Depression

Question 1

what are some of the affective disorders

Answer 1

major depression
subthreshold depressive symptoms
dysthymia
bipolar disorder (manic depressive illness)

Question 2

what are subthreshold depressive symptoms

Answer 2

the criteria fall below major depression.
there is at least one key symptom of depression but with insufficient other symptoms and/or functional impairment

Question 3

what is dysthymia

Answer 3

symptoms that are subthreshold for depression but lasts at least 2 years

Question 4

what are three broad diagnoses

Answer 4

1. loss of interest and enjoyment in ordinary things
2. low/ depressed mood
3. emotional, cognitive, behavioural symptoms

Question 5

what is somatization

Answer 5

the manifestation of psychological distress by the presentation of physical symptoms

Question 6

what is the DSM-IV

Answer 6

it is the criteria that depression assessment should include:
1. number and severity of symptoms
2. duration of the current episode
3. course of illness
stands for DIAGNOSTIC AND STATISTICAL MANUAL for mental disorders

Question 7

what are the nice guidelines CG90

Answer 7

Appendix assessing depression and its severity for ages 18 and up

Question 8

depression is a broad and heterogenous diagnosis?

Answer 8

yes

Question 9

what are the key symptoms of depression

Answer 9

persistent sadness or low mood
and/or
marked loss of interest or pleasure

at least one of these, most days, most of the time for at least 2 weeks

Question 10

what associated symptoms should you ask if a patient presents with the key symptoms

Answer 10

disturbed sleep
change in appetite/ weight
fatigue/ loss of energy
agitation/ slowing of movements
poor concentration/ indecisiveness
feeling worthlessness/ excessive guilt
suicidal thoughts/ acts

also ask:
duration
associated disability
fam and past history
availability of social support

Question 11

name some emotional symptoms

Answer 11

loss of interest/ pleasure that were once enjoyed- ANHEDONIA
persistent sadness/ unresponsive to circumstances
irritability
tearfulness

Question 12

what is anhedonia

Answer 12

inability to feel pleasure

Question 13

what are some cognitive symptoms

Answer 13

negative view of self
-lowered self esteem/ confidence
-guilt/worthlessness
-hopelessness/helplessness
-pessimistic
poor concentration
reduced attention
difficulty making decisions
mental slowing
suicidal intention

Question 14

what are behavioural symptoms

Answer 14

lowered appetite/ weight change
insomnia
low energy
loss of libido
social withdrawal

Question 15

why be aware of chronic physical health

Answer 15

major cause of depression

Question 16

what are some risk factors for depression

Answer 16

genetic/ family factors
early life experiences
stressful life events
social support
gender

Question 17

does a genetic component mean you will become depressed

Answer 17

no

Question 18

about a three fold increased risk for major depression in the first-degree relatives with major depression > general population

Question 19

what are some early life experiences that have an affect and increase vulnerability

Answer 19

poor parent- child relationship
marital discord
neglect
abuse

Question 20

what did brown and harris (1978) find when interviewing women in Camberwell

Answer 20

15-20% mod-severely depressed and NOT receiving treatment
rate of depression was 3 times higher among women who lost their mum before 11 and experienced a severe recent loss

Question 21

what did brown (2002) find about early loss of mother and that affect on neglect

Answer 21

early loss of mother increased risk of neglect and abuse
-marked parental neglect
-physical abuse
-sexual

Question 22

in 2002 brown discussed the importance of humiliation and entrapment in the development of depression

Answer 22

true

Question 23

name some stressful events that can precede depression

Answer 23

failure
marital separation
rejection from a loved one
death of a child
fam ill
physical illness

Question 24

why is social support important in regards to depression

Answer 24

it offers protection to the individual in dealing with stressors
lack of intimate relationships can increase the risk of depression

Question 25

discuss gene-by-environment interaction

Answer 25

genetic factors influence overall risk of illness but also influence the SENSITIVITY of individuals to the depressogenic effects of environmental difficulty

Question 26

do genes on their own cause depression?

Answer 26

no

Question 27

discuss depression and gender and the factors around this

Answer 27

major depression more common in women women may express and report symptoms more hormones early life stress (more likely to be sexually abused) stressors like single mum, aging parents, responsibilities at home and work

Question 28

discuss issues around chronic illness and depression

Answer 28

depression is approximately 2-3 times more common in patients with a chronic physical health problem. occurs in 20% of people with a chronic problem depression can also exacerbate the pain and distress and can shorten life expectancy

Question 29

discuss depression and physical illness

Answer 29

many signs of depression can also be signs of the disease itself (fatigue, insomnia, weight loss) drugs can also cause depression (hypertensives, corticosteroids and chemotherapy, oral combined pill)

Question 30

discuss depression and coronary heart disease

Answer 30

2-4 fold increase risk for cardiac mortality (hospitalised MI patients) depressed people without cardiac disease have an increased risk of cardiac mortality also less lilely to adhere to meds, interventions, rehab programmes may also promote bad health practices (smoking) trigger dysregulation of neurohormonal systems responsible to cortisol and catecholamine secretion

Question 31

describe the relationship between depression and CV (Elderon and Whooley 2013)

Answer 31

depression->behavioral factors->bio factors->CV disease->manifestations->depression

Question 32

what are the treatments options for depression

Answer 32

pharmacological psychological physical activity electroconvulsive treatment

Question 33

describe CBT

Answer 33

short term psychological treatment role of thinking in how we feel and what we do identify unhealthy modes of thinking and CHALLENGE it 1-1 or group

Question 34

describe the cbt chain

Answer 34

thoughts->behaviour->emotion->thoughts

Question 35

when should individual CBT be offered

Answer 35

if relapsed despite meds if there is a significant history of depression use mindfulness if: currently healthy but have experienced 3+ previous episodes of depression

Question 36

describe some risks of suicide

Answer 36

1. health system- access, stigma 2. Community/ relationships- war/ disaster, discrimination, abuse, violence, isolation 3. individual factors- previous attempts, mental disorders, alcohol abuse, financial loss, chronic pain, fam history of suicide personality cognitive factors social factors negative life events

Question 37

how to assess suicide risk

Answer 37

ask about depression directly and about intent assess whether there is adequate social support arrange help advise them to seek further help if situ gets worse

Question 38

what to do is patient is assess to be at suicidal risk

Answer 38

more support (contact with primary care/ telephone and setting up appointments) find out social support specialists