Abnormal Mood: Depression

Question 1

50% of all mental disorders start before what age?

Answer 1

14

Question 2

50% of all mood disorders start before what age?

Answer 2

30

Question 3

what is the definition of anhedonia?

Answer 3

loss of enjoyment / pleasure

Question 4

what is the definition of anergia?

Answer 4

lack of energy

Question 5

what is the definition of amotivation?

Answer 5

lack of motivation

Question 6

what is the definition of diurnal variation?

Answer 6

mood varies over the day

Question 7

what is definition of early morning wakening?

Answer 7

waking at least 2 hours before expected / normal waking time

Question 8

what is definition of psychomotor retardation?

Answer 8

subjective or objective slowing of thoughts and / or movement

Question 9

what is definition of stupor?

Answer 9

the absence of relational functions ie action and speech

Question 10

what is definition of euthymia?

Answer 10

normal mood

Question 11

what appearance and behaviour symptoms might you see in depression?

Answer 11

reduced facial expression 
brow is classically furrowed 
reduced eye contact 
limited gesturing - movements may be slowed or absent 
rapport is often difficult to establish

Question 12

what speech symptoms may you see in depression?

Answer 12

reduced rate
lowered in pitch 
reduced in volume 
reduced intonation (monotone)
increased speech latencies 
limited content

Question 13

what is the definition of mood?

Answer 13

a prolonged prevailing state or disposition; typically associated with what the patient describes (subjective)

“how do you feel”

Question 14

what is the definition of affect?

Answer 14

mood applied to things (events, people etc)

how the patients feelings change in relation to their surroundings and context; something you observe

how the patient reacts

Question 15

what types of mood may patient describe?

Answer 15

low, miserable, unhappy, sad
can be describes as “flat”
often “empty”, “black”, “numb”

Question 16

what types of affects may the patient experience?

Answer 16

depressed (ie low)
reduced range (stays low)
limited reactivity (doesn’t respond to change in subject, context or emotion)
emotional paralysis

Question 17

what is the typical form of thought in depression?

Answer 17

normal

Question 18

what is the typical flow of thought in depression?

Answer 18

slowed; pondering

can be almost absent (subjectively or objectively)

Question 19

what is the typical content of flow in depression?

Answer 19

negative, self accusatory, failure, guilt, low self esteem, pessimism

delusions can occur: guilt, poverty, nihilism, hypochondriasis

Question 20

what perceptual disturbances may occur in depression?

Answer 20

in most cases - none
some report increased self-referential thinking (people talking about me)
hallucinations can occur

Question 21

what kind of hallucinations can occur in those with depression?

Answer 21

almost always auditory
usually second person and derogatory (you are a bad person and deserve to die)
the voices reflect depression

Question 22

what cognitive symptoms could someone with depression develop?

Answer 22

cognition is slow with complaints of poor memory (inattention)

pseudo-dementia

involves working memory, attention and planning

Question 23

do people with depression often have a problem with insight?

Answer 23

no (in contrast to schizophrenia and mania)

people are usually ware of their symptoms

however, attribution can be affected - symptoms blamed on sins, physical illness, personal failings and weakness

Question 24

what type of posture may someone with depression have?

Answer 24

“defeated”

Question 25

what problem with sleep may those with depression experience?

Answer 25

poor sleep (initial insomnia; broken sleep)

Question 26

do those with depression tend to be worried and exhausted?

Answer 26

yes

Question 27

what do UK and european psychiatrists use to classify mental / depressive disorders?

Answer 27

international classification of diseases, version 10

Question 28

what do american psychiatrists use to classify mental / depressive disorders?

Answer 28

diagnostic and statistic manual, version 5

Question 29

what is the general criteria for diagnosis of depression?

Answer 29

the depressive episode should last at least 2 weeks there have been no sufficient hypomanic or manic symptoms at any time in individuals life

Question 30

at least two of the what CORE three symptoms must be present to diagnose depression?

Answer 30

1) depressed mood that is abnormal, present for most of day every day and sustained for at least 2 weeks 2) loss of interest or pleasure in activities 3) decreased energy or increased fatiguability

Question 31

an ADDITIONAL symptom or symptoms from which list should be present to give a total of at least four symptoms?

Answer 31

1) loss of confidence 2) unreasonable guilt 3) suicidal behaviour 4) diminished concentration 5) agitation or retardation (either subjective or objective) 6) sleep disturbance 7) change in appetite

Question 32

ICD-10 rates severity of depression by what?

Answer 32

number (and to some extent, the severity) of symptoms

Question 33

how many symptoms are needed for diagnosis of moderate depressive episode?

Answer 33

two core symptoms + four others to give total of at least SIX

Question 34

how many symptoms are needed for diagnosis of severe depressive episode?

Answer 34

all three core symptoms + five others to give total of at least EIGHT

Question 35

what is the main symptom of atypical depression?

Answer 35

mood reactivity (mood brightens in response to actual or potential positive events)

Question 36

for mild depression, antidepressants are no better than placebo and are not indicated - true or false?

Answer 36

true

Question 37

four of what eight symptoms should be present for a diagnosis of somatic syndrome?

Answer 37

1) loss of interest in activities 2) lack of emotional response to events or activities 3) waking 2 hours before usual time 4) depression worse in morning 5) marked psychomotor retardation or agitation 6) loss of appetite 7) weight loss 8) marked loss of libido

Question 38

what is the main symptom of atypical depression?

Answer 38

mood reactivity (mood brightens in response to actual or potential positive events)

Question 39

to be diagnosed with atypical depression, you must have two (or more) of what symptoms?

Answer 39

1) weight gain or increase appetite 2) hypersomnia 3) leaden paralysis (heavy feelings in arms or legs) 4) long standing pattern of interpersonal rejection sensitivity that results in social or occupational impairment

Question 40

what is psychotic depression and what are examples of thoughts?

Answer 40

occasionally paranoid, typically "mood-congruent" or hypochondriacal "people out to kill me" "im being poisoned to punish me for my sins" "ive got cancer because i deserve it"

Question 41

what is cotard's syndrome?

Answer 41

more common in elderly nihilistic delusions - "i cant eat because my bowels have turned to dust" may be as extreme as "im dead.. the world doesnt exist"

Question 42

what are the five Rs - stages of depression?

Answer 42

``` response (acute - 12 weeks) remission (acute - 12 weeks) relapse (continuation - 4-9 months) recovery (maintenance - >1 yr) recurrent (maintenance - >1 yr) ```

Question 43

what % of affective disorders are recurrent and what % are chronic?

Answer 43

10 year recurrence - >80% | chronic - 20%