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MD4001 > The Social and Psychological Bases of Depression and Suicide > Flashcards

The Social and Psychological Bases of Depression and Suicide Flashcards

1
Q

What are Subthreshshold Depressive Symptoms?

A

At least one key symptom of depression but with insufficient other symptoms and/or functional impairment to meet the criteria (of depression)

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2
Q

What is Dysthymia?

A

Symptoms that are sub threshold for depression but lasts for at least 2 years

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3
Q

What is Bipolar Disorder?

A

Characterised by severe highs (mania) and lows (depression)

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4
Q

What is the assessment of major depression based on?

A

The criteria in the DSM.IV. It should include the number and severity of symptoms, duration of the current episode and the course of illness

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5
Q

What NICE guideline covers assessment of depression?

A

CG90

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6
Q

What are the biophysychosocial principles of assessment of depression?

A

Don’t assess purely on symptom count, take the degree of functional and/or disability associated with possible depression and the duration of the current episode

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7
Q

What are the key symptoms of depression?

A
  • Persistent sadness or low mood

* Marked loss of interest/pleasure

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8
Q

In relation to the key symptoms, what are the requirements for a diagnosis of depression?

A

At least one key symptom, most days, most of the time for at least 2 weeks.

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9
Q

What are the associated symptoms of depression?

A
  • Disturbed sleep
  • Decreased or increased appetite and/or weight
  • Fatigue or loss of energy
  • Agitation or slowing of movements
  • Poor concentration or indecisiveness
  • Feelings of worthlessness or excessive inappropriate guilt
  • Suicidal thoughts or acts
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10
Q

Aside from key and associated symptoms of depression, what should you also ask the patient about?

A
  • Duration
  • Associated disability
  • Past history of mood disorders
  • Family history of mood disorders
  • Availability of social support
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11
Q

What are the emotional symptoms of depression?

A
  • Anhedonia- loss of interest or pleasure in hobbies and activities that were once enjoyed
  • Persistent sadness or low mood, unresponsive to circumstances
  • Irritability, tearfulness
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12
Q

What are the cognitive symptoms of depression?

A

• Negative view of the self
- lowered self esteem and self confidence
- feelings of guilt and worthlessness
- feelings of hopelessness and helplessness
- pessimistic and negative thoughts about oneself, world and the future (negative cognitive triad)
• Poor concentration and reduced attention, difficulty making decisions
• Mental slowing or rumination
• Suicidal ideation may be present

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13
Q

What are the biological/behavioural symptoms of depression?

A
  • Lowered appetite, weight loss, sometimes gain
  • Insomnia, early morning awakening, feeling worse in the morning
  • Low energy, fatigue
  • Loss of libido
  • Social withdrawal
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14
Q

What are risk factors of depression?

A
  • Gender
  • Genetic and family factors
  • Early life experiences
  • Stressful life events
  • Social support
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15
Q

Describe genetics as a risk factor

A
  • Approx. 3 fold increase risk for major depression in the first degree relative (parents, siblings, offspring) of individuals with major depression versus that of the general population
  • Twin studies suggest a genetic component: major lifetime depression concordance is 46% for monozygotic twins compared to 20% for dizygotic twins
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16
Q

How can early life experiences increase risk of depression?

A

• Certain experiences can increase risk such as:
- Poor parent-child relationship
- Marital discord and divorce
- Neglect
- Physical and sexual abuse
- Early child hood loss
• The rate of depression was almost 3 times higher in women who had lost their mother before the age of 11 and who also experienced a recent loss (early loss of mother could also increase risk of neglect and abuse)

17
Q

What are most episodes of depression preceded by?

A 
A recent stressful event such as:
• Failure at work or school
• Marital separation
• Rejection by a loved one
• Death of a child 
• Illness of a family member 
• Physical illness
18
Q

How can social support influence depression?

A

Availability of a good social support network offers the individual protection in dealing with stressors which may A lack of intimate or confounding relationships may increase the risk of depression

19
Q

Gene by environment interaction relating to depression

A

Genetic factors influence the overall risk of illness and also the sensitivity of of individuals to the depressogenic effects of environmental adversity

20
Q

Gender and depression

A

Major depression seems more common in women, this could be because:
• Women may express and report symptoms more often than men
• Hormones
• Early life stressors e.g. more likely to experience sexual abuse
• Additional stresses such as responsibilities both at home and at work, single parenthood, caring for children and ageing parents

21
Q

Chronic illness and depression

A

• Depression is 2-3 times more likely in patients with a chronic illness than those with good physical health
• occurs in 20% of people with a chronic illness
• A chronic illness can both cause and exacerbate depression due to
- pain
- functional impairment and disability
• Depression can exacerbate pain and distress associated with chronic illness

22
Q

Why can assessment of depression in the chronically ill be problematic?

A
  • Many signs of depression such as fatigue, insomnia or weight loss may also be an expression of the disease itself
  • Drug treatments can also cause depression as a side effect, especially hypertensives, corticosteroids and chemotherapy agents
23
Q

Depression and coronary heart disease

A
  • Major depression is associated with a 2 to 4 fold increased risk for cardiac mortality among patients hospitalised for MI
  • Depressed people without cardiac disease also have significantly increased risk of cardiac mortality
24
Q

How may depression affect specifically patients with CHD?

A

• Depressed CHD patients are less likely to adhere to:
- Cardiac medication regimens
- Lifestyle rise factor interventions
- Cardiac rehabilitation programmes
• May promote maladaptive health practices e.g. smoking
• May contribute to CHD by triggering dysregulation of neuro-hormonal symptoms responsible for cortisol and catecholamine secretion

25
Q

What are the different categories of treatment for depression?

A
  • Pharmacological
  • Psychological
  • Physical activity (in mild/sub-threshold depression)
  • Electroconvulsive treatment (severe/ complex depression)
26
Q

For people with mild to moderate depression or persistent sub threshold depressive symptoms, what interventions can be considered?

A
  • Individual guided self help based on the person’s principles of cognitive behavioural therapy (CBT)
  • Computerised cognitive behavioural therapy (CCBT)
  • A structured group physical activity programme
27
Q

What is cognitive behavioural therapy?

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
28
Q

What interventions should be considered to help prevent relapse?

A

• Individual CBT:
- for people who have relapsed despite antidepressant medication
- for people with significant history of depression and residual symptoms despite treatment
• Mindfulness- based cognitive therapy
- for people who are currently well but have experienced 3 or more episodes of depression

29
Q

What are the health system related risk factors for suicide?

A
  • Health care access
  • access to means of suicide
  • media reporting
  • Stigma against seeking help for suicidal behaviours/ mental health issues/ substance abuse
30
Q

What are the community/relationship related risk factors for suicide?

A
  • War/disaster

* Discrimination; isolation; abuse/violence

31
Q

What are the individual related risk factors for suicde?

A
  • Previous suicide attempts
  • Mental disorders
  • Harmful use of alcohol
  • Financial loss
  • Chronic pain
  • Family history of suicide
32
Q

What should you do if the patient is assessed as a suicide risk?

A
  • Offer additional support e.g. more frequent direct contacts with primary care staff or telephone contacts
  • Inquire about social support and awareness of sources of help
  • Refer to specialists
33
Q

If there is a risk of the patient self harming what should you do?

A
  • Assess if the have adequate social support and is aware of the sources of help
  • Arrange help appropriate to the level of risk
  • Advise the person to seek further help if they deteriorate

MD4001 (28 decks)

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