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5. People and Illness > Depression > Flashcards

Flashcards in Depression Deck (67):
1

What is psychiatry?

medical speciality concerned with the diagnosis, treatment and prevention of mental health disorders

2

What is the different between a psychiatrist and a psychologist?

- psychiatrist = medical degree, assess, diagnose, treat

- psychologist = pyschology degree, postgrad clinical psycology, asses, formulate, treat

work together and very similar

3

what is the incidence of psychiatric conditions in the UK?

1 in 4 per year in UK

4

How many people worldwide are estimated to have a psychiatric condition?

500 million people globally

5

What is the diagnostic hierarchy in psychiatry?

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

What is an organic disorder in psychiatry?

change in mental function that is secondary to physical processes rather than a psychiatric illness

7

Why are organic disorders assessed for first?

- mimic psychiatric disorders
- usually life-threatening that need immediate treatment
- usually reversible

8

How are anxiety disorders and personality disorders diagnosed?

- usually a diagnosis of exclusion

9

What is psychosis?

altered relationship with reality

10

What is a delusion?

- fixed false belief
- held despite evidence to the contrary
- outwith sociocultural norms

11

What is a hallucination?

sensory perception in the absence of external stimuli

12

What is an illusion?

misperception of real external stimuli

13

What is depression?

pathologically low mood that impacts on function

14

What is mood?

subject feeling of sustained emotion
(patient will report)

15

What is affect?

Objective immediate conveyance of emotion

16

What is euthymia?

Normal mood state

17

What is mania?

elevated mood

18

What is hypomania?

mildly elevated mood

19

What is subsyndromal depression?

mild depression

20

What is bipolar disorder?

more than 2 mood disturbances one of which is mania

21

What causes depression?

- biological
- psychological
- social

22

What are the biological causes of depression?

- 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

Describe the pathogenesis of depression from a biological point of view

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

What are monoamines?

- 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