Week 1 - B - Abnormal Mood - Depression - Symptoms, Mental State Exam, Diagnosis (core features & additional symptoms), subtypes Flashcards
What age do 50% of all mental health disorders start before? Name the different mental disorders?
50% of all mental disorders start before the age of 14
The mental disorders in the graphs were only the ones tested for this investigation But the statement above is true that 50% of all mental disorders start before the age of 14
Mental disorders include - 50% start before the age of 14 At what age do half of all mood disorders start at?
50% of all mood disorders start before the age of 30 years old
What are mood disorders? 50% of mental disorders start before what age? 50% of mood disorders (a type of mental disorder) start before what age?
Mood disorders are mental disorders which affect mood (the persons long term feeling)
50% of mental disorders start before the age of 14
50% of mood disorders start before the age of 30
There is different psychopathology to describe the different symptoms of mood disorders What is Anhedonia? Anergia?? Amotiviation? Mood diurnal variation?
Anhedonia is when there is the lack of enjoyment / pleasure (usually in things you used to find pleasurable)
Anergia - lack of energy
Amotivation - lack of motivation
Mood diurnal variation - this is where the mood varies over the day
There is different psychopathology to describe the different symptoms of mood disorders What is Early morning wakening? Psychomotor retardation? Stupor? Euthymia?
Early morning wakening - this is where the patient wakes at least 2 hours before the expected / normal wakening tie
Psychomotor retardation - this is the slowing of thoughts/movement
Stupor - this is the absence of relational functions eg action or speak - completely unresponsive
Eythymia - normal mood
State what anhedonia, anergia, amotivation, dirunal variation, ealy morning wakening, psychomotor disturbances, stupor and euthymia all mean?
* Anhedonia - the lack of enjoyment/pleasure in activities that you used to enjoy
* Anergia - lack of energy
* Amotiviation - lack of motivation
* Diurnal variation - mood varies throughout the dasy
* Early morning wakening - wakening at least 2 hours before the expected/normal wakening time
* Psychomotor retaration - slwoing of thoughts/movements
* Stupor - completely unresponsive
* Euthymia - normal mood
How would someone with depression present appearance / behaviour wise?
Reduced facial expression with the brow classically furrowed (ie neck is flexed, doesnt want to show face)
Reduced eye contact
Limited gesturing
Rapport is often very difficult to form
How would someone with depression present speech wise? (talk about the rate, pitch, volume, time for thinking of an answer)
There is often a reduced rate of speech - slow speech
There is also a reduced pitch - monotonous
And reduced volume - quiet
There is increased speech latencies - where there is a long time between us asking a question and them beginning to answer it
There is almost always limited content with what they are saying
What is the difference between mood and affect? Which is objective and which is subjective?
Mood - this is how the patients has been feeling - it is typically subjective
Affect is how the patients feeling appear to react to changes in the surroundings or environment -
Weather is to climate as affect is to mood
Hot climate, still can rain (just feeling down today) but can be a cold climate where it always rains (low mood and flattened/blunted affect - depression)
How would you describe a person with depression in terms of mood and affect?
Mood - would say low miserable, unhappy
Affect - would say flattened/blunted - reduced range of affect as it stays relatively low throughout (reduced range of emotion) - there is limited reactivity to the surroundings or conversation
In a mental state examination for depression, the affect tends to match the mood, what is this known as?
In a mental state examination this is known mood congruence
Low mood and usually a flattend/blunted affect - they dont react to their surroundings/situations
How would someone with depression present thought wise? What is delusion? What delsuional thoughts can occur in depression?
Thought form - typically in am orderly manerly - linear, bit the form is slow and there is no tangent of though
Thought content - need to ask if any thoughts of self harm or suicide, could ask if any positive thoughts
Delusions are fixed beliefs that cannot be shaken despite logical argument
In depression can include feelings of guilt or nihilism
What is nihilism?
The belief that there is no meaning anymore
Depressive state where you think the world or part of the body doesn’t exist or isn’t worth existing anymore
Nihilistic delusions – “I can’t eat because my bowels have turned to dust”
What is paranoia?
Paranoia is where there is self-referential thinking that presents as unreasonable suspicion/mistrust/jealousy - ie they are being watched
What is the difference between the presentation of paranoia in depression and psychosis? In which condition is insight likely to be lost?
In depression likely to be much more sensitive to criticism - feeling guilty / blaming oneself
In psychosis - there is a lack of perception about what is going in whereas depressed or a lot more conscious
Insight is often lost in psychosis but preserved in depressed patients
Describe the type of hallucinations (if present) that would show in depression?
The hallucinations would be speaking in 2nd person most commonly and are almost always auditory and derogatory - ie “you are going to die” “ you are worthless”
Do people with depression get depressed because the hear the voice telling them derogatory things?
It is much more common for people with depression to become depressed and the voices reflect the depression rather than becoming depressed due to the voices
Typically reflect negative and depressive themes: the voices reflect the depression rather than someone getting depressed because of the voic
How is the cognition with patients with depression?
Typically their memory is bad and can be referred to as pseudo-dementia
What is the patients insight like in depression?
Unlike other mood disorders- insight is typically good.
People are generally aware of their symptoms.
What symptoms are typical of depression?
* Anhedonia * Anergia * Amotivation * Diurnal variation * Early morning wakening * Psychomotor retardation * Stupor - severe depressive state * Euthymia - normal mood isnt common
Usually also have feelings of guilt and self-burden
Mental state examination example history * • Classic furrowed brow * • Tearful * • Probably not sleeping (was up at 3am) * • Feelings of guilt, pessimism, low self-esteem, * and being a burden to others * • Suicidal ideation and apparent intent
Describe the different components for depression in full for the mental state examination?
- * A+B - classic furrowed brow, reduced facial expression and reduced eye contact, poor rapport
- * Speech - reduced rate, volume and tone (monotony), limited content
- * Mood+affect - low mood, flattened/blunted affect - no reactivity
- * Thoughts - nihilism, self harm, paranoia possibly
- * Perception - 2nd person auditory hallucinations
- * Cognition - typically slow and bad memory -pseudo-dementia
- * Insight - insight is typically maintained
What are the two tools used to classify depression?
ICD-10 - international classification of disease 10
DSM-5 - diagnostic and statistical manual 5
Depressive Illness • Not just ‘low mood’ . Everyone will have been sad, or unhappy, or down, or gloomy or miserable at some stage • Must be clearly abnormal for the individual concerned, it must persist, and it should interfere with normal function to a significant degree • Grief is similar In the diagnosis of depression, there is the general criteria, core features and additional symptoms What are the general criteria for depression?
The depressive episodes should last at least 2 weeks with and there have been no symptoms sufficient to meet a criteria for a hypomanic or manic episode - ie bipolar
So the general criteria of depression means there is depressive epsiodes for at least 2 weeks with no hypomanic or manic symptoms suggestive of hypomania or mania The depressive episodes have different core features and additional symptoms What are the core features of depression? (need at least 2 out of the three)
Core features
* Depressed mood which is abnormal for the individual present for most of the day everyday for 2 weeks and is largely uninfluenced by circumstances
* There is a loss of interest or pleasure inactivities that were normally pleasurable - anhedonia
* Lack of energy or extreme fatigue - anergia
For a diagnosis of depression - need to have 2 out of the three core features with at least 2 or more of the addditonal symptoms What are the addiontal symptoms to choose from for the diagnosis of depression? (there are 7)
- loss of confidence or self-esteem
- unreasonable guilt or self reproach
- Recurrent thoughts of death, suicide or actual suicide attempts
- Complaints of diminished ability to concentrate
- Change in psyhcomotor activity - either retardation or agitation
- sleep disturbance of any type
- Change in appetitie (increase or decrease) WITH an associated weight gain/loss
Is the change in psyhcomotor activity usually agitation or retardation? Is the change in apetitie usually increase or decrease?
Change in psychomotor activity - usually retardation but can also be agitation
Change in appetite - almost always decreased with weight loss (rarely is increase with weight gain)
Describe the core features of depression and the additonal symptoms?
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What is depression fully known as?
Unipolar major depression - unipolar as there are no manic/hypomanic episodes
Severity • Can be assessed using rating scales, e.g. – Hamilton Rating Scale for Depression (HRSD, HAM-D) – Montgomery-Asperg Depression Rating Scale (MADRS) – Beck Depression Inventory (BDI)
How does the ICD rate the depression severity?
ICD-10 rates depression severity based on the number and sometimes severity of the symptoms
When you meet the 2 out of 3 core features of depression and the 2 out of the 7 additional symptoms, how severe is the depression classified as?
Meeting 2 out of the 3 core features and 2out of the 7 additional symptoms gives a total of 4 for the score - this is mild depression
Having 2 out of 3 core features and 2 out of 7 additional symptoms gives you a classification of mild unipolar major depression (aka mild depression)
What is the difference between the classifications of moderate and severe unipolar major depression?
Moderate depression - need 2 out of the 3 core features and at least 4 additional symptoms of depression - total score of 6
This is moderate depression
Severe depression - need all 3 core feature (depressed mood most of the day every day for 2 weeks, anhedonia & anergia)
And at least 5 of the additonal symptoms
Mild - =/> 2 core, 2 additional at least Moderate - =/> 2 core, 4 additional at least Severe - = 3 core, 5 additional at least Is mild, moderate or severe depression the majority diagnosed in primary care?
Mild depression is the commonest presenting type of depression in primary care
What is the treatment of mild depression?
CBT is used for treatments of all depression Drugs may not be required for mild depression and are not routinely used in the treatment unless:
* a past history of moderate or severe depression or
* initial presentation of subthreshold depressive symptoms present for at least 2 years or
* subthreshold depressive symptoms or mild depression persisting after other interventions.
What is the herbal remedy that is often given to treat depression but should not be advised by the GP due to uncertainties?
ST Johns Wort
Different types of depression are known as: * Somatic depression * Atypical depression * Psychotic depression Somatic depression is the most common subtype as it basically has the same criteria as normal depression
What is the syndrome seen in psychotic depression where there are nihistic delusions which can be extreme?
Cotard’s syndrome is the syndrome in psychotic depression - usually in elderly and patients have nihilistic delusions
How long is it recommended that the treatment for depression is taken after symptoms have ended?
It is recommended to take the medication for at least 6 months after symptoms have ended
What is the 1 year, 5 year and 10 year recurrence rates of depression in patients who have recovered?
1 year recurrence rate is 30%
5 year recurrence rate is >/=60%
10 year recurrence rate is >/=80%
Is the risk of suicide higher or lower in males or females with mental health disorders?
The risk of suicide is higher in males
