Depressive disorders Flashcards
What are mood disorders?
Persistent, pervasive change in mood, which affects social and occupational functioning
What modd disorders are considered primary?
Depressive, manic, mixed and hypomanuc episodes
What modd disorders are considered primary?
Depressive, manic, mixed and hypomanuc episodes
How are episodes graded by severity
Mild
Moderate - with/without psychoitc symptoms
Severe
How are episodes graded by severity
Mild
Moderate - with/without psychoitc symptoms
Severe
What are the two types of mood disorder?
Episodes - depressive, manic, mixed
Patterns over time - bipolar, unipolar
When are episodes classed as recurrent?
History of two or more episodes and no significatn mood disturbance between each episode lasting for several months
When are episodes classed as recurrent?
History of two or more episodes and no significatn mood disturbance between each episode lasting for several months
What is cyclothymia?
Move between hypomania and mild form of depression
How does dysthymia vary from cyclothymia?
Dysthymia people experience range from mild depression but no mania
What symptoms are present in every depressed patient?
Low mood
Diminished activities (apathy/anhedonia) occuring most of the day or nearly every day
Apart from the two core symtpoms of depression what other symptoms can be present?
Difficulty concentrating
Feelings of hopelessness/worthlessness/fort the future
Excessive/innapropriate guilt
Recureent thoughts of death/suicide, thought/plan
Change appetite/weight
Change in sleep
Psychomotor agitiation or retardation
Reduced energy or fatigue with expenditure of minimum effort
Significant impairment in personal, family, social, educational, occupational funcitoning of the individual
What types of psychotic symptoms can present with depressive disorders?
Themes of delusions (mood congruent), hallucinations
How long do the two main symptoms of depression have to be present for for a diagnosis of dperession?
2 weeks
Why important to check for prev mood episodes when diagnosing depressive disorders?
Never been any prior episodes of manic, hypomanic or mixed episodes
Why important to check for prev mood episodes when diagnosing depressive disorders?
Never been any prior episodes of manic, hypomanic or mixed episodes
Themes of delusions that can occur in depressive disorders
Guilt - blame self
Blame - repsonsible for disasters unrelated to them
Persecutory - police/government coming for them
Poverty - no evidence financial worries but believe poor
Nihilistic- insides are rotting
What is a risk factor for developing psychosis after depressive disorders?
Auditory 2nd person hallucinations - accusatory
Hallucnations that can occur with depressive disorders
Mainly derogatory in nature
-Auditory - 2nd person accusotory voices
Olfactory - smells bad, rotting flesh
Visual - not common
How can depression present atypically?
Irritability/emptiness - feel numb/no emotions
More lethargy/oversleeping and eating
How can depressive disorders present in people with pre-exisitng mental or physical illness?
Worsening of anxiety symptoms
Phobic/obsessional symptoms
Increase preoccupation with physcial health (cultural differences - present with physical complaints)
What can cause depersonalisation, derealisation?
Extreme fatigue
Sleep deprivation
Severe traumatic incident eg accident/natural disorders
Lifetime prevalenve of depressive disorders in general pop
15-20%
How does gender affect risk of depression?
females 2x more likely than males
How does gender affect risk of depression?
females 2x more likely than males
Heritability of depression
37% contribution of genetic factors to development of depression
Risk assessment for depression
Suicide
Homicide
Neglect
Alcohol + recreational drug use
Misuse of prescription drug/over the counter prep
How many people with depression commit suicide?
10-15%
When do you especially focus on homicide risk in depressive disorders?
Adults with caring reponsibilities to vulnerable individuals
Neglect mainfestation in depression
Poor self care
Not eat/hydrating
Debility and physical complications esp in chronic illness
Neglect mainfestation in depression
Poor self care
Not eat/hydrating
Debility and physical complications esp in chronic illness
What OTC drugs are often misused?
Analgesia, benzos, steroids, antihistamines for sedative properties
What need to take into account when treating depressive disorder?
Physical ilness
Potential DDI
Parental/career responsibilities
Employment repsonsibilities
First line treatment depressive disorder?
SSRI - sertraline, escitalopram
What to explain when start a patient on SSRIs?
Take 4-6 weeks to be effective
Increase risk of suicide first 2 weeks - weekly follow up if high risk, carer or community psychiatric nurse
What to base the treatment of depression on?
Severity of the problem
Past experiences of treatment
Persons preferences
What to base the treatment of depression on?
Severity of the problem
Past experiences of treatment
Persons preferences
How treat
What is behavioural activation?
Do activities that used to enjoy force to do it and eventually regain joy
How manage all known cases of depression (least severe)
Assessment, referral, psychoeducation, active monitoring and support
How to treat less severe depression and more severe depression?
High or low intensity psychological and psychosocial interventions, medication
If more severe or limited response -> combined treatments
Treatments for chronic depression, psychotic depression or depression with personality disorder?
Medication, high intensity psychological interventions, ECT, crisis, combined treat, multiprofessional adn inpatient care
What types of depression are classed as the highest severity?
Chronic depression, psychotic depression and depression with personality disorder
