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MD4001 Pathology > Social and Psychological Bases of Depression and suicide > Flashcards

Social and Psychological Bases of Depression and suicide Flashcards

1
Q

What are the 2 key factors of depression?

A
  • Persistent sadness or low mood
  • Marked loss of interests or pleasure
    More than just feeling sad/down
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2
Q

What is dysthymia?

A

Subthreshold depression over the course of 2 years

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3
Q

What is bipolar disorder (manic-depressive illness) characterised by?

A

Severe highs (mania) and lows (depression)

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4
Q

What is the term given to the way depression should be assessed?

A

Biopsychosocial
- Not just symptom count, take into ccount degree of functional impairment and/or disability associated with the depressionand duration of episode

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5
Q

What are the 2 KEY symptoms associated with depression?

A
  • Persistent sadness or low mood and/or
  • Marked loss of intrests or pleasure
  • At least one of these, most days, most of the time for at least 2 weeks
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6
Q

What are the associated symptoms one should ask the patient about if they present one of the key symptoms?

A
  • Disturbed sleep (decreased or increasded compared to usual)
  • Decreased or increased apetite and/or weight
  • Fatigue or loss of energy
  • Agitation or slowing of movements
  • Poor concentration or indecisiveness
  • Feelings of worthlessness or excessive inapropriate guilt
  • Suicidal thoughts or acts
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7
Q

What is anhedonia?

A

Loss of intrest or pleasure in hobbies and activities that were once enjoyed

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8
Q

What are some cognitive symptoms related to depression?

A
  • Negative view of self (inferior, incompetant, hopelessness)
  • Poor concentration and reduced attention, difficulty making decisions
  • Mental slowing or rumination
  • Suicidal ideation may be present
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9
Q

What is the negative cognitive triad?

A

Negative thoughts about oneself, world and future

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10
Q

Name some biological/behavioral symptoms associated with depression?

A
  • Lowered appetite, weight loss, sometimes weight gain
  • Insomnia, early-morning awakening, feeling worse in the morning
  • Low energy, fatigue
  • Loss of libido
  • Social withdrawal
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11
Q

What sort of questions should you ask to bring up the topic of depression (particularly in patients with a history)?

A
  • During the last month, have you 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
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12
Q

What are the vulnrability factors which can lead to depression?

A
  • Genetic and family factors
  • Early life experiences
  • Stressful life events
  • Social support
  • Gender
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13
Q

What is the increase in chances of depression in a first-degree relative of a depressed person?

A

3-fold increase

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14
Q

What are the chances of depression in a twin?

A

Concordance for lifetime major depression in:

  • Monozygotic twins = 46%
  • Dizygotic twins = 20%
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15
Q

What early-life experiences can increase chances of depression?

A
  • Poor parent-child relationship
  • Marital discord and divorce
  • Neglect
  • Physical and sexual abuse
  • Loss of family member
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16
Q

What are most depressions preceded by?

A

Stressful event (i.e unemployment, divorce, death, illness)

17
Q

What factor cacn significantly reduce chances of depresion?

A
  • Availability of good-quality support from friends and family
  • Intimate or confiding relationship
  • Both provide protection from stressors which otherwise may lead to a depressive episode
18
Q

What may lead to an increased prevelance of depression in women?

A
  • Express and report symptoms more than men
  • Hormones
  • Early life stress (sexual abuse)
  • Home, work stress, single parenthood, caring for children and/or aging parents
19
Q

What is the increased risk of chronic illness for depression?

A
  • 2-3x more likely

- 20% of people with chronic illness

20
Q

What can make assessment of depression in chronically ill patients problematic?

A
  • Many signs of depression such as fatigue, insomnia weight loss associated with disease itself
  • Drug treatments may cause depression
21
Q

What is the increase in cardiac mortality among patients who are hospitilised for an MI who have major depression?

A

2-4x (depression also increases risk of cardiac disease)

22
Q

What are the factors which lead to an increased risk of cardiac mortality for those who are depressed?

A

Less likely to adhere to:

  • Medication
  • Lifestyle risk factor interventions
  • Cardiac rehabilitation programmes
23
Q

How can depression lead to increased risk of CV disorders?

A
  • Beahvioural factors e.g physical inactivity, med non-adherence, smoking
  • Dysregulation of neurohormonal systems responsible for cortisol and catecholamine secretion
24
Q

What are effective non-interventional treatment which can be used to treat mild or moderate depression?

A
  • Physical activity
  • Individual guided self-help based on the principles of cognitive behavioral therapy
  • Computerised cognitive behavioural therapy
25
Q

What does cognitive behavioural therapy involve?

A
  • Short-term psychological treatment
  • Emphasises the role of thinking in how we feel and what we do
  • Identifying and challenging unhealthy modes of thinking that cause depressed feelings and behaviour
  • Can be delivered one-to-one or in group settings
26
Q

What are the psychological interventions for relapse prevention?

A
  • Individual CBT (for those who have relapsed despite medication/treatment or a significant history and residual symptoms despite treatment)
  • Mindfulness-based cognitive therapy (currently well but have experienced 3 or more previous episodes of depression)
27
Q

In what age group are suicides most common?

A

70 or older

28
Q

What is the gender gap in suicides?

A
  • High income countries: Men 3x higher

- Low income countries: Women 1.5x higher

29
Q

What is the second leading cause of death among 15-29 year olds globally?

A

Suicide

30
Q

WHat are the main kinds of factors which lead to suicide?

A
  • Health system (access, stigma for mental health)
  • Community/relationships (war/disaster, discrimination)
  • Individual factors (FH, abuse, unemployment, mental disorders, chronic pain)
31
Q

What are some myths about suicide?

A
  • People who talk about it do not do it

- Talking openly about the topic puts the idea in the head

32
Q

What is needed if a patient is assessed to be at a suicidal risk?

A
  • Additional support such as more frequent direct contacts with primary care staff or telephone contacts are particularly useful
  • Inquire about social support and awareness of sources of help
  • Referral to specialists
  • ASK directly

MD4001 Pathology (18 decks)

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