Low Mood

Question 1

what does euthymic mood mean

Answer 1

normal mood

Question 2

what does hypothermic mood mean

Answer 2

elevated mood

Question 3

what does cyclothymic mean

Answer 3

low mood

Question 4

what is anhedonia

Answer 4

loss of enjoyment/pleasure

Question 5

what is anergia

Answer 5

lack of energy

Question 6

what is amotivation

Answer 6

lack of motivation

Question 7

what is diurnal variation

Answer 7

(mood) varies over the day

Question 8

what is early morning wakening

Answer 8

wakening at least 2 hours before the expected/normal waking time

Question 9

what is psychomotor retardation

Answer 9

slowing of thoughts and/or movement

Question 10

what is stupor

Answer 10

absence of relational functions i.e action and speech

Question 11

what does MSE appearance and behaviour look like in depression

Answer 11

reduced facial expression

brow ‘furrowed’ - look worried

reduced eye contact

limited gesturing, movements may be slow or absent

rapport is often difficult to establish

Question 12

In MSE what does speech sound like in depression

Answer 12

Reduced rate

lowered in pitch

reduced in volume

reduced intonation (speech is monotonous)

increased speech latencies (longer time between end of a q and them starting to speak)

limited content (short, brief answers, unembellished)

Question 13

what is mood

Answer 13

prevailing state or deposition

how the patient describes that they feel - subjective

Question 14

what is affect

Answer 14

Mood applies to things (events, people etc) so how their mood changes in response to whats going on around them

not described, but observed - objective

Question 15

terms used to describe mood in depression

Answer 15

low, down, miserable, unhappy, sad, flat, empty, numb etc

Question 16

terms used to describe affect

Answer 16

Depressed (low)
Reduced range (stays low throughout)
Limited reactivity (doesn’t respond or react to changes in subject, context, emotion etc)
May report emotional paralysis (numbness)

Question 17

in MSE how are thoughts in depression

Answer 17

Normal form

Slow flow, almost absent

Content - negative, self-accusatory, failure, guilt, low self-esteem, pessimism

Delusions can occur - guilt, poverty, nihilism, hypochondriasis

suicidal thinking common

Question 18

What is phenomenology - perception in depression

Answer 18

Increased self consciousness/self referential - hear people laughing and think its about them

Hallucinations

• usually second person auditory and derogatory (you are a bad person and deserve to die)
• typically reflect negative and depressive themes

Question 19

how is cognition impacted by depression

Answer 19

Subjectively cognition is slow with complaints of poor memory (more to do with inattention and not registering info that’s said to them)

pseudo-dementia - mind is elsewhere so not registering info

deficits involve working memory, attention and planning

often compounded by anxiety

Question 20

how is insight impacted in depression

Answer 20

Usually preserved in depression

however can recognise that they are depressed but not realise it isn’t something directly related to sins, personal failings, weakness etc

Question 21

typically observations made of someone with depression

Answer 21

Slower movements 
Fiddling with fingers, tissues etc
'Defeated' posture 
Reduced facial expression 
Speech intonation reduced 
Mood low 
Poor sleep 
Exhaustion 
Worrying
Libido reduction

Question 22

how does ICD-10 (uk and eu classification) classified mood disorders

Answer 22

Mania
bipolar
depressive disorder
dysthymia

Question 23

how does DSM-5 classify depressive disorders

Answer 23

Major depressive disorder
Persistent depressive disorder (dysthymia in ICD10)

keeps bipolar disorders separate

Question 24

what is major depressive disorder the equivalent of in ICD-10

Answer 24

moderate/severe depressive disorder

Question 25

what is the diagnostic criteria for depression

Answer 25

depressive episode should last at least 2 weeks

there have been no hypomanic or manic symptoms sufficient to meet criteria for hypomanic or manic episodes at any time

meet 3 core symptoms:

1. depressed mood >2 weeks
2. loss of interest or pleasure in activities they used to enjoy
3. decreased energy or increased fatiguability

Question 26

‘it’s all about MEE’

Answer 26

Mood
Enjoyment
Energy

Question 27

what are some additional symptoms of depression

Answer 27

Loss of confidence/self esteem
Guilt
Suicidal behaviour
Unable to think/concentrate
Agitation or retardation
Sleep disturbance (increased or decreased)
Change in appetite (increased or decreased)

Question 28

What classifies as moderate depressive episode

Answer 28

2 core symptoms + 4 others to give a total of at least 6

Question 29

What classifies a severe depressive episode

Answer 29

all 3 core symptoms +5 others to give a total of at least 8

Question 30

what are the subtypes of depression

Answer 30

Somatic depression
Atypical depression
Psychotic depression

Question 31

What is psychotic depression

Answer 31

Paranoid, typically ‘mood-congruent’ or hypochondriacal

costard syndrome:
nihilistic delusions
may be as extreme as ‘im dead.. the world doesn’t exist anymore’

Question 32

what is chronic depression

Answer 32

DSM-IV criteria (in America) meaning persistent depression for 2 years