Depression

Question 1

what ages are mood disorders most common

Answer 1

2nd
3rd
4th
5th decades

50% start before the age of 30

Question 2

what age do 50% of all mental disorders start

Answer 2

14

Question 3

what is anhedonia

Answer 3

loss of enjoyment/ pleasure

Question 4

what is anergia

Answer 4

lack of energy

Question 5

what is amotivation

Answer 5

lack of motivation

Question 6

what is the typical diurnal variation of depression

Answer 6

worse in the morning

in atypical depression gets worse as day goes on

Question 7

what is psychomotor retardation

Answer 7

subjective/ objective slowing of thoughts and/ or movements

Question 8

what is stupor

Answer 8

absence of relational functions i.e. action and speech

Question 9

what is early morning wakening

Answer 9

waking at least 2 hours before the expected/ normal waking time

Question 10

what is ethymia

Answer 10

normal mood

Question 11

what are the features of appearance and behaviour in depression

Answer 11

reduced facial expression 
furrowed brow 
reduced eye contact 
limited gesturing, movements may be slowed or absent 
rapport is often difficult to establish

Question 12

what are common qualities of speech in depression

Answer 12

reduced rate
lowered pitch and volume
reduce intonation (monotonous)
increased speech latencies (longer time between end of a question and them starting to speak)
limited content (answers are often short, brief, and un-embellished)

Question 13

define mood

Answer 13

a prolonged prevailing state or disposition, typically associated with what the patient describes= subjective (how you you feel?)

Question 14

define affect

Answer 14

how the patient reacts in relation to their surroundings and the context
something you observed or infer = objective

Question 15

what is mood like in depression

Answer 15

low, miserable, unhappy, sad
flat
when extreme- empty, black, numb

Question 16

what is affect like in depression

Answer 16

depressed (low)
reduced range
limited reactivity
may report emotional paralysis (shutting down their emotions)

Question 17

what is the form, flow and content of thought like in depression

Answer 17

form usually normal

flow- slowed, pondering, can be almost absent

content- negative, self accusatory, failure, guilt, low self esteem, pessimism
delusions can occur: guilt, poverty, nihilism, hypochondriasis

Question 18

how does depression affect perception

Answer 18

in most cases there is no perceptual disturbance
some people report increased self referential thinking (people are talking about me)

hallucinations can occur- almost always auditory, usually 2nd person and derogatory. reflect negative and depressive themes

Question 19

how is cognition affected in depression

Answer 19

slow with complaints of poor memory (due to inattention not information recall)
‘pseudo-dementia’
defects in working memory, attention and planning
often worsened by anxiety

Question 20

how is insight affected in depression

Answer 20

typically preserved
usually aware of symptoms however attribution can often be affected- blamed on patients sins, physical illness, personal failings and weakness

Question 21

what form of paranoia can you get in depression

Answer 21

increased sensitivity to criticisms of others
much more self conscious/ self aware
feel under scrutiny

Question 22

how much of depression is chronic

Answer 22

20%- usually recurrent

Question 23

what is the suicide rate in depression

Answer 23

6-7%

7% in males

Question 24

what is the lifetime prevalence of depression

Answer 24

14-18%

Question 25

what are the current diagnostic schemes for depression

Answer 25

ICD-10 and DSM-5

Question 26

what form of depression is not considered in ICD-10

Answer 26

mild

Question 27

what must symptoms be for a patient to truly have depression

Answer 27

must be abnormal for the patient it must persist should interfere with normal function to a significant degree

Question 28

what is the general diagnostic criteria for depression

Answer 28

-episode should last a least 2 weeks -no hypomanic or manic episodes at any time during the patient life (if yes to this -> bi polar) at least 2 of: -depressed mood (definitely abnormal for patient, present for most of day, almost every day, largely uninfluenced by circumstances, sustained for >2 weeks) -loss of interest or please in activity that are normally pleasurable -decreased energy or increased fatiguability (remember by MEE: mood, energy, enjoyment -> MEE people become egocentric) plus an additional symptom

Question 29

what are the additional symptoms of depression

Answer 29

1. loss of confidence/ self esteem 2. feelings of self reproach/ excessive and unreasonable guilt 3. recurrent thoughts of death or suicide/ any suicidal behaviour 4. complaints/ evidence of diminished ability to think or concentrate (indecisiveness/ vacillation) 5. change in psychomotor activity with agitation or retardation (either subjective or objective) 6. sleep disturbance (increase/ decrease) 7. change in appetite with corresponding weight change (increase/ decrease)

Question 30

what defines a moderate depressive episode

Answer 30

two core symptoms + four additional symptoms | = total of at least 6

Question 31

what defines a severe depressive episode

Answer 31

all 3 core symptoms + 5 others | = total of at least 8

Question 32

what are the core symptoms of depression

Answer 32

depressed mood reduced enjoyment/ interest decreased energy

Question 33

when do you give anti depressants for mild depression

Answer 33

not indicated unless patient has recurrent episodes of mild to severe, then can give to prevent it become severe

Question 34

what is psychotic depression

Answer 34

occasionally paranoid: typically mood congruent or hypochondriacal “People are out to get me and kill me” “I’m being poisoned to punish me for my sins” “I’ve got cancer…I know I have…It’s because I deserve it” can have cotards syndrome- often nihilistic delusions, more common in the elderly

Question 35

what is the 10 year recurrence rate for depression

Answer 35

>80%

Question 36

how long until depression becomes classed as chornic

Answer 36

2 years

Question 37

what are the features of a typical depression

Answer 37

Mood reactivity (that is, mood brightens in response to actual or potential positive events) Two (or more) of the following: significant weight gain or increase in appetite hypersomnia leaden paralysis (that is, heavy, leaden feelings in arms or legs) long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment

Question 38

what features are present in somatic syndrome (a subtype of depression)

Answer 38

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 morning objective evidence of marked psychomotor retardation or agitation (remarked on or reported by other people) marked loss of appetite weight loss (5 % or more of body weight in the past month) marked loss of libido