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Psychiatry > Mood Disorders - Depression > Flashcards

Mood Disorders - Depression Flashcards

1
Q

What criteria do we use to classify mood disorders?

A

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

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

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2
Q

What does depression mean as a symptom?

A

A systemic symptom with similarities to pain & fatigue

It’s also a form of sadness not just the absence of happiness

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3
Q

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

A

There’s no clear divide so psychiatrists look at:

  • Symptom persistance
  • Symptom pervasiveness
  • Degree of impairment
  • Presence of specific symptoms/signs
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4
Q

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

A
  • Low mood
  • Anxiety
  • Perplexity
  • Anhedonia
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5
Q

What do we mean by perplexity & anhedonia?

A

Perplexity - the feeling of being overwhelmed

Anhedonia - No pleasure in normally enjoyable activities

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6
Q

How can depression affect your Thought Content?

A

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

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7
Q

In what ways can depression affect you physically?

A 
Sleep disturbance
Appetite problems
Loss of libido
Fatigue
Constipation
Pain

Can also have psychomotor agitation or retardation

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8
Q

What form does sleep disturbance take in depression?

A

Most severe depression comes with waking early insomnia

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

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9
Q

How can depression affect you socially?

A 
Loss of interest in activities
Irritability
Apathy
Withdrawal & loss of confidence
Loss of conc & memory
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10
Q

We will use ICD-10 criteria for diagnosing depression.

Come up with 4 criteria that must be met before going for depression diagnosis?

A
  • Lasted 2+wks
  • No hypomanic/manic episodes ever
  • Not attributable to a psychoactive substance or organic disorder
  • Excluded other psychotic illness (if psychotic symptoms)
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11
Q

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

A

At least 2 of:

  • Abnormally low mood (most of every day for 2wks)
  • Anhedonia
  • Low energy & high fatigability

Plus others from list for a total of at least 4:

  • Lost confidence/self esteem
  • Unreasonable guilt/self-reproach
  • Suicidal thoughts
  • Lost Conc
  • Agitation/retardation
  • Sleep disturbance
  • Appetite changes
  • Loss of libido
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12
Q

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?

A

Atleast 6 criteria = Moderate depression

Atleast 8 = Severe depression

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13
Q

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

A

Any psychotic symptoms

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14
Q

Define retardation and agitation?

A

Retardation - slowing of motor responses including speech

Agitation - Restless overactivity, aimless or ineffective

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15
Q

What is a stupor

A

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

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16
Q

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

A 
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
17
Q

What are dysthymia and cyclothymia?

A

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

18
Q

What treatments do we have for depression?

A

Drugs:

  • Selective Serotonin Reuptake Inhibitors
  • SNRIs,
  • Tricyclic Antidepressants
  • Monoamine Oxidase Inhibitors

Psych e.g. CBT etc

Physical e.g. ECT, psychosurgery etc

19
Q

How do we measure depression during research?

A

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

Also SCID (used with DSM-5 criteria)

20
Q

How do we assess depression in practice?

A

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

21
Q

What is the mean onset age of depression?

A

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

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

22
Q

What ‘risk factors’ are associated with depression?

A

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

23
Q

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

A

On average 4-6months

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

24
Q

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

A

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
25
Q

What are the psychotic symptoms that come with Affective disorders?

A

Hallucinations & delusion

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

26
Q

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

A
  • Interest (anhedonia)
  • Guilt
  • Appetite & Agitation (Psychomotor)
  • Mood
  • Energy
  • Concentration & confidence
  • Sex, Sleep & Suicide
27
Q

What can depression be classified?

A
  • Symptoms
  • Syndrome
  • Recurrent Illness
28
Q

Post-natal depression

A
  • increase psychiatric admission 30 days following childbirth
  • 75% of women experience baby blues within 2 weeks
  • 10% of women develop MDD within 3-6 months
29
Q

outcome

A
  • typical episode lasts 4-6 months
  • 54% recover at 26 weeks
  • 15% die by suicide
  • 80% and more have recurrent episodes

Psychiatry (22 decks)

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