Mood disorders Flashcards
two questions screen for depression
‘During the last month, have you often 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?’
screening tool depression, how work
Patient Health Questionnaire (PHQ-9)
asks patients ‘over the last 2 weeks, how often have you been bothered by any of the following problems?’
9 items which can then be scored 0-3
includes items asking about thoughts of self-harm
less severe - <16
more severe - same or >16
criteria to grade depression
DSM-IV
criteria grades depression how work
- Depressed mood most of the day, nearly every day
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
- Significant weight loss or weight gain when not dieting or decrease or increase in appetite nearly every day
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation nearly every day
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day
- Diminished ability to think or concentrate, or indecisiveness nearly every day
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
MILD - >5 for diagnosis (otherwise subthreshold)
MOD
SEV -> most sx, interfere with functioning, with or without psychosis
anhedonia
lack of interest/enjoyment
sx depression
core, somatic, cognitive
core - lack of energy, anhedonia
somatic - loss of libido, early morning waking, diurnal variation of mood, agitation
cognitive - low self esteem , guilt, suicidal, hypochondral
psychotic depression
hallucinations - usually auditory
delusions - hypochondrical, guilt, nihilstic, persecutory
delusions
not based on reality, or individual’s cultural or religious background
less severe management depression
less severe - avoid antidepressant meds unless person’s preference
1st line -> guided self help, CBT, BA, individual CBT, BA, group exercises, mindfulness, IPT, SSRI, counselling, STPP (most ->least)
more severe management depression
1st line - individual CBT + antidepressant
then individual BA, individual problem solving, counselling, STPP, IPT, guided self help, group exercise
switching antidepressants guidlines
Switching from citalopram, escitalopram, sertraline, or paroxetine to another SSRI
the first SSRI should be withdrawn* before the alternative SSRI is started
Switching from fluoxetine to another SSRI
withdraw then leave a gap of 4-7 days (as it has a long half-life) before starting a low-dose of the alternative SSRI
depression over dementia
short history, rapid onset
biological symptoms e.g. weight loss, sleep disturbance
patient worried about poor memory
reluctant to take tests, disappointed with results
mini-mental test score: variable
global memory loss (dementia characteristically causes recent memory loss)
prevalence depression
lifetime prevalence 10-20%
depression risk factors
female
chronic physical health conditions
sx of hypomania
interference for at least several days ->
- mildly elevated mood
- increased energy
- increased self esteem
- sociabke, talkative
- increased sex drive
- reduce need for sleep
- difficulty in focussing on one task alone
sx of mania
- elevated mood
- increased energy, agitated
- gradiosity
- pressure of speech (not make sense)
- flight of ideas
- distractible
- reduced need for sleep
- increased libido
- social inhibitions lost
- psychotic sx
mania v hypomania
mania - at least 7 days, severe functional impairment, require hospitalisation, psychotic sx
hypomania - lesser version, <7 days, high functioning, no psychotic sx or hospitalisation
BPD ddx
-> cyclothymia - mild episodes of elation/depression
early onset, chronic course
common in relatives of BPD
-> emotionaly unstable personality disorder
depression ddx
dysthymia - chronic low mood, not fulfil criteria of depression
