Low Mood Flashcards
What is the M:F ratio for depression?
1:2
What is the change in life expectancy of depressed patients?
5-10years reduced
What is the aetiology of depression?
Genetics Gender Early life experience Social adversity Personality traits Stressful life event Physical Illness Drugs
What is depression?
At least 2 core symptoms of low mood, anhedonia, anergia lasting for at least 2wks.
What are the additional symptoms in depression?
Loss of confidence/self esteem Self-reproach/excessive guilt Recurrent thoughts death, suicide, suicidal behaviour Reduced concentration Change psychomotor activity Sleep disturbance Change appetite
How is the severity classified in depression?
Mild: 2 core plus others to total minimum 4
Moderate: 2 core plus others to total minimum 6
Severe: 3 core plus others to total minimum 8
(severe +/- psychotic symptoms)
How is the function classified in depression?
Mild: distressed, continue most activities
Moderate: difficulty continuing most activities
Severe: symptoms marked and distressing, suicidal thoughts/acts common, usually somatic symptoms
What are the associated symptoms of depression?
Anxiety, irritability
Depersonalisation/derealisation
Psychotic symptoms
Physical symptoms
What is the somatic syndrome?
Four of the following symptoms :
marked loss of interest or pleasure in activities that are normally pleasurable
lack of emotional reactions to events or activities that normally produce an emotional response
waking in the morning 2 hours or more before the usual time
depression worse in the morning (diurnal variation)
objective evidence of marked psychomotor retardation or agitation (remarked on or reported by other people)
marked loss of appetite
weight loss (5 % or more of body weight in the past month)
marked loss of libido
What can speech be like in depression?
Reduced rate, volume intonation
Lowered in pitch
Limited content
Increased speech latency
What can appearance be like in depression?
Varied- both ends of spectrum
What can the thought flow be like in depression?
Slow
Poverty of thought
What can the thought form be like in depression?
Unusual
What can the thought content be like in depression?
Negative cognitive distortions Obsessions, ruminations Thoughts death, guilt Delusions -usually mood congruent -guilt, nihilism, hypochondriasis
What is Beck’s triad?
Self>World>Future>
What can perception be like in depression?
Hallucinations in any modality
Usually mood-congruent
Auditory most common-second person and derogatory
Illusions
What can cognition be like in depression?
Subjectively- slow thinking, poor memory
Objectively- deficits in working memory, planning and attention
‘Pseudodementia’
What can insight be like in depression?
Insight typically preserved
Recognition of symptoms normally intact
-ve cognitions can influence views on attribution of illness, treatments and recovery
May lose insight completely in severe cases
What is recurrent depression?
Repeated episodes of mild, moderate or severe depression
No episodes fulfilling criteria for mania or hypomania
What is mixed anxiety and depression?
Symptoms of anxiety and depression not significant enough to justify individual diagnosis
What is dysthymia?
Chronic low mood Doesn't fulfil RDD criteria May have fulfilled criteria for mild episode (but not recurrent episode) Tired + depressed for months at a time Usually able to cope with life demands
Describe depression in old age
Often undetected/treated
Can present as pseudodementia
Passive thoughts of death common
Suicidal ideation uncommon, but higher risk when present
What is the organic low mood ddx?
Neurological eg Parkinson’s Endocrine eg hypothyroidism Metabolic eg hypoglycaemia Haematological eg anaemia Inflammatory eg SLE Infection eg Syphilis Sleep disorders eg sleep apnoea Medication eg beta blockers Drugs eg alcohol
What are the low mood psychiatric disorders?
Schizophrenia (negative symptoms) Schizoaffective disorder Bipolar disorder Cyclothymia Dysthymia Adjustment disorder PTSD Emotionally unstable personality disorder
