Depressive disorder Flashcards
Define depressive disorder.
Pervasive low mood, loss of interest + enjoyment, neurovegetative disturbance, + reduced energy, causing varying levels of social + occupational dysfunction
Accompanied by social, biological Sx.
Give 6 risk factors for depression
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)
What are the core symptoms of depressive disorder?
Low mood
Low energy
Anhedonia
What are 4 biological signs of depressive disorder?
Poor sleep/ Early morning wakening >2h
Loss of appetite + weight loss
Poor concentration
Low libido
What negative cognitions may be experienced in depression?
Hopelessness
Helplessness
Worthlessness
Guilt
What psychotic symptoms may be experienced in depression?
Mood congruent delusions e.g. Nihilistic
Hallucinations
Catatonia
What are 2 additional symptoms of depression?
Low self esteem
Thoughts of self harm or suicide
How are the symptoms used to characterise depressive disorder?
- Mild: 2 core + 2 additonal
- Moderate: 2 core + 3 additional
- Severe: 3 core + 4 additional
- Severe with psychosis: 3 core + hallucination/ delusion/ stupor
What are the investigations for depressive disorder?
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
What self-rating scales can be used in depression?
Becks depression inventory
PHQ-9
Hospital anxiety + depression scale (HAD)
What is the management for depressive disorder?
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
What is the management for mild depression?
1st:
Watchful waiting F/U in 2w
Education: MIND UK, Sleep hygiene, diet, exercise
2nd:
Group/ Computerised CBT
Guided self-help
What is the management for moderate depression?
Individualised CBT
SSRI
What is the management for severe depression?
Individualised CBT
Sertraline
ECT
What medication should be used in depression? What if this is ineffective?
1: SSRI + increase every 2w
If ineffective, swap to another SSRI
2: SNRI
3: Antipsychotic e.g. quetiapine, Lithium, Other
4: ECT
What are the DSM-5 criteria for depression that are felt everyday/ nearly everyday?
- Depressed mood most of the day
- Loss of interest/ pleasure in all, or almost all, activities most of the day
- Significant unintentional weight loss/ gain, decrease/ increase in appetite
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Feelings of worthlessness or excessive or inappropriate guilt
- Diminished ability to think or concentrate, or indecisiveness
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan/ a suicide attempt/ a specific plan for committing suicide
Give 4 differentials of organic conditions appearing like depression
Hypothyroidism
Adverse medication affects
Cushings
Vit B12/ D deficiency
Give 3 differentials of psychotic disorders that may appear like depression
Bipolar
Schizoaffective disorder
Anxiety with depression
What is Becks cognitive triad of depression?
Worthlessness: I am a bad person
Helplessness: My life is terrible
Hopelessness: Things will not improve
What features indicate a high risk suicide attempt?
» 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
