depressive disorder Flashcards
questions to identify depression
during the last mo have you been bothered by feeling down, depressed or hopeless
during the last month, have you often been bothered by having little interest or pleasure in doing things
if Yes to either - mental health assessment including risk assessment of self harm and suicide
classification of depression
based on number and severity of features
determines mx, Rx and prognosis
aetiology of depression
interaction between biological, psychological and social factors in someone with RF for these
epidemiology of depression
worldwide 5.8% of men and 9.5% of women experince depressive episode in 12mo
ie 121million
5-10% of consultations in primary care
biological influence on depression
heritability for major depression - 37%
concordance for monozygotic twins
monoamine theory of depression
endo - dexamethasone suppression test is abnormal in 1/3
structural brain change ventricular enlargement and raised sucal prominence
monoamine theory of depression
low monoamine (5-HT, noradrenaline, dopamine) function = depression
psychological influence on depression
personality traits neurotocism suggests mood liability, autonomic hyperarousal, negative biases in attention and processing
low self esteem RF - debatable whether cause or symptom
childhood experience may increase sensitivity to events
social influences on depression
disruption due to life events (births, job loss, divorce, illness)
stress associated with poor social environment and social isolation can precipitate and perpetuate depression
social drift to lower classes
core sx of depression
- depressed mood for most of the day, everyday, little variation in mood despite changes in time, circumstances or activity, may be diurnal - worse in morning
- anhedonia - loss of interest or pleasure of daily life, especially things prev enjoyed
- fatigue
typical sx of depression
poor appetite with marked weight loss w/o diet (occaisionally opposite)
disrupted sleep - insomnia or early waking 3+ hrs earlier than normal
psychomotor retardation - limited spontaneous movement or sluggish thought process or agitation (subjective feeling of restlessness)
decreased libido
reduced concentration
feeling of worthlessness or inappropriate guilt or self-reproach
recurrent thooughts about death, suicide ideation or suicide attempts
dx of depression
sx must be present everyday or nearly everyday w/o sig changes through day for >2wks
and represent change from normal personality w/o alcohol or drugs, medical disorders or bereavement
must be at least 2 core and 2 or more typical sx
definition of depressive disorders
Depressive disorders are typically characterised by persistent low mood, loss of interest and enjoyment, neurovegetative disturbance, and reduced energy, causing varying levels of social and occupational dysfunction.
major depressive disorders
characterised by the presence of at least five symptoms
can be classified along a spectrum of mild to severe.
Severe episodes may include psychotic symptoms such as paranoia, hallucinations, or functional incapacitation.
subthreshold depression
characterised by the presence of two to four depressive symptoms, including depressed mood or anhedonia, lasting longer than 2 weeks.
