Low Mood

Question 1

What is the M:F ratio for depression?

Answer 1

1:2

Question 2

What is the change in life expectancy of depressed patients?

Answer 2

5-10years reduced

Question 3

What is the aetiology of depression?

Answer 3

Genetics
Gender
Early life experience
Social adversity
Personality traits
Stressful life event
Physical Illness
Drugs

Question 4

What is depression?

Answer 4

At least 2 core symptoms of low mood, anhedonia, anergia lasting for at least 2wks.

Question 5

What are the additional symptoms in depression?

Answer 5

Loss of confidence/self esteem
Self-reproach/excessive guilt
Recurrent thoughts death, suicide, suicidal behaviour
Reduced concentration
Change psychomotor activity
Sleep disturbance
Change appetite

Question 6

How is the severity classified in depression?

Answer 6

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)

Question 7

How is the function classified in depression?

Answer 7

Mild: distressed, continue most activities
Moderate: difficulty continuing most activities
Severe: symptoms marked and distressing, suicidal thoughts/acts common, usually somatic symptoms

Question 8

What are the associated symptoms of depression?

Answer 8

Anxiety, irritability
Depersonalisation/derealisation
Psychotic symptoms
Physical symptoms

Question 9

What is the somatic syndrome?

Answer 9

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

Question 10

What can speech be like in depression?

Answer 10

Reduced rate, volume intonation
Lowered in pitch
Limited content
Increased speech latency

Question 11

What can appearance be like in depression?

Answer 11

Varied- both ends of spectrum

Question 12

What can the thought flow be like in depression?

Answer 12

Slow

Poverty of thought

Question 13

What can the thought form be like in depression?

Answer 13

Unusual

Question 14

What can the thought content be like in depression?

Answer 14

Negative cognitive distortions
Obsessions, ruminations
Thoughts death, guilt
Delusions
-usually mood congruent
-guilt, nihilism, hypochondriasis

Question 15

What is Beck’s triad?

Answer 15

Self>World>Future>

Question 16

What can perception be like in depression?

Answer 16

Hallucinations in any modality
Usually mood-congruent
Auditory most common-second person and derogatory
Illusions

Question 17

What can cognition be like in depression?

Answer 17

Subjectively- slow thinking, poor memory
Objectively- deficits in working memory, planning and attention
‘Pseudodementia’

Question 18

What can insight be like in depression?

Answer 18

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

Question 19

What is recurrent depression?

Answer 19

Repeated episodes of mild, moderate or severe depression

No episodes fulfilling criteria for mania or hypomania

Question 20

What is mixed anxiety and depression?

Answer 20

Symptoms of anxiety and depression not significant enough to justify individual diagnosis

Question 21

What is dysthymia?

Answer 21

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

Question 22

Describe depression in old age

Answer 22

Often undetected/treated
Can present as pseudodementia
Passive thoughts of death common
Suicidal ideation uncommon, but higher risk when present

Question 23

What is the organic low mood ddx?

Answer 23

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

Question 24

What are the low mood psychiatric disorders?

Answer 24

Schizophrenia (negative symptoms)
Schizoaffective disorder
Bipolar disorder
Cyclothymia
Dysthymia
Adjustment disorder
PTSD
Emotionally unstable personality disorder