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Flashcards in Depression Deck (24)
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Describe the core symptoms of depression.

1. Low mood
a. Pervasively low for 2 weeks (1 week if very severe – in this case will also be very out of touch with reality)
b. May show diurnal variation

2. Anhedonia
a. Loss of pleasure, even in things previously enjoyed

3. Low energy
a. Can be very extreme


Describe the cognitive features of depression.

1. Distorted thoughts
2. Slowed speed of thought
3. Reduced concentration and attention (depressive pseudo-dementia)
4. Reduced self-esteem and self-confidence
5. Ideas of guilt and worthlessness
6. Bleak and pessimistic views of the future
7. Hopelessness
8. Ideas or acts of self harm/suicide


Describe the somatic features of depression.

1. Disturbed sleep
2. Diminished appetite
3. Weight loss
4. Loss of libido
5. Low energy
6. Constipation
7. Amenorrhoea


Describe the psychotic features of depression.

1. Delusions ("fixed false ideas that are not in keeping with the patient's usual beliefs")
a. Mood congruent (i.e. negative)
b. Often involve guilt, poverty, hypochondriasis or persecutory delusions

2. Hallucinations ("perception in the absence of external stimuli")
a. Often auditory


Discuss the prevalence of depression.

Point prevalence: 4-7%
Lifetime incidence: 20%

Female:male ratio of 2:1


List the causes of depression.

1. Biological causes
a. Genetics
b. Neurochemistry
c. Neuroendocrine

2. Psychological causes
a. Psychodynamic
b. Behavioural
c. Cognitive distortion

3. Social causes
a. Predisposing
b. Precipitating


Describe the biological causes of depression.

1. Genetics
a. 40-50% concordance in monozygotic twins

2. Neurochemical theories
a. Dopamine loss
b. Serotonin
c. Noradrenaline

3. Neuroendocrine theories
a. Hypothalamo-pituitary-adrenal axis
b. Hypothalamo-pituitary-thyroid axis (e.g. hypothyroidism)


Describe the types of cognitive distortion which may cause depression.

1. Arbitrary interference
2. Selective abstractions
3. Magnification
4. Minimisation
5. Overgeneralisation
6. Personalisation


What investigations would you want to do in a patient presenting with depression?

1. Good clinical history
2. Risk assessment
3. MSE
4. Blood tests to rule out other causes, e.g.
a. Thyroid
b. Anaemia
c. Medications (e.g. steroids, propranolol)


Describe the biological (pharmacological) treatment of depression.

1. SSRIs (selective serotonin reuptake inhibitors)
a. Examples:

2. TCAs (tricyclic antidepressants)
a. Used less frequently now
b. Example:

3. Second line medications:
a. Serotonin-noradrenaline reuptake inhibitors (SNRIs)
---Example: Venlafaxine

b. Noradrenergic and specific serotonergic antidepressants (NASSAs)
---Example: Mirtazepine

c. Noradrenergic reuptake inhibitors (NARIs)
---Example: Reboxetine


List some side effects of SSRIs.

1. Nausea/vomiting
2. Agitation
3. Sexual dysfunction
4. Hyponatraemia
5. Sweating


Describe the psychological treatment of depression.

1. Behavioural therapy
2. Cognitive therapy
3. Psychotherapy


Describe the social treatment of depression.

1. Advice or help with adverse social circumstances, e.g.
a. Housing
b. Finances
c. Employment
d. Relationships


Describe the 2 different theories of adjustment to death/illness.

Kubler Ross:
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Murray Parkes:
1. Numbness
2. Pining
3. Disorganisation and despair
4. Reorganisation


What are the features of an abnormal grief reaction?

1. Unexpected loss
2. Grief despite ambivalent relationships with the person who's died
3. Chronic grief
4. Delayed grief


List the steps in the standardised format of an MSE.

1. Appearance and behaviour
2. Speech
3. Mood and affect
4. Thought form and content
5. Perception
6. Cognition
7. Insight


Describe what features you would assess in the appearance and behaviour category of an MSE.

1. Describe patient's general appearance
2. Biological/chronological age - do they look old for their age?
3. Well kempt or not
4. Evidence of self-neglect
5. Look ill or intoxicated
6. Distinguishing features, especially:
a. Self harm scars
b. Tar stains on fingers

1. Level of motor activity (agitation/retardation)
2. Eye contact
3. Rapport and engagement with interview
4. Body language
5. Posture
6. Unusual/socially inappropriate behaviour


Describe what features you would assess in the speech category of an MSE.

1. Rate and quantity of speech
2. Rhythm
3. Volume
4. Tone (e.g. monotone)
5. Spontaneity


Describe what features you would assess in the mood and affect category of an MSE.

Mood - "emotional state overall"
1. How are they feeling most of the time?
2. Subjective - use direct quotes from the patient
3. Objective - your impression of the person's mood during the interview

Affect - "changes in person's emotions that you observe moment to moment during the interview"
1. Reactive - appropriate reaction to the situation or topic being discussed
2. Flattened - limited emotional reaction
3. Blunted - no observed emotional reactions
4. Labile - excessive emotional fluctuations


Describe what features you would assess in the thought form and content category of an MSE.

Thought form:
1. Patterns in the patient's thoughts - are there logical connections?
a. No formal thought disorder - normal pattern
b. Flight of ideas - rapid flow of speech, moving from topic to topic with logical connections
c. Loosening of associations/knight's move thinking - little/no logical connections

Thought content:
1. Delusions - "fixed false beliefs that is not in keeping with the patient's usual beliefs"
a. Paranoid - perceived threat from others
b. Grandiose - considerable overestimation of ability or possession of special powers
c. Nihilistic - belief that they are dead or do not exist at all
d. Delusions of reference - belief that external events/objects are directly related to them
e. Thought interference - insertion, withdrawal or broadcasting of thoughts

2. Over-valued idea
3. Obsessions - "reccurent, intrusive, distressing ideas/impulses/images that the patient recognises as their own"


Describe what features you would assess in the perception category of an MSE.

1. Hallucinations - "perception in the absence of external stimulus"

2. Illusion - "false perception of a real stimulus"


Describe what features you would assess in the cognition category of an MSE.

1. Alertness
2. Orientation
3. Attention/concentration
4. Memory
5. Learning disabilities


Describe what features you would assess in the insight category of an MSE.

1. Do they believe their experience is unusual?
2. Do they think it is part of an illness?
3. Do they think they require treatment?
4. Do they think they need to be admitted to hospital?


Describe a full MSE.

1. Appearance and behaviour

2. Speech
a. Rate
b. Quantity
c. Rhythm
d. Volume
e. Tone
f. Spontaneity

3. Mood and affect
a. Mood
b. Affect
i. Reactive
ii. Flattened
iii. Blunted
iv. Labile

4. Thought form and content
a. Thought form:
i. No formal thought disorder
ii. Flight of ideas
iii. Loosening of associations/knight’s move thinking
b. Thought content:
i. Delusions
---Delusions of reference
---Thought interference
ii. Over-valued idea
iii. Obsessions
c. Risk

5. Perception
a. Hallucination
b. Illusion

6. Cognition
a. Alertness
b. Orientation
c. Attention/concentration
d. Memory
e. Learning disabilities

7. Insight