Depression

Question 1

How does someone with depression appear or behave?

Answer 1

Reduced facial movements - furrowed brow
Reduced eye contact
Limited gesturing
Slowed movement

Question 2

How is a depressed persons speech?

Answer 2

Slow 
Low pitch
Quiet
Reduced intonation
Increased latency 
Limited content
Difficult to establish rapport

Question 3

What is the mood of a depressed patient?

Answer 3

Low
Miserable 
Unhappy
irritable 
Flat
Empty 
Numb

Question 4

What is the affect of a depressed patient?

Answer 4

Limited reactivity

Reduced range

Question 5

What form does a depressed persons thoughts take?

Answer 5

Typically normal

Question 6

What Flow does a depressed persons thoughts take?

Answer 6

Slowed
Pondering
Almost absent

Question 7

What is the content of a depressed persons thoughts?

Answer 7

Negative Self accusatory failure guilt pessimism
Suicidal thought is common
Delusions of guilt poverty nihilism

Question 8

What is Cotards Syndrome?

Answer 8

Nihilistic delusion

Belief you are already dead and waiting for your body to decay away.

Question 9

What is a depressed patients perception like?

Answer 9

Usually normal

Can report increased self referential thinking

Question 10

What is self referential thinking?

Answer 10

“People are talking about me”

Question 11

Can someone with depression present with hallucinations?

Answer 11

They can
Always auditory second person derogatory
Reflect negative depressive themes

Question 12

What is a depressed patients cognition like?

Answer 12

Usually preserved

Complaints of poor memory

Question 13

What cognitive defects do depressed patients complain of?

Answer 13

Working memory

Attention and planning deficits

Question 14

Describe a depressed patients insight.

Answer 14

Usually Preserved

Aware of the symptoms but believe them to be down to a personal weakness of failing

Question 15

IDC10 definition of depression

Answer 15

2 out of 3 main symptoms
>4 additional symptoms
Last more than 2 weeks
No hypomanic or manic symptoms

Question 16

What are the main symptoms of depression?

Answer 16

Abnormally depressed mood lasting for most of the day
Loss of enjoyment
Decreased energy or increased fatiguability

Question 17

What are some additional symptoms of depression?

Answer 17

Loss of confidence 
Recurrent suicidal behaviour 
Diminished ability to concentrate
Sleep disturbances 
Change in appetite

Question 18

ICD 10 - Moderate depression

Answer 18

2 core

4 additional

Question 19

ICD 10 - Severe depression

Answer 19

3 core

>5 additional

Question 20

What is Psychotic depression?

Answer 20

Occasional paranoia but it is mood congruent

e.g. ive got cancer because I deserve it

Question 21

Describe the distribution of 5-HT receptors in depression.

Answer 21

Decreased in Frontal cortex, Amygdala and Temporal Cortex

Increased in Hippocampus Raphe Nuclei

Question 22

Give a list of ways to ascertain level of depression in patient.

Answer 22

Inventory of Depressive Symptomology
Quick Inventory of Depressive Symptomology Self Report 16
Hospital Anxiety and Depression Scale
Montgomery Asberg Rating Scale

Question 23

What is the Inventory of Depressive Symptomology?

IDS

Answer 23

Self Reported questionnaire

30 items

Question 24

What is the Quick Inventory of Depressive Symptomology Self Report 16?

Answer 24

Shorter version of IDS

Question 25

What is covered in the Quick Inventory of Depressive Symptomology Self Report 16?

Answer 25

``` Sleep Sadness Appetite Weight Concentration View of self Suicidal thoughts General interest Energy ```

Question 26

What is the Hospital Anxiety and Depression Scale?

Answer 26

14 item self rated

Question 27

Why would the Hospital Anxiety and Depression Scale be used over the IDS?

Answer 27

Requires far less reading and comprehension skills.

Question 28

What is the Montgomery Asberg Rating Scale?

Answer 28

10 Items | Observer Rated scale

Question 29

Why would the Montgomery Asberg Rating scale be used?

Answer 29

It is very sensitive to change - good for monitoring

Question 30

In terms of medicating for depression what is the rule?

Answer 30

Match the drug to the patient you are treating the symptoms not the condition.

Question 31

What is the best all round SSRI?

Answer 31

Escitalopram

Question 32

What is first line treatment for depression?

Answer 32

SSRIs Better tolerated and safer in overdose Setraline Fluoxetine

Question 33

Which SSRI has a good cardiac safety profile and you are able to titrate slowly?

Answer 33

Setraline

Question 34

What is a risk associated with Escitalopram?

Answer 34

Prolongs QT

Question 35

Why is Mirtazapine used?

Answer 35

Promotes sleep eating and weight gain | Less sexual dysfunction associated

Question 36

Venlaxafine

Answer 36

Higher rate of adverse effects | Dose/ response relationship is more effective than others

Question 37

What is the most common combination of Antidepressants?

Answer 37

SSRI/SNRI + Mirtazapine

Question 38

What can Antidepressants be augmented with?

Answer 38

Antipsychotics | Lithium

Question 39

If someone has a relapse what is the course of action?

Answer 39

Continue medication for at least 6 months after full recovery without reducing dose.

Question 40

If someone has a second relapse what is the course of action?

Answer 40

Continue medication without reducing dose for 1-2 years

Question 41

If someone has relapsed on medication alone what should be considered?

Answer 41

Consider psychological therapy or lifestyle factors

Question 42

If a patient with depression presents with an acute episode of Mania or Hypomania what should you do?

Answer 42

Maximise Antimania drugs if already on maintenance Discontinue antidepressants Combination therapy Likely to need hospital admission

Question 43

If an old patient with depression present with a history of falls what drug should be considered?

Answer 43

Mirtazapine as less risk of postural hypertension