Low Mood Flashcards
Describe the M:F ratio for depression
1:2
Describe the relationship between depression and physical health
Bidirectional - if feel more depressed, more likely to get a physical illness
pt. s with depression = 2-3 times higher rates chronic illness and = 5-10yrs reduced life expectancy
psych. co-morbidity common
What does the aetiology depression include?
Individual vulnerability factors: -genetics -gender -early life experiences -social adversity -personality factors Current factors: -stressful life events -physical illness -drugs
What is the diagnostic criteria for depression?
Sx. for at least 2 weeks = signif. incapacity At least two core symptoms: -anhedonia -anergia -low mood Plus additional symptoms: -loss confidence/self esteem -self reproach/excessive guilt -low conc. -recurrent thoughts death/suicide/suicidal behavior -change appetite -sleep disturbance -change in psychomotor activity
What is the diagnostic criteria for mild/moderate/severe depression
Mild: 2 core + others to total 4 or more
Moderate: 2 core + others to total 6 or more
Severe: 3 core + others to total 8 or more
What is the difference in function with mild vs moderate vs severe depression?
Mild = distressed - continues most activities Moderate = difficult continuing most activities Severe = sx marked/distressing, suicidal thoughts/acts common, usually somatic symptoms
List 9 other symptoms assoc. with depression
- anxiety
- irritability
- panic attacks
- secondary obsessional symptoms
- secondary phobic symptoms
- depersonalisation
- derealisation
- psychotic symptoms
- physical symptoms
Name some physical symptoms associated with depression
- insomnia
- poor appetite
- wt loss
- constipation
- loss libido
- erectile dysfunction
How to diagnose somatic syndrome?
4 of symptoms of somatic syndrome
What are the 8 different symptoms assoc. with somatic syndrome?
- marked loss interest/pleasure in activities normally pleasurable
- lack emotional reactions to events/activities normally produce emotional reac.
- early morning wakening (2hrs B4 normal waking time)
- diurnal variation (worse in morning)
- objective evidence marked psychomotor retardation/agitation (reported by 3rd person)
- marked loss appetite
- weight loss
- marked loss libido
Describe the speech assoc. with depression in MSE
- decreased rate/vol/pitch, monotonous, increase in speech latency, limited content
Describe the mood and affect assoc. with depression in MSE
- depressed/miserable/irritable
Describe the perceptions assoc. with depression in the MSE
- Hallucinations in any modality, usually mood congruent
- most commonly auditory hallucinations (2nd person - insulting patient and suggesting suicide)
- illusions if severe
Describe the thoughts assoc. with depression in the MSE
Flow/Form/Content
-• Flow: slow/poverty of thought
• Form: unusual
• Content: negative cognitive distortions/obsession/ruminations/ death/guilt/delusions
o (usually mood congruent dilusions-guilt,nihilism,hypochondriasis)
o beck’s triad
o delusions of poverty and non-existence (nihilism) can occur particularly in the elderly with more severe forms of depression
o delusions of guilt, persecution and bodily disease are not uncommon
What is beck’s triad?
3 types of negative thoughts present in depression:
- self (self is worthless)
- world and environment (unfair world)
- future (hopeless future)
What is the insight assoc. with depression
-typically preserved, can recog. symp., -ve cognition can afftect view on illness/tx/recovery
May lose insight in severe forms depression
What is cognition assoc. with depression?
subjectively - slow thinking/poor memory
objectively - deficits in working memory/planning/attention
(psuedodementia)
What is pseudodementia?
in severe forms of depression memory and concentration can be severely affected mimicking dementia
How to diagnose recurrent depressive disorder?
-repeated episodes of mild/mod/severe depression
- no hypomanic/manic symptoms in lifetime
(discrete periods depression that come and go)
What is mixed anxiety and depression?
Symptoms of anxiety and depression not significant enough to justify either diagnosis individually
Describe dysthymia? Are demands of everyday life coped with?
chronic low mood that doesn’t fulfill criteria for recurrent depressive disorder
- may have fulfilled criteria for mild depressive episode (not mild recurrant episode)
- tired + depressed for months at a time
- usually able to cope w/ demands
What is a major problem in depression in old age?
10-15% elderly
-often undetected and untreated
How can depression in old age present?
pseudodementia
What kind of suicidal thoughts are particularly common in depression in old age?
passive thoughts of death common
suicidal ideation less common but prob. more high risk when it is.
When a patient is suffering from a depressive episode, what are the 7 main diagnoses to consider in addition?
1 - recurrant depressive disorder 2- bipolar disorder 3- schizoaffective disorder 4 - schizophrenia 5 - dementia 6- delirium 7- substance misuse
What are the 5 main different diagnoses for low mood?
1 - organic 2 - psychotic 3 - affective (mood) 4 - neurotic (anxiety) 5 - Personality disorder
What are the organic causes for low mood?
- neurological e.g. parkinsons
- endocrine e.g. hypothyroid
- metabolic e.g. hypoglycaemia
- haematological e.g. anaemia
- inflammatory causes e.g. SLE
- infection e.g. syphilis
- sleep disorder e.g. sleep apnoea
- medication e.g. beta blockers
- recreational drugs e.g. alcohol
what are the affective causes for low mood?
¥ Bipolar disorder
¥ Cyclothymia
¥ Dysthymia
What are the neurotic causes for low mood?
anxiety
PTSD
adjustment disorder
What is the personality disorder cause for low mood?
emotionally unstable personality disorder`
What are the psychotic causes for low mood?
schizophrenia/schizoaffective disorder
age onset of depression
27yrs
