Week 1 - B - Abnormal Mood - Depression - Symptoms, Mental State Exam, Diagnosis (core features & additional symptoms), subtypes

Question 1

What age do 50% of all mental health disorders start before? Name the different mental disorders?

Answer 1

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

Question 2

Mental disorders include - 50% start before the age of 14 At what age do half of all mood disorders start at?

Answer 2

50% of all mood disorders start before the age of 30 years old

Question 3

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?

Answer 3

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

Question 4

There is different psychopathology to describe the different symptoms of mood disorders What is Anhedonia? Anergia?? Amotiviation? Mood diurnal variation?

Answer 4

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

Question 5

There is different psychopathology to describe the different symptoms of mood disorders What is Early morning wakening? Psychomotor retardation? Stupor? Euthymia?

Answer 5

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

Question 6

State what anhedonia, anergia, amotivation, dirunal variation, ealy morning wakening, psychomotor disturbances, stupor and euthymia all mean?

Answer 6

* 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

Question 7

How would someone with depression present appearance / behaviour wise?

Answer 7

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

Question 8

How would someone with depression present speech wise? (talk about the rate, pitch, volume, time for thinking of an answer)

Answer 8

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

Question 9

What is the difference between mood and affect? Which is objective and which is subjective?

Answer 9

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)

Question 10

How would you describe a person with depression in terms of mood and affect?

Answer 10

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

Question 11

In a mental state examination for depression, the affect tends to match the mood, what is this known as?

Answer 11

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

Question 12

How would someone with depression present thought wise? What is delusion? What delsuional thoughts can occur in depression?

Answer 12

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

Question 13

What is nihilism?

Answer 13

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”

Question 14

What is paranoia?

Answer 14

Paranoia is where there is self-referential thinking that presents as unreasonable suspicion/mistrust/jealousy - ie they are being watched

Question 15

What is the difference between the presentation of paranoia in depression and psychosis? In which condition is insight likely to be lost?

Answer 15

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

Question 16

Describe the type of hallucinations (if present) that would show in depression?

Answer 16

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”

Question 17

Do people with depression get depressed because the hear the voice telling them derogatory things?

Answer 17

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

Question 18

How is the cognition with patients with depression?

Answer 18

Typically their memory is bad and can be referred to as pseudo-dementia

Question 19

What is the patients insight like in depression?

Answer 19

Unlike other mood disorders- insight is typically good.

People are generally aware of their symptoms.

Question 20

What symptoms are typical of depression?

Answer 20

* 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

Question 21

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?

Answer 21

• * 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

Question 22

What are the two tools used to classify depression?

Answer 22

ICD-10 - international classification of disease 10

DSM-5 - diagnostic and statistical manual 5

Question 23

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?

Answer 23

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

Question 24

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)

Answer 24

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

Question 25

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)

Answer 25

1. loss of confidence or self-esteem
2. unreasonable guilt or self reproach
3. Recurrent thoughts of death, suicide or actual suicide attempts
4. Complaints of diminished ability to concentrate
5. Change in psyhcomotor activity - either retardation or agitation
6. sleep disturbance of any type
7. Change in appetitie (increase or decrease) WITH an associated weight gain/loss

Question 26

Is the change in psyhcomotor activity usually agitation or retardation? Is the change in apetitie usually increase or decrease?

Answer 26

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)

Question 27

Describe the core features of depression and the additonal symptoms?

Answer 27

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Question 28

What is depression fully known as?

Answer 28

Unipolar major depression - unipolar as there are no manic/hypomanic episodes

Question 29

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?

Answer 29

ICD-10 rates depression severity based on the number and sometimes severity of the symptoms

Question 30

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?

Answer 30

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

Question 31

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?

Answer 31

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

Question 32

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?

Answer 32

Mild depression is the commonest presenting type of depression in primary care

Question 33

What is the treatment of mild depression?

Answer 33

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.

Question 34

What is the herbal remedy that is often given to treat depression but should not be advised by the GP due to uncertainties?

Answer 34

ST Johns Wort

Question 35

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?

Answer 35

Cotard’s syndrome is the syndrome in psychotic depression - usually in elderly and patients have nihilistic delusions

Question 36

How long is it recommended that the treatment for depression is taken after symptoms have ended?

Answer 36

It is recommended to take the medication for at least 6 months after symptoms have ended

Question 37

What is the 1 year, 5 year and 10 year recurrence rates of depression in patients who have recovered?

Answer 37

1 year recurrence rate is 30%

5 year recurrence rate is >/=60%

10 year recurrence rate is >/=80%

Question 38

Is the risk of suicide higher or lower in males or females with mental health disorders?

Answer 38

The risk of suicide is higher in males