2. The social and psychological bases of depression and suicide Flashcards
(31 cards)
Identify the symptoms of major depression
Loss of interest and enjoyment in ordinary things/experiences and low energy
Low mood
Emotional, cognitive, physical and behavioural symptoms
Key symptoms: - Persistent sadness/low mood -marked loss of interests or pleasure -At least one of these, most days, most of the time for at least 2 weeks Associated symptoms: -Disturbed sleep -Decreased or increased appetite and/or weight -Fatigue or less of energy -Agitation or slowing of movements -Poor concentration of indecisiveness -Feelings of worthlessness/guilt -Suicidal thoughts or acts
What is a dysthymia?
Long term, chronic symptoms that do not disable by keep one from functioning well or feeling good
What is anhedonia?
Loss of interest or pleasure in hobbies and activities that were once enjoyed
Emotional symptoms of depression?
Anhedonia
Persistent sadness or low mood, unresponsive to circumstances
Irritability, tearfulness
Cognitive symptoms of depression?
• Negative view of the self:
– Lowered self-esteem and self-confidence
– Feelings of guilt and worthlessness
– Feelings of hopelessness and helplessness
– Pessimistic and recurrently negative thoughts about oneself, past and future
• Poor concentration and reduced attention, difficulty making decisions
• Mental slowing or rumination
• Suicidal ideation may be present
Biological/behavioural symptoms of depression?
- Lowered appetite, weight loss, sometimes weight gain
- Insomnia, early-morning awakening, feeling worse in the morning
- Low energy, fatigue
- Loss of libido
- Social withdrawal
Which two questions should be asked to identify patients with 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?”
Which two questions should be asked to identify patients with 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?”
What are the vulnerability factors to consider in cases of depression?
Genetic and family factors
Gender
Stressful life events
Early life experiences
What early life experiences can increase a person’s vulnerability to depression in later life?
–Poor parent-child relationship,
–marital discord and divorce,
–neglect,
–physical and sexual abuse
What early life experiences can increase a person’s vulnerability to depression in later life?
–Poor parent-child relationship (e.g. women who had lost their mother at 3x risk)
–marital discord and divorce,
–neglect,
–physical and sexual abuse
Examples of stressful life events that can influence the onset and course of depression?
– Failure at work, at school, loss of a job; – Marital separation; – Rejection by a loved one; – Death of a child; – Illness of a family member; – Physical illness
Impact of gender on depression?
Women more common
Contributing factors:
-More likely to express and report symptoms
-Hormones
-Early life stress e.g. sexual abuse
-More stresses e.g. More responsibility at home and work, single parenthood, caring for children and aging parents
Impact of gender on depression?
Women more common
Contributing factors:
-More likely to express and report symptoms
-Hormones
-Early life stress e.g. sexual abuse
-More stresses e.g. More responsibility at home and work, single parenthood, caring for children and aging parents
Relationship between depression and chronic illness?
Diseases affected: Stroke, cancer, heart, HIV patients
2-3x more likely in chronically physically ill patients
Which patients of chronic illness commonly present with depression?
– Life threatening conditions
– Unpleasant treatments
– Pain and disability
– Low social support and adverse social circumstances
– Personal or family history of depression and other psychological vulnerabilities
– Alcohol or substance abuse
Why is the assessment of depression in chronically ill patients problematics?
– as 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, corticostreoids, and chemotherapy agents
How do depressed stroke patients differ from those without depression?
– have longer hospital stays
– are more likely to be discharged to nursing homes
– show less motivation to undergo rehabilitation
– are less likely to restore their quality of life to pre- stroke levels
DEPRESSION CAN SIGNIFICANTLY INFLUENCE THE COURSE OF THE MEDICAL DISEASE
Describe the relationship between depression and CHD?
2-4x increase in cardiac mortality for patients in hospital with an MI who HAVE DEPRESSION
Also increased risk for those with cardiac disease
Despression increases smoking and diabetes, and reduced exercise for CHD patients
Even after controlling for these factors, depression remains as an independent predictor of cardiac morbidity and mortality
Effects of depression of the treatment of CDH patients?
Less likely to adhere to:
– cardiac medication regimens;
– Lifestyle risk factor interventions;
– Cardiac rehabilitation programmes
How may depression be involved in triggering CHD?
Contributes to CHD by triggering dysregulation of neurohormonal systems responsible for cortisol and catecholamine secretion
Relationship between depression and diabetes?
Depression 2x higher prevalence in diabetics vs general population
Why? Depression patients with diabetes have:
-Poorer glycemic control
-More severe diabetes symptoms and disability
-Added complications and higher health care use
In which 3 ways is depression linked to chronic illness generally?
– Adapting unhealthy behaviours (e.g., smoking, bad diet, lack exercise, poorer sleep, alcohol and substance abuse)
– Not adhering to medical regimens
– Direct effects on physiological mechanisms
What are the 5 main treatment options?
Pharamacological treatments Psychological treatments Exercise (mild and moderate depression) Electroconvulsive treatment (for severe and complex depression) **Stepped care model**
