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AIP: Self-harm > Depression > Flashcards

Depression Flashcards

1
Q

What is depressive disorder?

A

affective mood disorder characterised by a persistent low mood, loss of pleasure and/or lack of energy accompanied by emotional, cognitive and biological symptoms

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2
Q

What are 6 possible factors that contribute to the aetiology of depressive disorder?

A
  1. Heritability
  2. Monoamine hypothesis
  3. Over-activitity of hypothalamic-pituitary adrenal (HPA) axis
  4. Psychosocial factors such: personality type
  5. Stressful life events
  6. Failure of effective stress control mechanisms i
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3
Q

What is the monoamine hypothesis?

A

deficiency of monoamines (noradrenaline, serotonin and dopamine) cause depression, supported by fat antidepressants which increase their concentration improve clinical features

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4
Q

What are 3 groups that the aetiological factors in depressive disorder can be split into?

A

predisposing, precipitating and perpetuating (also biological, psychologicla and social)

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5
Q

What are 7 biological factors predisposing to depression?

A
  1. Female gender (2:1)
  2. Postnatal period
  3. Genetics/family history
  4. Neurchemical: reduced serotonin, noradrenaline, dopamine
  5. Endocrine: increased activity of HPA axis
  6. Physical comorbidities
  7. Past history of depression
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6
Q

What are 2 biological factors precipitating depression?

A
  1. Poor compliance with medication
  2. Corticosteroids
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7
Q

What is a biological factor perpetuating depression?

A

chronic health problems: e.g. diabetes, COPD, CCF, chronic pain syndromes

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8
Q

What are 4 psychological factors predisposing to depression?

A
  1. Personality type
  2. Failure of effective stress control mechanisms
  3. Poor coping strategies
  4. Other mental health co-morbidities e.g. dementia
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9
Q

What is 1 psychological factor precipitating depression?

A

acute stressful life events e.g. personal injury, loss of loved one, bankruptcy

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10
Q

What are 2 psychological factors perpetuating depression?

A
  1. Poor insight
  2. Negative thoughts about self, the world and the future
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11
Q

What are 3 social factors predisposing to depression?

A
  1. Stressful life events
  2. Lack of social support
  3. More common in asylum seeker and refuge population
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12
Q

What are 3 social factors precipitating depression?

A
  1. Unemployment
  2. Poverty
  3. Divorce
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13
Q

What are 3 social factors perpetuating depression?

A
  1. Alcohol and substance misuse
  2. Poor social support
  3. Reduced social status
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14
Q

What proportion of adults in general practice in the UK experience an episode of depression?

A

1 in 20

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15
Q

What age is onset of depression most common?

A

in 40s in males, 30s in females

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16
Q

What are 8 key risk factors for depression?

A
  1. Female
  2. Family history
  3. Alcohol
  4. Adverse events
  5. Past depression
  6. Physical co-morbidities
  7. Low social support
  8. Low socioeconomic status
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17
Q

What are the 3 core symptoms of depressive disorder?

A
  1. Anhedonia (lack of interest in previously enjoyable things)
  2. Low mood - present for at least 2 weeks
  3. Lack of energy (anergia)
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18
Q

In addition to the core symptoms of depression what are 2 further groups of depressive symptoms?

A

cognitive and biological

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19
Q

What are 4 cognitive symptoms of depression?

A
  1. Lack of concentration
  2. Negative thoughts
  3. Excessive guilt
  4. Suicidal ideation
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20
Q

What are 4 biological symptoms of depression?

A
  1. Diurnal variation in mood: usually more pronounced in the morning
  2. Early morning wakening: waking up to 2 hours earlier than they usually would (hypersomnia in atypical depression)
  3. Loss of libido
  4. Appetite or weight change
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21
Q

What is the mnemonic to rememebr the symptoms of depression in an OSCE setting?

A

DEAD SWAMP

  • D: depressed mood
  • E: energy loss
  • A: anhedonia
  • D: death thoughts (suicide)
  • S: sleep disturbance
  • W: worthlessnes sor guilt
  • A: appetite or weight change
  • M: mentation (concentration)
  • P: psychomotor retardation
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22
Q

What is Beck’s cognitive triad?

A

negative views about oneself, the world, and the future

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23
Q

What is psychomotor retardation?

A

can be considered a biological symptom of depression; slow speech as well as slow movement

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24
Q

What are 2 possible psychotic symptoms of depression which may be experienced in some cases?

A
  1. Hallucinations: second person auditory hallucinations
  2. Delusions: hypochondriacal, guilt, nihilistic, persecutory
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25
Q

What are the 4 classifications of depression according to ICD-10?

A
  1. Mild depression
  2. Moderate depression
  3. Severe depression
  4. Severe depression with psychosis
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26
Q

How is mild depression diagnosed according to ICD-10?

A

2 core symptoms + 2 other symptoms

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27
Q

How is moderate depression diagnosed according to ICD-10?

A

2 core symptoms + 3-4 other symptoms

28
Q

How is severe depression diagnosed according to ICD-10?

A

3 core symptoms + 4 or more other symptoms

29
Q

How is severe depression with psychosis diagnosed according to ICD-10?

A

3 core symptoms + 4 or more other symptosm + psychosis

30
Q

What will a mental state examination reveal in depressive disorder, specific to the 8 key parts of MSE?

A
  • Appearance: signs of self-neglect, thin, unkempt, depressed facial expression, tearful
  • Behaviour: poor eye contact, psychomotor retardation, slow movements, slow responses, psychomotor agitation (in some cases)
  • Speech: may be slow, non-spontaneous, reduced volume and tone
  • Mood: low (subjectively) and depressed (objectively)
  • Thoughts: pessimistic, guilty, worthless, helpless, suicidal, delusions (if psychotic)
  • Perception: second person auditory hallucinations (often derogatory)
  • Cognition: impaired concentration
  • Insight: usually good
31
Q

What are 3 investigations to consider in the workup for depression?

A
  1. Diagnostic questionnaire e.g. PHQ9, HADS and Beck’s depression inventory
  2. Bloods tests: FBC, TFTs, U+Es, LFTs, calcium levels, glucose
  3. Imaging: MRI or CT of head
32
Q

What are 3 examples of diagnostic questionnaires for depressive disorder?

A
  1. PHQ-9
  2. HADS
  3. Beck’s depression inventory
33
Q

What are 6 blood tests which may be performed in the workup for depression and why is each performed?

A
  1. FBC - anaemia
  2. TFTs - hypothyroidism
  3. U+Es - baseline
  4. LFTs - baseline
  5. Calcium - abnormalities may cause physical symptoms which can mimic some depressive symptoms
  6. Glucose - diabetes can cause anergia
34
Q

What are 5 differentials for depression?

A
  1. Other mood disorders e.g. bipolar affective disorder
  2. Secondary to physical condition e.g. hypothyroidism
  3. Secondary to psychoactive substance abuse
  4. Secondary to other psychiatric disorders e.g. psychotic disorders, anxiety disorders, adjustment disorder, personality disorder, eating disorders, dementia
  5. Normal bereavement
35
Q

What are 8 other depressive disorders in addition to depressive disorder?

A
  1. Recurrent depressive disorder
  2. Seasonal affective disorder
  3. Masked depression
  4. Atypical depression
  5. Dysthymia
  6. Cyclothymia
  7. Baby blues
  8. Postnatal depression
36
Q

What is recurrent depressive disorder?

A

recurrent depressive episode refers to when a patient has another depressive episode after their first

37
Q

What is seasonal affective disorder?

A

depressive episodes occurring annually at same time each year, usually during the winter months

38
Q

What is masked depression?

A

depressed mood not particualrly prominent but other deatures of a depressive disorder are e.g. sleep disturbance, diurnal variation in mood

39
Q

What atypical depression?

A

usually occurs with mild-moderate depression with reversal of symptoms e.g. overeating, weight gain, hypersomnia

40
Q

What is dysthymia?

A

depressive state for at least 2 years which does not meet the criteria for a mild, moderate or severe depressive disorder and is not the result of a partially-treated depressive illness

41
Q

What is cyclothymia?

A

chronic mood fluctuation over at least a 2-year period with episodes of elation and of depression which are insufficient to meet the crtieria for a hypomanic or depressive disorder

42
Q

What are the baby blues?

A

seen in around 60-70% of women, typically 3-7 days following birth, more common in primiparae

mothers anxious, tearful and irritable. reassurance and support all that is required

43
Q

What proportion of women are affected by postnatal depression?

A

10%

44
Q

What is the timeframe of postnatal depression?

A

most cases start within a month and typically peak at 3 months

45
Q

What does the management of depression depend on?

A

severity

46
Q

What is the approach taken to managing depression?

A

biopsychosocial

  • biological: antidepressants, adjuvants e.g. antipsychotics, ECT
  • psychological: psychotherapies, self-help programmes, physical activity
  • social: social support groups
47
Q

What are 5 aspets of the management of mild-moderate depression?

A
  1. Watchful waiting
  2. Antidepressants: not usually recommended for mild unless certain criteria met
  3. Self-help programmes: self-help manual with HCP providing support
  4. Computerised CBT
  5. Physical activity programme e.g. group exercise class
  6. Psychotherapies if other options fail
48
Q

What does the watchful waiting type of management of mild-moderate depression involve?

A

reassess patient again in 2 weeks

49
Q

What are the 4 situations when antidepressants may be used as first line therapy for mild depression?

A
  1. Depression has lasted a long time
  2. Past history of moderate-severe depression
  3. Failure of other interventions
  4. The depression complicates the care of other physical health problems
50
Q

When should psychotherapies be tried for mild-moderate depression?

A

if all the other optoins fail

51
Q

What are 8 aspects of the management of moderate-severe depression?

A
  1. Suicide risk assessment
  2. Psychiatry referral in certain instances
  3. Mental Health Act may be necessary in some cases
  4. Antidepressnats
  5. Adjvants: can be augmented with lithium or antipsychotics
  6. Psychotherapy: refer for CBT and interpersonal therapy
  7. Social support: engaging with activities in the community that individual is avoiding/attending social support groups
  8. ECT
52
Q

What are 4 situations when a psychiatry referral is indicated for moderate-severe depression?

A
  1. Suicide risk is high
  2. Depression is severe
  3. Recurrent depression
  4. Unresponsive to initial treatment
53
Q

What is the first line antidepressant recommended for moderate-severe depression?

A

SSRIs e.g. citalopram

54
Q

What are 4 types of antidepressants and which can only be prescribed by specialists?

A
  1. SSRIs
  2. SNRIs
  3. TCAs
  4. Monoamine oxidase inhibitors < can only be prescribed by specialist
55
Q

For how long should antidepressants be continued after resolution of symptoms for the first depressive episode?

A

6 months

56
Q

For how long should antidepressants be continued after resolution of symptoms for the second depressive episode?

A

2 years

57
Q

For how long should antidepressants be continued after resolution of symptoms for patients who have had multiple severe episodes?

A

long term

58
Q

What are 2 adjuvant drugs which may be used to augment the effects of antidepressants?

A
  1. Lithium
  2. Antipsychotics
59
Q

What are 5 types of psychotherapy that may be used for moderate-severe depression?

A
  1. CBT
  2. Interpersonal therapy (IPT)
  3. Behavioural activation
  4. Counselling
  5. Psychodynamic therapy
60
Q

What are 5 indications for the use of electroconvulsive therapy for moderate-severe depression?

A
  1. Acute treatment of severe depressino which is life-theratening
  2. Rapid response rquired
  3. Depression with psychotic features
  4. Severe psychomotor retardation or stupor
  5. Failure of other treatments
61
Q

How is CBT used to treat depression?

A

depression causes negative thoughts, which can lead to negative behaviours. CBT alows people to identify and tackle negative thoughts; conducted in groups or individually

62
Q

How is IPT used to treat depression?

A

helps identify and solve relationship problems, whether it is with family, partners or friends

63
Q

How is behavioural activation used to treat depression?

A

encourages depressed patients to develop more positive behaviour or activities that they would usually avoid

64
Q

How is counselling used to help treat depression?

A

enables patients to explore their problems and symptoms. counsellors offer support and guide patients to help themselves for a particular focus e.g. bereavement or relatinoship counselling

65
Q

How can psychodynamic therapy be used to help treat depression?

A

aim is to explore and understand the dynamics and difficulties of a patient’s life which may have begun in childhood

AIP: Self-harm (15 decks)

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