Mood Disorders Flashcards
What is an emotion?
A complex action that includes things like facial expression, posture, and internal milieu that is accompanied by thought process
What are feelings?
Affect or presentation of an emotion
What is mood vs affect?
Mood is the subject aspect of a person feeling state, it is more the climate of the feeling
Affect is the more objective aspect, it is also the moment by moment expression of feeling eg weather
What are mood disorder more broadly?
Disorder in normal mood, whether lower or higher
What are the cardinal symptoms for depression diagnosis?
> 2 weeks duration of: must have at least one of
- Depressed mood - of a particular quality, with loss of reactivity, and classically in a diurnal pattern (worse in the morning, better at night)
- Anhedonia
What is reactivity?
The response of a person to events eg laughing at sometime funny, sadness towards an event
What are the neuro-vegetative secondary symptoms for depression diagnosis?
- Sleep disturbance
- Appetite disturbance
- PSYCHOMOTOR RETARDATION
- Impaired concentration, set shifting, rumination
- Working memory deficits
- Libidinal changes
What are the cognitive-affective symptoms of depression?
- Anxiety
- Helplessness
- Loss of self esteem, WORTHLESSNESS
- Social withdrawal
- Depersonalisation, derealisation
- GUILT
- Shame
- Rage
- Nihilism
- Hopelessness
- Suicidal ideation
What are the psychotic symptoms of depression?
- Hallucinations
- Delusions
What is characteristic of psychotic depressive symptoms?
Mood congruent - will match the mood
What is the likelihood that a depressive episodes will recur?
50%
What is the rate of postpartum depression?
~10% of mothers, 1/2 that will be severe
What is the recurrence rate of postpartum depression?
50%
How is depression in the elderly different?
Somatic symptoms often predominate
Organic conditions are common
Often precipitated by loss
What are some medical causes of depression?
Hypothyroidism Cushing's Ca MS HIV Stroke (especially involving left frontal pole)
Which medications can trigger or exacerbate depression?
Monoamine depletion Corticosteroids - dose effect GABA-ergic drugs - benzodiazepines, alcohol Chemotherapy OCP (rare) Interferon
How do you differentiate grief from depression?
- Duration of symptoms >6 months, grief is usually better
- In grief, the sadness is focussed on the object of loss
- Grief feels like a transient process
How heritable is depression?
- Moderately
- Genes increase our sensibility to life events
How might patients with depression brain appear?
Smaller hippocampus
Larger ventricles
What are some psychosocial risk factors for depression?
Parental loss + poor parenting afterwards
Chronic exposure to severely depressed mothers
Childhood sexual abuse
1 good relationship & a higher IQ is protective
Confiding other is very protective
What are some precipitating event types?
Loss
Humiliation
Entrapment
Danger
What are some protective environmental factors?
Employment and financial independence
Neutralising or fresh start events
What is the anaclitic personality?
Exaggerated need for relatedness, preoccupation, entanglement
What is the introjective personality?
Independent, autonomy
What are some psycho-social treatment for depression?
CBT IPT Couple therapy Psychodynamic - more complex depression Exercise Sleep, diet, alcohol reduction Confiding other
What are some pharmacological treatment for depression?
SSRI's - sertraline, escitalopram, fluoxetine SNRI's - venlafaxine, duloxetine Mirtazepine TCA - Nortriptyline, imipramine Lithium Thyroxine Second generation anti-psychotic
How long do you continue therapy?
6-12 months at the full treatment dose for the 1st episode
Indefinite if 2nd or 3rd treatment
When is ECT useful?
Melancholic Psychotic Puerperal/postpartum Bipolar depression or mania Prominent suicidality Poor oral intake
