Depressive disorders Flashcards
What is the lifetime risk of a woman developing diagnosed depression?
10-25%
What is the lifetime risk of a man developing diagnosed depression?
5-12%
What is the average age of onset for depression?
Late 20s
How much of a part do genetics play in depression?
Twin studies show the heritability of depression is between 40-50%.
Some evidence shows that a particular allele for the serotonin transporter gene is associated with an increased risk of depression, but only in those who experience an adverse life event.
What early life experiences might lead to someone developing depression?
- Parental separation during childhood
- Neglect
- Physical and sexual abuse
What personality traits are most associated with depression?
Neuroticism:
- anxious
- shy
- moody
- easily stressed
What are the neurobiological factors associated with an increased risk of developing depression?
Reduced volume of the hippocampus, amygdala and certain regions of the frontal cortex.
What are the two main neurotransmitter pathways associated with depression?
- Overactivity of the hypothalamic-pituitary-adrenal (HPA) axis
- Deficiency of monoamines (noradrenaline, serotonin, dopamine)
What are the three core symptoms of depression as described by the ICD-10?
Depressed mood - varies little from day to day and is unresponsive to circumstances.
Markedly reduced interest in almost all activities (anhedonia) - associated with the loss of ability to derive pleasure from activities
Lack of energy - increased fatiguability on minimal exertion leading to diminished activity (anergia)
What are the biological (somatic) symptoms associated with depression?
- Problems with sleep - especially early morning wakening
- Depression worse in the morning
- Marked loss of appetite - might have weight loss as a result
- Psychomotor retardation or agitation Loss of libido
What are the cognitive symptoms associated with depression?
- Reduced concentration and memory
- Low self esteem
- Guilt
- Hopelessness
- Thoughts of suicide or self harm
What are the ICD-10 criteria for a depressive?
At least 2 of the core symptoms present for at least 2 weeks:
- Depressed mood
- Loss of interest and enjoyment
- Reduced energy or increased fatiguability
AND at least 2 of the following:
- Reduced concentration
- Reduced self esteem
- Ideas of guilt
- Bleak and pessimistic views of the future
- Ideas of acts of self harm or suicide
- Disturbed sleep
- Diminished appetite
How is the severity of depressive episodes graded according to the ICD-10 criteria?
Mild: total of four or five symptoms, where most normal activities are continued
Moderate: total of six or seven symptoms, where the patient finds it difficult to continue normal activities.
Severe: total of eight or more symptoms including all three core symptoms, unable to continue normal activities
What grade of severity is given to a depressive episode if the patient is experiencing psychotic symptoms?
Severe
What is dysthymia?
Chronically depressed mood with periods of wellness in between.
The patient’s low mood rarely (if ever) meet the criteria for the mild depressive episodes.
What investigations might you do for a patient who presents with the signs and symptoms of depression?
- Gather collateral history - family and GP
- Ask patient to keep a mood diary
- Beck Depression Inventory (BDI)
- Hospital Anxiety and Depression Score (HADS)
- FBC
- U+Es - baseline for elimination of medication
- LFTs - baseline for elimination of medication
- TFTs
Is there a link between self-harm and suicide?
Yes. A patient who presents with self-harm have a 100-fold greater chance of completing suicide in the following year compared to the general population.
What are the epidemiological risk factors for suicide?
- Male
- LGBT
- Prisoners
- Being unmarried (seperated > widowed > single)
- Unemployment
- Certain occupations - Farmer, vet, nurse, doctor)
- Low SES
- Social isolation
What are the clinical risk factors for suicide?
- Psychiatric illness
- Personality disorder
- Alcohol dependence
- History of self harm
- Physical illness - debilitating, chronic or terminal conditions
- Family history
- Recent adverse events - bereavement
What factors might demonstrate strong suicidal intent?
- Planning in advance
- Precautions taken to avoid discovery
- Dangerous method was used
- No help sought after the act
What is the psychiatric illness with the strongest association with suicide?
Anorexia nervosa - 30 fold increase compared to general population
Which groups of patients experiencing a depressive episode should be admitted as a in-patient?
- Depressive episodes associated with highly distressing hallucinations, delusions or other psychotic phenomena.
- Active suicidal ideation
- Lack of motivation leading to extreme self-neglect