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Psychiatry > Depressive Disorders > Flashcards

Depressive Disorders Flashcards

1
Q

Depression in lay terms

A

Affective mood disorder characterised by persistent low mood, loss of pleasure and or lack of energy - accompanied by emotional, cognitive and biological symptoms

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2
Q

Epoidemiology of DD

A

1 in 20 adults experience an episode

Most common in 40s for men and 30s for female

10% women post partum

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3
Q

Monoamine hypothesis

A

lack of monoamine (noradrenaline, serotonin and dopamine) causes depression - proven via antidepressants that inc conc of neurotransmitters in synaptic cleft improve symptoms.

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4
Q

Causes of depression

A

Monoamine hypothesis
Overactivity of HPA axis
Psychosocial - personality type, stressful life events and failure of effective stress control mechanisms.

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5
Q

Biological predisposing factors

A

Female (2:1 F:M)
Postnatal period
Genetics - 40-50% MZT
Neurochemical
HPA axis
Physical co-morbidities
PMH of depression

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6
Q

Biological precipitating factors

A

Poor compliance with medication
Corticosteroids

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7
Q

Perpetuating biological factors

A

Chronic health problems - diabetes, COPD, and chronic pain syndromes

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8
Q

Psychological predisposing factors

A

Personality type
Failure of effective stress control mechanisms
Poor coping strategies
Other mental health co-morbidities - dementia e.g.

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9
Q

Psychological precipitating factros

A

Acute stressful life events

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10
Q

Perpetuating psychological factors

A

Poor insight
Becks Triad

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11
Q

Social predisposing

A

Stressful life events
Lack of social support
More common in asylum seeker and refugee populations.

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12
Q

Precipitating social factors

A

Unemployment
Poverty
Divorce

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13
Q

Perpetuating social factors

A

Alcohol and substance misuse
Poor social support
Low social status

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14
Q

RF of Depressive

A

FF / AA / PP / SS

Female

Family Hx

Alcohol

Adverse events

Past depression

Physical co-morbidities

Social support and socioeconomic status - low

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15
Q

General symptoms of depression

A

DEAD SWAMP

  • Depressed mood - 2/52 +
  • Energy loss - anergia
  • Anhedonia and Amenorrhoea - Loss of libido
  • Death thoughts
  • Sleep disturbance
  • Worthlessness or guilt
  • Appetite or weight change
  • Mentation reduce
  • Psychomotor retardation
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16
Q

Becks negative triad

A

negative views of oneself, the world and the future.

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17
Q

DMV

A

diurnal variation in mood - variation during the day ( usually in the morning)

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18
Q

EMW

A

early morning wakening - insomnia or in rarer cases hypersomnia.

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19
Q

MSE results

A
  • Appearance - Signs of self neglect. Thin, unkept and depressed facial expression. Tearful
  • Behaviour - Poor eye contact, tearful, psychomotor retardation, slow movements and responses.
  • Speech - Slow, non-spontaneous at a reduced volume and tone
  • Mood - Low and depressed
  • Thought - Pessimistic, guilty, worthless and helpless. Suicidal
  • Perception - Second person auditory hallucinations
  • Cognition - impaired concentration
  • Insight - usually good.
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20
Q

Classification of mild depression

A

2 core + 2 other symptoms

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21
Q

Classification of moderate

A

2 core + 3-4 other

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22
Q

Classification of severe

A

3 core + 4< other

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23
Q

Core symptoms of depression

A

Low mood, Anergia, Anhedonia

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24
Q

Biological symptoms of depression

A

DVM, EMW and LOL. Psychomotor retardation and weight loss and LOA

25
Q

Psychotic symptoms of depression

A

Hallucinations and delusions

26
Q

Cognitive symptoms of depression

A

LO Concentration, Negative thoughts, excessive guilt and suicidal ideation.

27
Q

Investigations for Depression

A
  • Explore core symptoms
  • Explore cognitive
  • Explore biological symptoms
  • Diagnostic questionnaires - PHQ-9, HADS and Becks depression inventory
  • BT - FBC, TFT, U+E, LFT and calcium levels, Glucose. - Biochemical abnormalities can cause physical symptoms and cloud concentration.
  • Imaging - may be required where suspicious of intracranial lesion. - Unexplained headache or personality change.
28
Q

Biological Treatment

A
  • Antidepressants
  • Adjuvants e.g. antipsychotics
  • Electroconvulsive therapy
29
Q

Psychological treatments

A
  • Psychotherapies
  • Self - help programmes
  • Physical activity
30
Q

Social treatments

A

Support groups

31
Q

Mild depression treatment

A
  • Watchful waiting - review in 2 weeks
  • Self-help programmes
  • CBT
  • Physical activity programme
  • Psychotherapies
  • Antidepressants
    • Not normally first line unless -
    • Depression lasted a long time
    • PMH of moderate to severe depression
    • Failure of other interventions
    • Depression complicates the care of other physical health problems.
32
Q

Moderate depression treatment

A
  • Suicide risk assessment
  • Psychiatry referral
  • MHA - Implementation necessary?
  • Antidepressants
  • Adjuvants
  • Psychotherapy
  • Social support
  • ECT
33
Q

What antidepressants to use

A
  1. First line SSRI
  2. TCA’s
  3. SNRI’s
  4. Monoamine oxidase Inhibitors
34
Q

Examples of SSRI

A

citalopram, sertraline, Escitalopram, Fluoxetine, Paroxetine

35
Q

Example of TCA

A

amitriptyline, clomipramine, dosulepin, imipramine, lofepramine and nortriptyline

36
Q

Examples of SNRI

A

duloxetine, and venlafaxine

37
Q

Monoamine oxidase inhibitors

A

isocarboxazid, phenelzine, selegiline.

38
Q

When to use ECT

A
  1. Acute treatment of severe depression which is life threatening
  2. Rapid response required
  3. Depression with psychotic features
  4. Severe psychomotor retardation or stupor
  5. Failure of all other treatments
39
Q

How long on antidepressants

A

continued for 6 months after resolution of symptoms from 1st episode, 2 years from 2nd and long term in recurrent episodes.

40
Q

Ddx of depressive disorder

A
  • Bipolar affective
  • Other depressive disorders
  • Hypothyroidism - TFT to rule this out
  • Secondary psychoactive substance abuse
  • Secondary to other psych disorders - anxiety or psychosis
  • Normal bereavement.
41
Q

Types of depressive disorder

A

Recurrent depressive disorder
Seasonal affective disorder
Masked depression
Atypical depression
Dysthymia
Cyclothymia
Baby blues
Post natal depression

42
Q

Recurrent depressive disorder

A

another depressive episode after their first

43
Q

Seasonal affective disorder

A

depressive episodes recurring annually the same time each year

44
Q

Masked depression

A

depressed mood not prominent but other features of depressive disorder are

45
Q

Atypical depression

A

mild moderate depression with reversal of symptoms - weight gain and hypersomnia

46
Q

Dysthymia

A

Depressive state for at least two years which does not meet criteria of mild, moderate or severe depressive disorder and is not the result of a partially-treated depressive illness.

47
Q

Cyclothymia

A

Chronic mood fluctuation over at least 2 years with episodes of elation and depression insufficient for hypomanic or a bipolar disorder.

48
Q

Baby blues

A

3-7 days following birth and is more common primiparae. Mothers are anxious, tearful and irritable. Reassurance and support is all that is required

49
Q

Post natal depression

A

10% women. Within a month and peak at 3. Similar to depression.

50
Q

Complications of depression

A
  • Physical symptoms
  • Social Symptoms
  • Socioeconomic - loss of job, poorer education, lack of prospects
  • Threatening to life - suicide, substance misuse, reckless behaviour.
51
Q

Types of psychotherapy

A

CBT - Negative thoughts and behaviours are challenged.

IPT - Helps to identify and solve relationship problems

Behavioural Activation - Develop more positive behaviour or activities they would usually avoid

Counselling - Enables patients to explore their problems and symptoms. Support and guide patients for a particular focus

Psychodynamic therapy - Explore and understand the dynamics and difficulties of a patients life, which may have begun in childhood.

52
Q

Tryptophan depletion in depression

A

Creates symptoms of depression as it is the enzyme that makes serotonin.

53
Q

Atypical depression symptoms

A

Weight gain
Inc appetite
Oversleeping
Leaden paralysis - heavy limbs
Rejection sensitivity

54
Q

DSM V criteria

A

5/9 symptoms
Significant distress to daily life
Not substance or medical condition causing it
Not better explained by another metal health condition
No manic or hypomanic episodes

55
Q

DSM V 9 symptoms

A

Depressed mood
Dec interest and pleasure
Weight loss or gain
Inability to sleep or over sleeping
Psychomotor agitation or impairment
Fatigue
Feelings of worthlessness
Dec concentration
Thoughts of death or suicide - passive or active

56
Q

Dysthymia Symptoms

A

2+ years of milder symptoms
Change in appetitie
Change in sleep
Fatigue
Dec self esteem
Dec Concentration
Hopelessness or pessimism

57
Q

How can physical activity help depression

A

Inc body temp
Dec muscle tension
Inc neurotransmitters
Inc endorphins
Inc endocannabinoids

58
Q
A

Psychiatry (17 decks)

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