Abnormal Mood - Depression

Question 1

What is the epidemiology of mental disorders?

Answer 1

Peak in late 30s and onwards
50% of all mental disorders start before age 14
50% of all mood disorders starts before age 30

Question 2

What are some terms used to describe mood?

Answer 2

Euthymic = normal mood
Cyclothymic = variable mood

Question 3

What are some key terms used for symptoms of depression?

Answer 3

Anhedonia = lack of enjoyment or pleasure
Anergia = lack of energy
Amotivation = lack of motivation

Question 4

What does diurnal variation mean?

Answer 4

Symptoms vary over the course of the day

Question 5

What is psychomotor retardation?

Answer 5

Subjective or objective slowing of thoughts and/or movement

Question 6

What is stupor?

Answer 6

Absence of relational features

Question 7

What are some features of a depressed patient’s mood and behaviour in the mental state examination?

Answer 7

Reduced facial expression = classically furrowed brow
Reduced eye contact and limited gesturing
Rapport often difficult to establish

Question 8

How may a depressed patient’s use of language appear in a mental state examination?

Answer 8

Reduced rate, volume and intonation of speech

Increased speech latencies and limited content

Question 9

How is mood defined?

Answer 9

Prolonged/prevailing state or disposition = subjective, associated with what the patient describes

Question 10

How is affect defined?

Answer 10

How mood is applied to things = objective, something you observe or infer from how the patient reacts

Question 11

How may a patient with depression describe their mood?

Answer 11

Low, down, miserable, unhappy, flat, empty, numb

Question 12

What is the affect of a patient with depression?

Answer 12

Depressed, reduced range, limited reactivity, may report emotional paralysis

Question 13

What parameters are used to describe thought?

Answer 13

Form, flow and content

Question 14

How does depression affect a patient’s though form and flow?

Answer 14

Form = usually normal
Flow = thoughts are slowed, can be almost absent

Question 15

What are the content of the thoughts of a depressed patient?

Answer 15

Negative, self-accusatory, failure, low self-esteem, delusions of guilt or poverty, suicidal thinking

Question 16

What is Cotard’s syndrome?

Answer 16

Nihilistic delusions = more common in elderly

Question 17

How is perception impacted by depression?

Answer 17

Usually no perceptual disturbance
Some people report increased self-referential thinking
Hallucinations can occur

Question 18

What are some features of hallucinations that can occur in depression?

Answer 18

Almost always auditory
Usually second person and derogatory
Typically reflect depressive themes

Question 19

How is cognition affected by depression?

Answer 19

Slow with poor memory = pseudo-dementia
Deficits involve working memory, attention and planning
Often compounded by anxiety

Question 20

What are some features of insight in patients with depression?

Answer 20

Usually preserved = aware of symptoms

Attribution can be affected = blame symptoms on self

Question 21

What are some observations you may make on a patient with depression?

Answer 21

Slightly slower movements and fiddling
Defeated posture and tearful or worrying
Reduced facial expression and speech intonation
Exhausted due to poor sleep

Question 22

What are some features of major depression?

Answer 22

Common = 14-18% lifetime prevalence
Usually recurrent and chronic (>=20%)
Suicide rate = 6-7%

Question 23

How does the ICD-10 categorise mood disorders?

Answer 23

Mania, bipolar disorder, dysthymia, depressive disorder

Question 24

How does the DSM-5 categorise mood disorders?

Answer 24

Depressive disorders = major depressive disorder, persistent depressive disorder
Bipolar disorder grouped separately

Question 25

How may depressive disorders be grouped in the ICD-10?

Answer 25

May be moderate or severe

Question 26

What is a depressive illness?

Answer 26

Not just low mood = must be clearly abnormal for person, must be persistent and should interfere with normal function

Question 27

How does grief differ from a depressive illness?

Answer 27

Similar in quality, but function is usually not so impaired

Question 28

What is the general criteria for diagnosing depression?

Answer 28

Depressive episode should last at least 2 weeks | There have been no hypomanic or manic symptoms at any time in the patient's life

Question 29

What are the core features of depression?

Answer 29

Depressed mood Loss of interest/pleasure in normally pleasurable activities Decreased energy or increased fatiguability

Question 30

What are the features of a depressed mood?

Answer 30

Abnormal for the person, present for most of the day and almost every day, largely uninfluenced by circumstance, lasts at least 2 weeks

Question 31

What are the additional symptoms of depression?

Answer 31

``` Loss of confidence or self-esteem Unreasonable guilt Recurrent thoughts of death or suicide Loss of concentration Sleep disturbance Change in appetite Change in psychomotor activity ```

Question 32

What are some scales that can be used to assess the severity of depression?

Answer 32

Hamilton rating scale (HAM-D) MADRS Beck Depression Index (BDI)

Question 33

How does the ICD-10 rate severity of depression?

Answer 33

According to number of symptoms Moderate = two core plus four additional symptoms Severe = all three core plus five additional symptoms

Question 34

What are some features of mild depression?

Answer 34

Mild depressive symptoms have weekly prevalence of 7.7% = majority of depression found in primary care Antidepressants are no better than placebo = generally self-resolves

Question 35

What are some features of psychotic depression?

Answer 35

Occasionally paranoid May have Cotard's syndrome Typically mood-congruent or hypochondrial