue

Ca2+: hyperparathyroidism

U+Es: electrolyte imbalance

Tox screen

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10
Q

What self-rating scales can be used in depression?

A

Becks depression inventory

PHQ-9

Hospital anxiety + depression scale (HAD)

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11
Q

What is the management for depressive disorder?

A

RA for suicide + self harm, risk to others.

Minimise adverse life events.

Primary care if mild.

Psychiatric intervention if severe, hospitalise if psychotic/suicidal.

Drug tx:

Antidepressant medication: TCA, SSRI, Lithium if refractory

Continue for 6m after Sx resolution

Antipsychotic if psychosis too

ECT if severe + resistant to tx

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12
Q

What is the management for mild depression?

A

1st:
Watchful waiting F/U in 2w
Education: MIND UK, Sleep hygiene, diet, exercise
2nd:
Group/ Computerised CBT
Guided self-help

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13
Q

What is the management for moderate depression?

A

Individualised CBT

SSRI

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14
Q

What is the management for severe depression?

A

Individualised CBT
Sertraline
ECT

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15
Q

What medication should be used in depression? What if this is ineffective?

A

1: SSRI + increase every 2w
If ineffective, swap to another SSRI
2: SNRI
3: Antipsychotic e.g. quetiapine, Lithium, Other
4: ECT

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16
Q

What are the DSM-5 criteria for depression that are felt everyday/ nearly everyday?

A
  1. Depressed mood most of the day
  2. Loss of interest/ pleasure in all, or almost all, activities most of the day
  3. Significant unintentional weight loss/ gain, decrease/ increase in appetite
  4. Insomnia or hypersomnia
  5. Psychomotor agitation or retardation
  6. Fatigue or loss of energy
  7. Feelings of worthlessness or excessive or inappropriate guilt
  8. Diminished ability to think or concentrate, or indecisiveness
  9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan/ a suicide attempt/ a specific plan for committing suicide
17
Q

Give 4 differentials of organic conditions appearing like depression

A

Hypothyroidism
Adverse medication affects
Cushings
Vit B12/ D deficiency

18
Q

Give 3 differentials of psychotic disorders that may appear like depression

A

Bipolar
Schizoaffective disorder
Anxiety with depression

19
Q

What is Becks cognitive triad of depression?

A

Worthlessness: I am a bad person
Helplessness: My life is terrible
Hopelessness: Things will not improve

20
Q

What features indicate a high risk suicide attempt?

A

» Careful planning (with high attention to detail),

» Final acts in preparation of death, suicide note

» Isolation at time of act, precautions taken to prevent discovery

» Definite intent to die, believing method to be lethal/ violent,

» Ongoing wish to die or regret the attempt failed

YR5 Psychiatry (33 decks)

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