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Psychiatry > Depressive Disorders > Flashcards

Depressive Disorders Flashcards

1
Q

How are depressive disorders classified?

A 
Specific symptoms:
-major depression
-persistent depressive disorder (dysthymia)
-other specified / unspecified Dd/o
Aetiology:
-premenstrual dysphoric d/o
-depressive d/o due to medical condition
-substance/medication induced depressive d/o
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2
Q

Incidence depressive symptoms reported in primary care? Prevalence major depression?

A

Depressive symptoms: 30%

Major depression: 10%

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3
Q

Depression v demoralisation and grief?

A

-tied to thoughts / reminders inciting event
-resolve when circumstances / events imporve
-interspersed with periods of positive emotion and humour
-not accompanied by pervasive feelings of worthlessness and self loathing
-lasts days (cf wk - mo)
-suicidal thoughts and loss of function less likely
BUT CAN PRECIPITATE major depression

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4
Q

Aetiology depression?

A
  • Unknown
  • Genetic (~50%) and environmental contributions
  • ?changes to NA/DA/5HT neurotransmission
  • ?neuroendocrine dysregulation (HPA, HPT axes; growth hormone)
  • Psychosocial fx (stress etc)
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5
Q

Theories as to why women at greater risk of depression?

A
  • Greater exposure/response to stresses (+ response to adversity ==> ruminative v active)
  • Higher MAO levels
  • Higher incidence thyroid dx
  • Endocrine changes with menstruation / menopause
  • power / parity / marriage role
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6
Q

What is SAD?

A
  • Sx in seasonal pattern
  • usually Autumn / Winter
  • usually climates with long / severe Winters
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7
Q

Which conditions are commonly accompanied by depression?

A
  • Thyroid / adrenal d/o
  • Benign and malignant brain tumours
  • Stroke
  • AIDS
  • Parkinsons
  • MS
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8
Q

Which drugs may precipitate depressive d/o?

A
  • Corticosteroids
  • Some B-blockers
  • Interferon
  • Reserpine
  • Abuse of recreational drugs (EtOH, amphetamines)
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9
Q

Symptoms of depression?

A
  • Cognitive, psychomotor and other dysfunction:
  • -poor concentration
  • -fatigue
  • -loss of sexual desire
  • -anhedonia
  • -sleep disturbance
  • -suicidal ideation
  • -anxiety / panic attacks
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10
Q

Medical sequelae of depression?

A
  • Reduce protective immune responses

- Increased risk CV d/o, MI and stroke

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11
Q

Why does depression have CV consequences?

A

?in depression cytokines and pro clotting factors are elevated, HR variability decreased (all potential RFx for CV d/o)

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12
Q

Appearance pt with major depression?

A
  • Miserable with tearful eyes
  • Furrowed brow
  • Down turned corners of mouth
  • Slumped posture
  • Poor eye contact
  • Lack of facial expression
  • Little body movement
  • Speech changes (soft voice, lack of prosody, monosyllabic)
  • May neglect personal hygiene
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13
Q

Symptoms for Dx major depression?

A

≥ 5 present nearly every day in same 2-wk period, one must be depressed mood or anhedonia (loss of interest or pleasure):

  • Depressed mood most of the day
  • Markedly diminished interest or pleasure in all or almost all activities for most of the day (anhedonia)
  • Significant (> 5%) weight gain or loss or decreased or increased appetite
  • Insomnia (often terminal insomnia + EMW) or hypersomnia
  • Psychomotor agitation or retardation observed by others (not self-reported)
  • Fatigue or loss of energy
  • Decreased libido
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Diminished ability to think or concentrate or indecisiveness; set shifting
  • Recurrent thoughts of death or suicide, a suicide attempt, or a specific plan for committing suicide
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14
Q

What is persistent depressive disorder (PDD)?

A

-Depressive symptoms that persist for >2y w/o remission

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15
Q

Symptoms and signs of PDD

A
  • Habitually gloomy, pessimistic
  • Humorless
  • Passive
  • Lethargic
  • Introverted
  • Hypercritical of self and others
  • Complaining
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16
Q

Dx symptoms of PDD?

A

Must have a depressed mood for most of the day for more days than not for ≥ 2 yr plus ≥ 2 of the following:

  • Poor appetite or overeating
  • Insomnia or hypersomnia
  • Low energy or fatigue
  • Low self-esteem
  • Poor concentration or difficulty making decisions
  • Feelings of hopelessness
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17
Q

What is anxious distress?

A

Patients feel tense and unusually restless; have difficulty concentrating as worry/fear something awful may happen or they will lose control of themselves

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18
Q

What is melancholia?

A
  • Lost pleasure in nearly all activities
  • Do not respond to pleasurable stimuli
  • Despondent and despairing
  • Excessive or inappropriate guilt
  • Early morning awakenings
  • Marked psychomotor retardation or agitation
  • Significant anorexia or weight loss
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19
Q

Diagnosis of depression?

A

-Clinical criteria (DSM)
-FBE, UEC, TSH, B12, folate (r/o medical cause)
Severity determined by degree of pain and disability (physical, social, occupational) and duration.

20
Q

DDx depression?

A
  • Demoralisation and grief
  • Anxiety d/o (mimics)
  • Major depression must exclude BpD
  • Dementia of depression
  • Early dementia -> depression
  • Physical/ medical d/o
21
Q

Which main medical conditions are linked with depression?

A
  • Hypothyroidism
  • Parkinson disease
  • Cushings
  • Ca (pancreatic, SClung)
  • MS
  • HIV
22
Q

Rx depression?

A
  • Support
  • Psychotherapy (CBT, IPT, couple therapy)
  • Drugs
  • Exercise
  • Lifestyle (sleep, diet, reduce EtOH)
  • Confiding in others
  • ECT
23
Q

Initial drug of choice?

A

SSRI

24
Q

When is ECT required?

A
  • melancholic
  • psychotic
  • puerperal
  • bipolar depression or mania
  • prominent suicidality
  • poor oral intake
25
Q

What are the neurovegetative (biological) symptoms of depression?

A
  • sleep disturbance (terminal insomnia + EMW)
  • appetite disturbance
  • psychomotor retardation
  • impaired concentration and set shifting, rumination
  • working memory deficits
  • libidinal changes
26
Q

What are the cognitive-affective Sx of depression?

A
  • anxiety
  • helplessness / hopelesness
  • loss of SE
  • social withdrawal
  • depersonalisation, derealisation
  • guilt / shame
  • nihilism
  • rage
27
Q

How many affected by post partum depression?

A

~10%; 1/2 severe

50% recurrence

28
Q

When does post partum depression occur?

A

4-12 weeks post partum

29
Q

Key features of depression in older adults?

A
  • loss common precipitant
  • organic d/o more common as precipitants
  • somatic complaints prominent (pain, dec function)
  • irritable more than sad
30
Q

Which drugs may induce mood d/os?

A
  • Monoamine depletion (reserpine, propranolol, alpha methyldopa)
  • CSTs: >80pred
  • GABAergics: benzos, vigabatrin, EtOH
  • Chemo
  • OC (rare)
  • Interferon
31
Q

What are common psych comorbidities?

A
  • Substance abuse (treat 1st, or simultaneously)
  • Anxiety d/o (treat concurrently)
  • personality d/o (treat in parallel)
32
Q

What are the childhood factors which predispose to depression?

A
  • Parental loss with poor parenting after
  • Chronic exposure to depressed mothers
  • Insecure attachment
33
Q

Protective factors depression in childhood?

A
  • 1 good relationship

- higher IQ

34
Q

Environmental factors contributing to depression (adult)?

A
  • loss
  • humiliation
  • entrapment
  • danger
35
Q

Anaclitic/sociotropic predisposition to depression?

A
  • exaggerated need for relatedness
  • characterised by emptiness, desperation, diffuse affectivity
  • personal slights significant
  • Rx termination often hard
36
Q

Introjective/ autonomous predisposition to depression?

A
  • need for autonomy
  • self critical
  • failure to achieve goal significant
  • may do well in Rx once engaged
37
Q

What are psychotic symptoms of depression like?

A

-Usually mood congruent
-Hallucinations (10-20%)
-Delusions - almost invariable
80% response rate to ECT or APA + anti deep

38
Q

How can depression in children present differently cf adults?

A
  • MSE changes subtle
  • Match behaviour / mood with age, gender, IQ peers
  • Function in various environments important clues
  • Utilise several sources
39
Q

What is pseudo depression following damage to frontal convexity?

A

-apathy
-motor slowness
-poverty of speech
in damage to frontal convexity

40
Q

What do orbital frontal lesions present with?

A
  • Shallow jocularity

- disinhibition

41
Q

How does nervous system structure and function differ in depressed pts?

A
  • Smaller hippocampus
  • Larger ventricles
  • MAO, BDNF, NMDA cascade changes
  • Cortisol changes
  • HPA & sympathetic NS changes
42
Q

What was Freud’s psychodynamic perspective of depression?

A

Mourning and internalised aggression

43
Q

What was Shengold’s psychodynamic perspective of depression?

A

Avoiding murdeorus feelings towards parental introject

44
Q

What was Pedder’s psychodynamic perspective of depression?

A

Inability to mourn, bring to mind

45
Q

What was Jacobson’s psychodynamic perspective of depression?

A

Regression and gap between ego ideal and self representation

46
Q

What was Winnicott’s psychodynamic perspective of depression?

A

terror Mother will not survive aggression (demands or separation) and or still love

47
Q

Duration pharm Rx depression, 1st ep?

A
  • 6-12 weeks full dose

- Maintain 6-12/12 post recovery

Psychiatry (16 decks)

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