Depression Flashcards
(67 cards)
1
Q
What is psychiatry?
A
medical speciality concerned with the diagnosis, treatment and prevention of mental health disorders
2
Q
What is the different between a psychiatrist and a psychologist?
A
- psychiatrist = medical degree, assess, diagnose, treat
- psychologist = pyschology degree, postgrad clinical psycology, asses, formulate, treat
work together and very similar
3
Q
what is the incidence of psychiatric conditions in the UK?
A
1 in 4 per year in UK
4
Q
How many people worldwide are estimated to have a psychiatric condition?
A
500 million people globally
5
Q
What is the diagnostic hierarchy in psychiatry?
A
the order in which disorders need to be excluded before reaching a diagnosis
- organic
- schizophrenia and related disorders
- bipolar spectrum disorders
- depressive disorders
- anxiety and somatoform disorders
- personality disorders
6
Q
What is an organic disorder in psychiatry?
A
change in mental function that is secondary to physical processes rather than a psychiatric illness
7
Q
Why are organic disorders assessed for first?
A
- mimic psychiatric disorders
- usually life-threatening that need immediate treatment
- usually reversible
8
Q
How are anxiety disorders and personality disorders diagnosed?
A
- usually a diagnosis of exclusion
9
Q
What is psychosis?
A
altered relationship with reality
10
Q
What is a delusion?
A
- fixed false belief
- held despite evidence to the contrary
- outwith sociocultural norms
11
Q
What is a hallucination?
A
sensory perception in the absence of external stimuli
12
Q
What is an illusion?
A
misperception of real external stimuli
13
Q
What is depression?
A
pathologically low mood that impacts on function
14
Q
What is mood?
A
subject feeling of sustained emotion
patient will report
15
Q
What is affect?
A
Objective immediate conveyance of emotion
16
Q
What is euthymia?
A
Normal mood state
17
Q
What is mania?
A
elevated mood
18
Q
What is hypomania?
A
mildly elevated mood
19
Q
What is subsyndromal depression?
A
mild depression
20
Q
What is bipolar disorder?
A
more than 2 mood disturbances one of which is mania
21
Q
What causes depression?
A
- biological
- psychological
- social
22
Q
What are the biological causes of depression?
A
- Genetic link
- medical comorbidities (hypothyroid, heart failure, MS, CVA)
- psychiatric comorbidities (schizophrenia)
- medications (steroids in cushings)
- neurochemical ( low serotonin, noradrenalin, dopamine)
- neuroendocrine (low t3, tsh, high cortisol)
23
Q
Describe the pathogenesis of depression from a biological point of view
A
neurochemical theory - monoamine hypothesis
+ serotonin cant be measured in the brain, but metabolites can be measured in the CSF = decreased
+ antidepressants work
+ neurochemical blockers induce depression
- antidepressants dont work immediately
- antidepressants dont always work
24
Q
What are monoamines?
A
- serotonin
- dopamine
- neoradrenaline
25
What are the psychological causes of depression?
- personality traits (anxious, obsessive)
- personality disorders
- maladaptive coping skills
- adverse life events (losses)
26
What are the social causes of depression?
- poor social support
- socioeconomic disadvantage
- northernization = the more north of the equator, the more likely to be depressed
27
Describe the epidemiology of depression
- point prevelance = 4-6%
- lifetime incidence = 20%
- any age (mean 30)
- female:male = 2:1
5 mean episodes per lifetime
28
What are the clinical features of depression
Core symptoms:
= low mood +/- anhedonia +/- fatigue
every day for >2 weeks
29
How id depression diagnosed?
using guidelines = ICD-10 from WHO
30
What is anhedonia?
Loss of enjoyment/pleasure in things you used to enjoy
31
What are the associated symptoms of depression?
Biological:
- diurnal variation
- insomnia
- decreased appetite
- decreased weight
- decreased libido
- constipation
- amenorrhoea
(tend to apply in more severe forms of depression)
32
What are the cognitive features of depression?
- decreased concentration
- slow/negative thinking
- guilt
- loss of self esteem
- hopelessness
- suicidality
Beck's cognitive triad (negative thinking about the world, the future and oneself)
33
What cognitive distortions are linked with depression?
- minimizing
- magnifying
- arbitrary
- inference
- selective abstraction
- personalization
- over-generalisation
- catastrophizing
34
What is psychotic depression?
If depression becomes severe enough it can tip over into psychosis
- delusions: mood congruent ('nihilistic' - match the mood of depression)
- guilt
- poverty
- hypochondriasis
- persecutory
- hallucinations: auditory second person "you're stupid"
35
What is cotard's syndrome?
self or part of self is dead
36
How is depression categorised?
mild: >2 core +/- 2 associated, function ok
moderate: >2 core +/- 4 associated, function decreased
severe: >2 core +/- 6 associated, function severely decreased
if psychosis present = severe
37
What are outcomes of depression?
- recurrent depressive disorder
- substance misuse
- anxiety
- suicide (attempted/completed)
- cardiovascular disease
38
What are the differentials of depression?
- dysthymia
- atypical depression (SAD)
- adjustment reaction
- grief
39
What is dysthymia?
mildly decreased mood more more than 2 years, but not enough to be classed as depression
40
What is cyclothymia?
alternating mild depression and mild mania, but not enough to be classed as bipolar
41
What is adjustment reaction?
- adaptation to stressor
- can include low mood
- onset <1 month from stress
- duration <6 months max
42
What is the Kubler-Ross model of grief?
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
43
Describe abnormal grief
- intense
- prolonged (> 6 months)
- delayed (2 weeks)
- absent (inhibited)
44
How is depression assessed?
- clinical history
- risk assessment
- MSE
- physical exam
- baseline bloods
45
How is life threatening depression treated?
(= suicidal, self neglect)
- may need hospitalisation
- if refusing treatment, may need to be detained under the mental health act
46
What is the biological treatment for depression?
Moderate depression: antidepressants
| Severe: antidepressants + antipsychotics, ECT
47
Name examples of SSRIs?
(selective serotonin reuptake inhibitors)
- citalopram
- fluoxetine
- sertraline
[also: SNRI, SARI, NASSA, NRI, DRI, NRDI, SPARI]
48
Name examples of TCAs
(tricyclics)
- amitryptiline
- doxepine
- amoxapine
49
Name examples of MAOIs
(monoamine oxidase inhibitors)
- isocarboxid
- phenelzine
- moclobemide
50
Describe the normal role or serotonin
Seortonin is produced in the neurons of the central nervous system and is released from the presynaptic cell, crossing the synapse, attaches to a receptor to induce a messenger in the postsynaptic cell. Then it gets reabsorbed in the presynaptic cell.
51
How do SSRI's work?
block the reuptake of serotonin, which increases the amount pr3esent in the synapse and magnifies its effects
52
Which antidepressent can be used to increase alertness in someone experiencing fatigue with depression?
Venlafaxine (SNRI)
53
Which antidepressent can be used to decrease alertness in someone experiencing insomnia with depression?
Mirtazepine (NASSA)
54
What are the side effects of SSRIs?
- nausea
- vomiting
- weight gain
- dizziness
- anxiety
- mania
- serotonin syndrome
- cardiac effects
be aware of discontinuation syndrome
55
What is the response rate of antidepressants?
- 33% will respond immediately
- 33% will respond after switching antidepressants
- 33% wont respond at all
56
What are first line antidepressants?
SSRIs
57
What are second line antidepressants?
TCAs
58
What are third line antidepressants?
MAOIs
59
How do TCA's work?
block serotonin, noradrenaline reuptake
| usually more potent than SSRIs but more adverse effects
60
What are the side effects of TCAs?
- antiadrenergic (decrease BP)
- anticholinergic (cant see, cant pee, cant shit, cant spit)
- more profound ECG changes (arrythmias, QTc prolonged)
61
How do MAOIs work?
monoamine oxidase = enzyme that breaks down serotonin, noradrenaline and dopamine in the CNS
MAOIs inhibit this enzyme
62
What are the side effects of MAOIs?
hypertensive crisis = 'cheese reaction'
MAO-A also in GI tract that breaks down tyramine (found in cheese and other foods)
Using MAOIs can cause this - patients on strict avoidance diet
If blocked, increases BP
63
What is ECT?
electrotherapy
- controlled seizure and anaesthetic
- used in depression, mania, catatonia
- more effective than drugs
can promote healing of certain cells and increases neurotransmitters, redirects blood flow
64
What are the side effects of ECT?
- anaesthetic risks
- memory (confused)
- in rare cases - memory loss
65
What are the primary talking therapies used in the treatment of depression?
- CBT
- Psychotherapy
- Family therapy
66
What is CBT?
thoughts, feelings, behaviours and physical is interlinked
by working on thoughts, can improve other aspects of life
usually intensive ~12 weeks
teaches skills for life
67
What are the social treatments of depression?
- occupational therapy (activity scheduling)
- social workers (housing, financial)
- Employment
