Mood Disorders - Depression

Question 1

What criteria do we use to classify mood disorders?

Answer 1

ICD-10 (mostly EU) - International Classification of Disease 10th ed

DSM-5 (mostly US) - Diagnostic & Statistical Manual of mental disorders 5th ed

Question 2

What does depression mean as a symptom?

Answer 2

A systemic symptom with similarities to pain & fatigue
It’s also a form of sadness not just the absence of happiness

Question 3

Obviously everyone gets sad sometimes, so at what point is it considered abnormal?

Answer 3

There’s no clear divide so psychiatrists look at:
- Symptom persistance
- Symptom pervasiveness
- Degree of impairment
- Presence of specific symptoms/signs

Question 4

Depression is a syndrome that affects the psychological (both mood & thoughts), physical and social domains. What are the major ways it can affect mood?

Answer 4

• Low mood
• Anxiety
• Perplexity
• Anhedonia

Question 5

What do we mean by perplexity & anhedonia?

Answer 5

Perplexity - the feeling of being overwhelmed

Anhedonia - No pleasure in normally enjoyable activities

Question 6

How can depression affect your Thought Content?

Answer 6

1) -ve emotions of guilt, hopelessness & worthlessness
2) Neurosis e.g. hypochondriasis, compulsions, panic attacks or agoraphobia
3) Delusions & hallucinations
4) Ideas of reference

Question 7

In what ways can depression affect you physically?

Answer 7

Sleep disturbance
Appetite problems
Loss of libido
Fatigue
Constipation
Pain

Can also have psychomotor agitation or retardation

Question 8

What form does sleep disturbance take in depression?

Answer 8

Most severe depression comes with waking early insomnia

But can also have frequent waking, problems falling asleep and hypersomnalence

Question 9

How can depression affect you socially?

Answer 9

Loss of interest in activities
Irritability
Apathy
Withdrawal & loss of confidence
Loss of conc & memory

Question 10

We will use ICD-10 criteria for diagnosing depression.
Come up with 4 criteria that must be met before going for depression diagnosis?

Answer 10

• Lasted 2+wks
• No hypomanic/manic episodes ever
• Not attributable to a psychoactive substance or organic disorder
• Excluded other psychotic illness (if psychotic symptoms)

Question 11

Depression is diagnosed using a score. What is featured on this score?

Answer 11

At least 2 of:
- Abnormally low mood (most of every day for 2ks)
- Anhedonia
- Low energy & high fatigability

Plus others from list for a total of atleast 4:
- Lost confidence/self esteem
- Unreasonable guilt/self-reproach
- Suicidal thoughts
- Lost Conc
- Agitation/retardation
- Sleep disturbance
- Appetite changes
- Loss of libido

Question 12

So in the ICD-10 criteria Mild depression is diagnosed by atleast 4 criteria including 2 from the first list. What makes more serious depression?

Answer 12

Atleast 6 criteria = Moderate depression

Atleast 8 = Severe depression

Question 13

So severe depression requires a score of 8, what else jumps you to a severe diagnosis?

Answer 13

Any psychotic symptoms

Question 14

Define retardation and agitation?

Answer 14

Retardation - slowing of motor responses including speech

Agitation - Restless overactivity, aimless or ineffective

Question 15

What is a stupor

Answer 15

Extreme retardation in which the patient stops eating, drinking, moving and speaking but can recall it all afterward

Question 16

Before you assume depression, what else would feature in the DDX?

Answer 16

Normal reaction to an event
SAD (seasonal affective disorder)
Dysthymia
Cyclothymia
BPD
Stroke, tumour or dementia
Hypothyroid, Addison’s or hyperparathyroid
Infection e.g. HEP or HIV
Drugs

Question 17

What are dysthymia and cyclothymia?

Answer 17

Dysthymia is depression but less severe (however it typically lasts longer, often as long as someone can remember)

Cyclothymia is like BPD but not severe enough for the episodes to be classed as a Major depressive episode or hypomanic episode

Question 18

What treatments do we have for depression?

Answer 18

Drugs e.g. SSRIs, SNRIs, TCAs & MAOIs

Psych e.g. CBT etc

Physical e.g. ECT, psychosurgery etc

Question 19

How do we measure depression during research?

Answer 19

SCAN - Schedules for Clinical Assessment in Neuropsychiatry (used with ICD-10)

Also SCID (used with DSM-5 criteria)

Question 20

How do we assess depression in practice?

Answer 20

Certain scales e.g:
HDRS - Hamilton depression rating scale
BDI-II - Beck Depression inventory 2
& others

Question 21

What is the mean onset age of depression?

Answer 21

27 (but at biggest risk anytime from 18-44)

Remember a lot of cases onset with adverse life events, particularly exit events like seperation

Question 22

What ‘risk factors’ are associated with depression?

Answer 22

Being female (2F:1M)
More associated with lower educational attainment
Less common with employment, financial independence & stable marriages

Question 23

How long does a depressive episode last and what are the outcomes?

Answer 23

On average 4-6months

12% don’t recover
15% commit suicide
80+% have further episodes

Question 24

There is a syndrome of depression called Somatic Syndrome. Waaaat is it?

Answer 24

A form of depression involving a specific constellation of signs/symptoms (mostly physical hence somatic):

• Anhedonia
• Loss of normal emotional reactions
• Early waking
• Worse in morning
• Psychomotor agitation/retardation
• Loss of appetite
• Weight loss
• Loss of libido

Question 25

What are the psychotic symptoms that come with Affective disorders?

Answer 25

Hallucinations & delusion

These would render the diagnosis “MDD with psychosis” or “Mania with psychosis”

Question 26

Try “I GAME CS” as a mnemonic for depressive symptoms:

Answer 26

• Interest (anhedonia)
• Guilt
• Appetite & Agitation (Psychomotor)
• Mood
• Energy
• Concentration & confidence
• Sex, Sleep & Suicide