Depression Flashcards
(58 cards)
What are the core features of depression?
Depressed mood
Loss of interest (anhedonia)
Lack of energy (anergia)
What are additional symptoms of depression?
Loss of confidence/senf-esteem
Unreasonable feelings of self-reproach or excessive guilt
Recurrent thoughts of death or suicide
Decreased ability to think or concentrate, indecisiveness
Change in psychomotor activity - agitation or retardation
Bleak and pessimistic views of the future
Sleep disturbance
Change in appetite and corresponding weight change
What is psychomotor retardation?
Slowing of thoughts and reduction of physical movements, speech and affect
How are appearance and behaviour altered in depression?
Reduced eye contact
Reduced facial expression
Limited gesturing (psychomotor retardation)
Difficult to establish rapport
Describe speech in depression
Slow
Lowered in pitch
Quiet
Monotonous (reduced intonation)
Increased latencies (longer time between end of a question and them starting to speak)
Limited content (answers are often short, brief, and unembellished)
Describe mood in depression
Low, down, miserable, unhappy, sad, flat, empty, black, numb
Describe affect in depression
Reduced range - stays low throughout
Limited reactivity
Describe thoughts in depression
Form - normal
Flow - slow
Content
- Negative, failure, guilt, low self esteem, pessimism
- Delusions - of poverty, nihilism, hypochondriasis
- Suicidal thinking
Describe perception in depression
Most have no perceptual disturbance
Increased self-referential thinking (people are talking about me)
Hallucinations (usually auditory, second person and derogatory, negative and depression)
Describe cognition in depression
Slow
Poor memory (inattention)
‘Pseudo-dementia’
Deficits in working memory, attention and planning
Describe insight in depression
Insight preserved
Aware of their symptoms - recognition intact
Attribution not always correct - symptoms can be blamed on sins, physical illness, personal failings
What are the subtypes of depression?
Somatic syndrome
Atypical depression
Psychotic depression
Chronic depression
What is somatic syndrome?
4 of the following present:
- Marked loss of interest or pleasure in activities that are normally pleasurable
- Lack of emotional reactions to events or activities that normally produce an emotional response
- Waking in the morning 2 hours before the usual time (early morning wakening)
- Depression worse in the morning
- Objective evidence of marked psychomotor retardation or agitation (remarked on or reported by others)
- Marked loss of appetite
- Weight loss (5% or more of body weight in the past month)
- Marked loss of libido
What is atypical depression?
Mood reactivity - mood brightens in response to actual/potential positive events
Weight gain or increase in appetite
Hypersomnia
Leaden paralysis - heavy feeling in arms or legs
Long-standing pattern of interpersonal rejection sensitivity
What is psychotic depression?
Depression with psychotic features
Occasionally paranoid
What is chronic depression?
2 years of depression
Not necessarily treatment refractory
What is the medical differential of depression?
Hypothyroidism Cushing's Syphilis SLE Drugs: steroids, isotretinoin, B blockers
What are the psychiatric differentials of depression?
Bipolar Schizophrenia Generalised anxiety disorder Substance misuse Dementia Dysthymia Bereavement reaction
How would you differentiate depression from bipolar disorder?
Have you ever had periods of the opposite where your mood has been very high?
How would you differentiate depression from schizophrenia?
Have you ever experienced anything (seeing or hearing) that others haven’t or had thoughts that seemed unusual but you weren’t able to shake?
How would you differentiate depression from generalised anxiety disorder?
Do you feel yourself anxious, any physical symptoms of anxiety?
What is dysthymia?
Chronic mild depression for a minimum of 2 years in which episodes are either not long enough or severe enough to meet criteria for depression
What is the criteria for depression?
Symptoms for minimum 2 weeks
Presence of at least 2 of the core symptoms
What is classed as mild depression?
2 core symptoms + 2 additional symptoms
In distress but able to continue with activities of daily living
