Depression

Question 1

what are the core features of depression

Answer 1

depressed mood
anhedonia
anergia

Question 2

elaborate on the “depressed mood” core feature of depression

Answer 2

must be present for most of the day almost every day for at least 2 weeks
must be to a degree that is definitely abnormal for that individual
is largely uninfluenced by circumstances

Question 3

depressed mood in depression tends to be worse at what time of day

Answer 3

morning

Question 4

what is anhedonia

Answer 4

loss of interest in activities they previously found pleasurable

Question 5

what is needed for diagnosis of depression

Answer 5

2

and an additional symptom(s) should be present

Question 6

what is anergia

Answer 6

decreased energy or increased fatiguability

Question 7

what are some additional features that may be seen in depression (7)

Answer 7

loss of confidence/self esteem
unreasonable feelings of guilt 
recurrent thoughts of death or suicide
diminished ability to think or concentrate
change in psychomotor activity
sleep disturbance
change in appetite with weight change

Question 8

what changes in psychomotor activity might be seen in depression

Answer 8

agitation
psychomotor retardation (slowing of thoughts/movement)

Question 9

what is the most common sleep disturbance seen in depression

Answer 9

early morning wakening (wakening at least 2 hours before expected/normal waking time)

Question 10

what are some other sleep disturbances

Answer 10

broken sleep

initial insomnia

Question 11

is an increase or decrease in appetite more common in depression

Answer 11

decrease

Question 12

according to ICD 10 what is moderate depression

Answer 12

2 core + 4 additional = at least 6

Question 13

according to ICD 10 what is severe depression

Answer 13

3 core + 5 additional = at least 8

Question 14

what is mild depression

Answer 14

less than 6 symptoms

Question 15

what kind of depression is the majority in primary care

Answer 15

mild - antidepressants not indicated

Question 16

what are some rating scales used to measure severity of depression

Answer 16

HRSD/HAM-D

MADRS

Question 17

what is Beck’s Triad

Answer 17

hopelessness
worthlessness
excessive guilt

Question 18

what is stupor

Answer 18

absence of relational functions i.e. actions, speech

Question 19

what are some somatic symptoms of depression

Answer 19

amenorrhoea
fatigue 
abdominal pain
constipation
indigestion

Question 20

what hallucinations most commonly occur in depression

Answer 20

2nd person auditory derogatory hallucinations

- you are a bad person and deserve to die

Question 21

is insight typically preserved or lost in depression

Answer 21

preserved

- attribution may be affected - blame depression on illness/personal feelings/weakness

Question 22

is insight typically preserved or lost in depression

Answer 22

preserved

- attribution may be affected - blame depression on illness/personal feelings/weakness

Question 23

50% of all mood disorders start before age

Answer 23

30

Question 24

50% of all mental disorders start before age

Answer 24

14

Question 25

what system is used for classification of mood disorders in the uk

Answer 25

International Classification of Diseases, version 10 | ICD 10

Question 26

what system is used for classification of mood disorders in america

Answer 26

Diagnostic and Statistical Manual, version 5 | DSM-5

Question 27

according to ICD 10 what are the classes of mood disorders

Answer 27

mania depressive disorder bipolar disorder dysthymia ``` Manic episode Bipolar Affective Disorder Depressive Episode Recurrent Depressive Disorder Persistent Mood Disorders Unspecified Mood Disorder ```

Question 28

according to ICD 10 what are the classes of depression

Answer 28

mild moderate severe

Question 29

do ICD 10 outline chronic depression

Answer 29

no

Question 30

what is the DSM - IV criteria for chronic depression

Answer 30

Full criteria for a Major Depressive Episode have been met continuously for at least the past 2 years

Question 31

what are 3 subtypes of depression

Answer 31

somatic syndrome atypical depression psychotic depression

Question 32

what is somatic syndrome

Answer 32

4 out of 8 of: - anhedonia - lack of emotional reaction to events that usually produce emotional reaction - objective evidence of psychomotor agitation or retardation - marked loss of appetite - weight loss > 5% body weight in past month - loss of libido - EMW - depression worse in morning

Question 33

what is diurnal variation

Answer 33

mood varies throughout the day

Question 34

what is the general criteria for depression

Answer 34

depressive episode should last at least 2 days and there be no hypo/manic symptoms sufficient to meet criteria for an episode at any point in individuals life

Question 35

what is atypical depression

Answer 35

mood reactivity: mood will brighten in response to actual or potential positive event - will also see 2 of: weight gain or increased appetite, hypersomnia, leaden paralysis, long standing pattern of interpersonal rejection sensitivity that results in significant social or occupational impairment

Question 36

psychotic depression is typically ___ _____ or ______ | it is occasionally ____

Answer 36

mood congruent or hypochondriacal | occasionally paranoid

Question 37

what is cotards syndrome and who is it common in

Answer 37

elderly patients | nihilistic delusions

Question 38

what the 5 Rs of depression

Answer 38

``` response remission relapse recovery recurrence ```

Question 39

what is recovery of depression

Answer 39

maintenance of remission for 1 year +

Question 40

a relapse after recovery is called

Answer 40

recurrence

Question 41

what is dysthymia

Answer 41

chronic mild depression for a minimum of 2 years in which episodes are not long enough or severe enough to meet criteria for depression

Question 42

what is the biggest risk factor for suicide

Answer 42

history of DSH

Question 43

what is a robust predictor or eventual fatal self-harm and should be included in MSE

Answer 43

hopelessness

Question 44

who is most likely to suicide after DSH

Answer 44

older males

Question 45

what is the 1st line treatment of depression

Answer 45

SSRI

Question 46

what do you do if SSRI doesn't work

Answer 46

dose increase, swap, combine or change

Question 47

what could you combine an SSRI with

Answer 47

SNRI | or mirtazapine

Question 48

how long should someone continue to take antidepressant after remission

Answer 48

6 months - reduces risk of relapse and not assoc. with addiction