Mental Health: depression Flashcards
Prevalence of depression
- 8 - 12% of UK population experience depression in any year
- more common in women in most age groups
- common in patients with physical illness
Aetiology of depression
- Multifactorial
- Biochemical
- Neuroendocrine
- Genetic
- Social
- Psychodynamic
Biopsychosocial model:
•Biological
- Psychological
- Social
- Predisposing
- Precipitating
- Perpetuating
Screening for depression
The following two questions can be used to screen for depression
- ‘During the last month, have you often been bothered by feeling down, depressed or hopeless?’
- ‘During the last month, have you often been bothered by having little interest or pleasure in doing things?’
A ‘yes’ answer to either of the above should prompt a more in depth assessment.
Diagnostic criteria for a depressive episode
- Depression can be mild, moderate or severe
- Diagnostic guidelines are that symptoms should last for at least 2 weeks, there are no symptoms (current or historic) that could indicate bipolar affective disorder and there are no other possible causes (organic / substance misuse)
- At least 2 of the 3 core symptoms must be met, most days for most of the time:
- Low mood
- Loss of interest or pleasure in activities usually interesting or pleasurable (anhedonia)
- Decreased energy levels (anergia)
What are core symptoms of depression?
- Low mood
- Loss of interest or pleasure in activities usually interesting or pleasurable (anhedonia)
- Decreased energy levels (anergia)
number of other symptoms needed to assess the level of depression
Number of core + additional symptoms → determine the level of depression (2 core needed to diagnose depression)
- 2 core + 2 additional symptoms = mild depression
- 2 core and 4 additional symptoms = moderate depression
- 3 core and at least 5 additional symptoms = severe depression
Other (apart from core) symptoms of depression (apart from core symptoms they are needed to describe the severity of depression)
- Loss of confidence / self esteem
- Guilt - feelings of self reproach
- Recurrent thoughts of death, recurrent suicidal ideation
- Diminished ability to think or concentrate, or indecisiveness
- Change in psychomotor activity (agitation or retardation)
- Sleep disturbances (of any type)
- Appetite disturbance, either decreased (anorexia) or increased (leading to hyperphagia)
Symptoms characteristics required for the diagnosis of depression (3)
- Symptoms should be present nearly every day
- The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning
- The symptoms are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition (e.g. hypothyroidism)
Psychosis and depression
- Severe depression may occur with or without psychotic symptoms
- Usually, psychotic symptoms are “mood congruent”, i.e. nihilistic delusions, persecutory hallucinations etc.
Physical symptoms of depression
- Loss of libido
- Physical complaints (i.e. somatic symptoms), e.g. aches, pains, constipation, increased worry about pre-existing medical problems
- Diurnal variation of mood (worst in the morning, improves as the day progresses)
- Irritability
- Anxiety, worry, dread, catastrophising
Thoughts pattern in depression
- Negative about self, world and future
- Helpless, worthless
- Worthless, useless, inadequate
- Burden, others better off without them
What does the severity of the depressive episode depend on?
- Number of symptoms of depression
- Degree of functional impairment
Diagnosis and management of mild depression
- enough symptoms to meet criteria
- a person with a mild depressive episode is probably capable of continuing with the majority of their activities
- Managed in primary care → Non-pharmacological treatment only
Moderate depressive episode
- characteristics
- management
- Between mild and severe
- A person with a moderate depressive episode will probably have difficulties continuing with their ordinary activities
Management:
- May require secondary care
- Combination of treatment (i.e. medication and psychological therapy)
Severe depression
- characteristics
- management
- People with this type of depression have symptoms that are marked and distressing
- Suicidal thoughts and acts are common
- Psychotic symptoms may be present, e.g. hallucinations, delusions, psychomotor retardation or severe stupor (referred to as a severe depressive episode with psychotic symptoms)
Management:
- usually require secondary services
- may require treatment in hospital
- may require detention under Mental Health Act 1983
