Depression

Question 1

Peak of depression in terms of life span?

Answer 1

2nd,3rd and 4th decade

Question 2

What is anhedonia?

Answer 2

Loss of enjoyment/ pleasure

Question 3

What is anergia?

Answer 3

Lack of energy

Question 4

Describe the diurnal variation of depression?

Answer 4

Worse in the morning and gets worse as the days go on

Question 5

What is stupor in terms of depression?

Answer 5

The absence of relational functions i.e. action and speech

Question 6

What is psychomotor retardation in terms of depression?

Answer 6

Subjective or objective slowing of thoughts and/or movement

Question 7

What is euthymia?

Answer 7

Normal mood

Question 8

What is the phenomenology of depression in terms of appearance and behaviour?

Answer 8

Reduced facial expression
Brow is classically furrowed 
Reduced eye contact 
Limiting gesturing; movement may be slowed, or absent
Rapport is often difficult to establish

Question 9

What can be seen in the speech category of the MSE in depression?

Answer 9

Reduced rate of speech 
Lowered in pitch 
Reduced in volume
Reduced intonation 
Increased speech latencies
Limited content

Question 10

What encompasses mood as part of the MSE?

Answer 10

Prolonged prevailing state or deposition; typically associated with what the patient describes; subjective
“How do you feel”

Question 11

What encompasses affect as part of the MSE?

Answer 11

Mood applied to things; events, people etc
Objective observation
How patient reacts to event changes

Question 12

What is the mood like in an MSE for depression?

Answer 12

Low, miserable, unhappy, sad 
Flat
Empty
Black 
Numb

Question 13

Describe the affect in depression in an MSE?

Answer 13

Depressed; low
Reduced range; stays low throughout
Limited reactivity; affect doesn’t respond or react to changes in subject, context, or emotion
May report emotional paralysis

Question 14

Describe the form of thought seen in depression

Answer 14

Normal

Question 15

Describe the flow of thought in depression?

Answer 15

Thoughts are slowed, pondering

Can be absent; subjectively or objectively

Question 16

Describe the content of thought in depression?

Answer 16

Negative, self accusatory 
Failure
Guilt 
Low-self esteem
Pessimism
Delusions; guilt, poverty, nihilism, hypochondriasis

Question 17

Is there commonly a perceptual disturbance in depression?

Answer 17

No

Question 18

What hallucinations can occurs in depression?

Answer 18

Almost always auditory
Usually 2nd person and derogatory
Typically are mood congruent and reflect the negative and depressive themes

Question 19

Is there paranoia in depression?

Answer 19

Increased sensitivity to criticism of others; often tied to guilt/ self blame
More self-conscious and self-aware
Feeling of being under scrutiny

Question 20

Is there paranoia in psychosis?

Answer 20

May have a bizarre quality
Other symptoms; persecutory ideas/delusions, altered perceptions
Insight lost

Question 21

What is the cognition like in depression?

Answer 21

Cognition is slow with complaints of poor memory
Pseudo-dementia
Deficits in working memory, attention and planning
Compounded by anxiety

Question 22

Is insight preserved in depression?

Answer 22

Yes
Aware of symptoms however attribution can often be affected by the illness; symptoms may be blamed on sins, physical illness, personal failings and weakness

Question 23

What systems are used to classify depression?

Answer 23

ICD-10

DSM-5

Question 24

How does the DSM-5 classify depression?

Answer 24

Depressive disorders; major depressive disorder

Persistent depressive disorder

Question 25

How does ICD-10 classify depression?

Answer 25

Mania Bipolar Depressive disorder Dysthymia

Question 26

What is the general criteria for the diagnosis of depression?

Answer 26

A; depressive episode should last at least 2 weeks | B; no hypomanic or manic symptoms sufficient to meet criteria (this would classify it as bipolar disorder)

Question 27

What are the core features of depression?

Answer 27

At least 2 out of 3: 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

Question 28

What are common additional symptoms of depression?

Answer 28

``` Loss of confidence or self-esteem Guilt Suicidal behaviour Lack of concentration Agitation or retardation Sleep disturbance Change in appetite ```

Question 29

How can the severity of depression be assessed?

Answer 29

Rating scales e.g.: Hamilton rating scale for depression Montgomery-Asberg depression rating scale Beck depression inventory ICD-10 rates severity according to the number of symptoms

Question 30

How is a moderate depressive episode defined?

Answer 30

2 core symptoms + 4 others = score of at least 6

Question 31

How is a severe depressive episode defined?

Answer 31

All 3 core symptoms + 5 other = total of at least 8

Question 32

Are mild depressive episodes treated?

Answer 32

NO; antidepressants no better than placebo and generally is self-limiting

Question 33

What needs to be present to diagnose somatic syndrome depression?

Answer 33

4 of the following: Marked loss of interest or pleasure in activities that are normally pleasurable Lack of emotional reactions to events or activities that normally produce an emotional response Waking in the morning 2 hours or more before the usual time Depression worse in the mornings Retardation or agitation Marked loss of appetite Weight loss Marked loss of libido

Question 34

What is atypical depression?

Answer 34

A; mood reactivity (mood brightens in response to actual or positive events) B; two or more: Significant weight gain Hypersomnia Leaden paralysis Long-standing pattern of interpersonal rejection sensitivity

Question 35

What is cotards syndrome?

Answer 35

Subtype of psychotic depression; More common in elderly Nihilistic delusions

Question 36

Is chronic treatment treatment-refractory?

Answer 36

No, not necessarily

Question 37

What is the criteria for the diagnosis of chronic depression?

Answer 37

MDD for at least 2 years

Question 38

What are the 5 R's of depression?

Answer 38

``` Response Remission Relapse Recovery Recurrence ```

Question 39

What is dysthymia?

Answer 39

Chronic depression of mood lasting at least several years, which is not sufficiently severe to justify a diagnosis of severe, moderate or mild recurrent depressive disorder