Depression Flashcards
Core features of depression?
Patient must have at least 2/3 of these features to be diagnosed with depression.
1) Depressed mood - to a degree that is definitely abnormal for the individual, present for most of the day and almost every day. Largely uninfluenced by circumstances and sustained for at least 2 weeks.
2) Loss of interest or pleasure in activities that are normally pleasurable.
3) Decreased energy or increased fatigability.
Additional features of depression?
Loss of confidence or self-esteem.
Unreasonable feeling of self-reproach or excessive and unreasonable guilt.
Recurrent thoughts of death/suicide, or any suicidal behaviour.
Sleep disturbance of any type.
Change in appetite (increase or decrease) with corresponding weight change.
Moderate depressive episode consists of?
Two core symptoms and four additional
Severe depressive episode consists of?
All 3 core symptoms and five additional
For mild depression, what is treatment plan?
- Antidepressants not recommended for initial treatment of mild depression.
- Consider watchful waiting, assessing again normally within 2 weeks.
- Consider offering one or more low-intensity psychosocial interventions e.g. CBT.
For moderate-severe depression, what is treatment plan?
Offer antidepressant medication combined with high intensity psychological treatment (CBT).
- 1st line antidepressant: SSRI e.g. escitalopram, sertraline and mirtazapine. If no benefit felt by 6 weeks then current drug is likely not suitable for current patient.
- 2nd line - change the SSRI
- 3rd line - consider an antidepressant from a different class that may be better tolerated i.e. tricyclic antidepressants or MAOI’s.
In a risk assessment for someone with depression, what is checked?
Risk to self: self-harm, suicide or neglect (commonest in depression)
Risk to others: when depression presents with psychotic features, such as command hallucinations, they may be at risk of harming others
Risk from others: patients with depressive symptoms may be more vulnerable to abuse, criminal acts or neglect
Mild depressive episode consists of?
Mild depression requires two typical core symptoms plus two additional symptoms
Risk factors associated with depression?
- Genetic susceptibility
- Life factors - i.e. social situation e.g. single mums
- Alcohol/drug dependence
- Abuse (sexual or not) - particularly in childhood
- Unemployed
- Previous psychiatric diagnosis
- Urban population
Appearance of depressed patient?
May be signs of personal neglect I.e. scruffy beard, dirty or ripped clothes etc.
Behaviour of depressed patient?
- Rapport is often difficult to establish
- Reduced eye contact
- Reduced facial expression
- Brow is classically ‘furrowed’
- Limited gesturing - movements may be slowed, or absent
- Psychomotor retardation - subjective or objective slowing of thoughts and/or movements
Speech of depressed patient?
- Reduced rate of speech
- Lower in pitch
- Reduced volume
- Reduced intonation (variation in voice -monotonous)
Mood of depressed patient?
Mood is subjective meaning it is how patient feels on the inside.
- ‘Low, ‘down’, ‘miserable’, ‘unhappy’, ‘sad’
- Can be described as ‘flat’
- Often ‘empty’, ‘black’, ‘numb’
Affect of depressed patient?
Affect is objective meaning it is how the patient feels from the clinician’s perspective in that exact moment.
- Depressed i.e. low
- Reduced range (stays low throughout)
- Limited reactivity - affect doesn’t respond or react to changes in subject, context, or emotion
Thought of depressed patient?
- Form: typically normal
- Flow: thoughts are slow, pondering, can be almost absent
- Content: negative, self-accusatory, failure, guilt, low self-esteem, pessimism, delusions, suicidal thinking
- Cotard’s syndrome (nihilistic delusions)
