Depression

Question 1

Psychosis

Answer 1

Altered mind and altered relationship with reality

Question 2

Delusion

Answer 2

Fixed false belief held despite evidence to contrary outwit sociocultural norms

Question 3

Hallucination

Answer 3

Sensory perception in the absence of external stimuli

Question 4

Mood

Answer 4

Subjective feeling of sustained emotion (happy, sad)

Question 5

Affect

Answer 5

Objective immediate conveyance of emotion (blunt, fat, labile)

Question 6

Depression

Answer 6

Decreased mood (pathological) and decreased function

Question 7

Bipolar disorder

Answer 7

>2 mood disturbance (minimum 1 hypomania, mania), depression

Question 8

3 factors contributing to depression

Answer 8

social

psychological

biological

Question 9

social eitology of depression

Answer 9

• Poor social support
• Socioeconomic disadvantage
• Northernization

Question 10

psychological aetiology of depression

Answer 10

• Personality traits - anxious, obsessive
• Personality disorders

• Coping skills

• Adverse life events

Question 11

epidemiology of depression

Answer 11

• Females
• onset at 30
• 5 episodes in lifetime

Question 12

what is given for moderate depression

Answer 12

Antidepressants

Question 13

what is given for servere depression

Answer 13

Antidepressants + Antipsychotics, ECT

Question 14

psychological treatment of depression

Answer 14

• CBT
• Psychotherapy
• Family therapy

Question 15

Electrotherapy to treat depression

Answer 15

Controlled seizure + anaesthetic

Depression, mania, catatonia

Side effect: memory (rare)

Question 16

1st, 2nd and 3rd line in treatment of depression

Answer 16

1st: SSRI
2nd: TCAs
3rd: MAOI

Question 17

SSRI

Answer 17

Block 5HT reuptake

4-5 weeks to have an effect

Question 18

TCAs

Answer 18


Block 5HT

NA reuptake

Question 19

MAOI

Answer 19

Block MAO-A

MAO-B – breaks down 5HT, NA, DA in CNS

Question 20

side effects of SSRI

Answer 20

Nausea, vomiting, weight gain, dizziness, discontinuation syndrome, anxiety, suicidality, mania, serotonin syndrome, cardiac effects (QTc)

Question 21

side effects of TCAs

Answer 21

Anti-adrenergic (↓BP)
Anti-cholinergic


ECG changes (arrhythmia, QTc prolongation)

Question 22

side effects of MAOI

Answer 22

Hypertensive crisis; ‘cheese reaction’

MAO-A also in GI tract; breaks down tyramine

If blocked, ↑ ↑ BP

Question 23

social treatments for depression

Answer 23

activities

housing, financial Employment

Question 24

neurochemical factors in depression

Answer 24

↓ 5HT serotonin

DA dopamine

NA noadrenaline

Question 25

neuroendocrine factors in depression

Answer 25

↓T3, TSH, ↑ cortisol

Question 26

discuss the monoamine hypothesis

Answer 26

Metabolites of 5HT ↓ in CSF Antidepressants work Neurochemical blockers induce depression ------ X Antidepressants don’t work immediately
 X Antidepressants don’t always work

Question 27

assessment of depression

Answer 27

Clinical history Risk assessment MSE (mental state exam) Physical exam Baseline blds

Question 28

4 differentials for depression

Answer 28

1. Dysthymia 2. Atypical Depression 3. Seasonal Affective Disorder (SAD) 4. Adjustment Reaction 5. Grief

Question 29

what is adjustment reaction

Answer 29

Adaptation to stressor Can include low mood Onset \<1 month from stress Duration \<6 months max

Question 30

what is dysthymia

Answer 30

↓mood, chronic \>2yrs but not enough depression

Question 31

core features of depression

Answer 31

↓ mood +/- anhedonia +/- fatigue Every day \>2 weeks

Question 32

biological features of depression

Answer 32

Diurnal variation insomnia ↓ appetite,↓ weight, ↓ libido, constipation, amenorrhoea

Question 33

Cognitive features of depression

Answer 33

↓ concentration, slow / negative thinking, guilt, loss of self esteem, hopeless, suicidality

Question 34

Cognitive distortions as feature of depression

Answer 34

Minimizing, magnifying, arbitrary inference, selective abstraction, personalization, overgeneralization, catastrophizin

Question 35

Psychosis features of depression

Answer 35

Delusions – mood congruent (‘nihilistic’) - - Hallucinations

Question 36

severities of depression

Answer 36

Mild – \>2 core + \>2 associated, function ok Mod – \>2 core + \>4 associated, function ↓ Sev – \>2 core + \>6 associated, function ↓↓ +/- psychosis

Question 37

outcomes of depression

Answer 37

* Recurrent depressive disorder * Substance misuse * Anxiety * Suicide * Cardiovascular disease

Question 38

Cyclothymia

Answer 38

alternating ↓mood (mild), ↑ mood (mild)

Question 40

Answer 40

Question 41

Answer 41