Low Mood

Question 1

pathology behind depression

Answer 1

hippocampal atrophy

low 5HT/noradrenaline activity

Question 2

how does depression affect cortisol production

Answer 2

increased production

Question 3

which gender is depression more common in

Answer 3

females

Question 4

core symptoms of depression

Answer 4

low mood
anhedonia
anergia

Question 5

what is anhedonia

Answer 5

loss of enjoyment

Question 6

what is anergia

Answer 6

lack of energy

Question 7

what are some key features of depression

Answer 7

diurnal variation
- mood varies over the day (typically worse in the morning)

early morning wakening - waking up at least 2 hours before normal time

psychomotor retardation - slowing of thoughts / action s

Question 8

MSE findings: appearance + behaviour

Answer 8

reduced facial expresión + eye contact
difficult to establish report
poor posture

Question 9

MSE findings: speech

Answer 9

slow speech
reduced volume
monotone
limited content- short answers

Question 10

MSE findings: mood + affect

Answer 10

mood: low, miserable, flat, empty, black
affect: depression, stays low throughout, limited reactivity (doesn’t respond or react to changes in subject, context or emotion)

Question 11

MSE findings: thought

Answer 11

slow thoughts
content: negative, self accusatory, failure, guilt, low self esteem
delusions can occur

Question 12

MSE findings: cognition

Answer 12

poor memory
trouble planning
thought block

Question 13

is there loss of insight?

Answer 13

no- typically preserved + aware of symptoms

Question 14

criteria for diagnosis of depression

Answer 14

at least 2 of the following must be present for >2 weeks

• depressed mood
• anhedonia
• anergia

additional >1 symptoms from:

• loss of confidence
• excessive/ unreasonable feelings of guilt
• recurrent thoughts of death/suicide
• agitation
• sleep disturbance
• change in appetite + corresponding weight change
• decreased concentration

Question 15

tools used to assess depression severity

Answer 15

Hamilton rating scale
Montgomery- asperg depression rating scale
Beck depression inventory

Question 16

mild depression

Answer 16

4 symptoms in total

at least 2 core + 2 others

Question 17

moderate depression

Answer 17

6 symptoms in total

at least 2 core + 4 others

Question 18

severe depression

Answer 18

8 symptoms in total

at least 2 core + 6 others

Question 19

what is post baby blues

Answer 19

brief episode of emotional instability - low mood, irritable, tearful
resolves within a few days

Question 20

what is post-natal depression

Answer 20

onset within 1 month of delivery
most resolve within weeks-year
negative thoughts around ability as a mother/ enstrangement from child

Question 21

what is puerperal psychosis

Answer 21

onset within weeks of delivery

psychosis + confusion

Question 22

features of somatic syndrome

Answer 22

4 of the following symptoms:

• anhedonia
• waking in the morning
• loss of appetite
• weight loss
• loss of libido
• lack of emotional response

Question 23

features of atypical depression

Answer 23

1) mood that reacts strongly to circumstances

2) +2 of:
- weight gain + increase in appetite
- hypersomnia
- leaden paralysis - heavy feeling in arms+legs
- extreme sensitivity

Question 24

what is dysthymia

Answer 24

persistent, mild symptoms of depression
worse at times of stress
lack of pleasure in life but can still cope

Question 25

management of low mood

Answer 25

CBT for all levels of depression
SSRIs first line in mild-moderate
if unsuccessful, try another from that class or different class
ECT recommend if severe long term depression that is not responding to treatment