Depressive Disorder Flashcards
What is depressive disorder?
Depressive disorder is an affective mood disorder characterized by a persistent low mood , loss of pleasure and/or lack of energy accompanied by emotional, cognitive and biological symptoms.
What is the heritability of depression?
Monozygotic twin studies show the heritability of depression as 40– 50% , and it is likely that multiple genes are involved.
Briefly describe the monoamine hypothesis
The monoamine hypothesis states that a deficiency of monoamines (noradrenaline , serotonin and dopamine) causes depression; this is supported by the fact that antidepressants which increase the concentration of these neurotransmitters in the synaptic cleft, improve the clinical features of depression.
How does the HPA axis affect depression?
Over-activity of the hypothalamic– pituitary– adrenal (HPA) axis has been linked to depression.
What are the predisposing factors for depression?
Note: biological, psychological and social
Biological
- Female gender (2:1)
- Postnatal period
- Genetics: 40– 50% monozygotic concordance rates, family history
- Neurochemical: ↓ serotonin, ↓ noradrenaline, ↓ dopamine
- Endocrine: ↑ activity of HPA axis
- Physical co-morbidities
- Past history of depression
Psychological
- Personality type
- Failure of effective stress control mechanisms
- Poor coping strategies
- Other mental health co-morbidities (e.g. dementia)
Social
- Stressful life events
- Lack of social support
- More common in asylum seeker and refugee population
What are the precipitating factors for depression?
Note: biological, psychological and social
Biological
- Poor compliance with medication
- Corticosteroids
Psychological
- Acute stressful life events (e.g. personal injury, loss of loved one, bankruptcy)
Social
- Unemployment
- Poverty
- Divorce
What are the perpetuating factors for depression?
Note: biological, psychological and social
Biological
- Chronic health problems (e.g. diabetes, CCF, COPD and chest pain syndromes)
Psychological
- Poor insight
- Negative thoughts about self, the world and the future (Beck’s Triad)
Social
- Alcohol and substance misuse
- Poor social support
- ↓ Social status
What are the risk factors for depression?
Note: FF, AA, PP, SS
- Female
- Family history
- Alcohol
- Adverse events
- Past depression
- Physical co-morbidities
- ↓ Social support
- ↓ Socioeconomic status
Globally, how many people in the world are thought to have depression?
350 million.
What age is onset of depression most common?
Men: 40s.
Women: 30s.
What are the core symptoms of depression?
- Anhedonia (lack of interest in things which were previously enjoyable to the patient)
- Low mood (present for at least 2 weeks)
- Lack of energy
What are the cognitive symptoms of depression?
- Lack of concentration
- negative thoughts
- Excessive guilt (feelings of worthlessness or excessive of inapproapriate guilt, nearly every day)
- Suicidal ideation
What are the biological symptoms of depression?
- Diurnal variation in mood (DVM)
- The patient’s low mood is more pronoucned during certain tiems of the day, usually in the morning
- Early morning wakening (EMW)
- Waking up to 2 hours earlier than they usually would premorbidly
- In atypical depression there may be hypersomnia (excessive sleep)
- Loss of libido
- Psychomotor retardation (slow speech and movement)
- Weight loss and loss of appetite
- In atypical depression weight gain and increased appetite may occur
What are the psychotic symptoms of depression?
- Hallucinations
- Normally second person auditory hallucinations
- Delsuoins
- They are usaully hypochondrical guilt, nilhilistic or persecutory in nature
What are the main symptoms of depression?
Note: DEAD SWAMP
- Depressed mood
- Energy loss
- Anhedonia
- Death thoughts
- Sleep disturbance
- Worthlessness or guilt
- Appetite of weight change
- Mentation (concentration) reduced
- Psychomotor retardation
Briefly describe Beck’s congnitive triad
Beck’s cognitive triad represents three types of negtive thought. The triad invovles negative thoughts about:
- Self
- World/ environment
- Future
Briefly describe the ICD-10 Classification of depression
Note: mild, moderate, severe and severe with psychosis
Mild depression = 2 core symptoms + 2 other symptoms
Moderate depression = 2 core symptoms + 3– 4 other symptoms
Severe depression = 3 core symptoms + ≥4 other symptoms
Severe depression with psychosis = 3 core symptoms + ≥4 other symptoms + psychosis
Briefly describe the MSE for depression
Appearance: signs of self-neglect, thin, unkempt, depressed facial expression and tearful.
Behaviour: poor eye contact, tearful, psychomotor retardation, slow movements, slow responses, may sometimes present with psychomotor agitation.
Speech: may be slow, non-spontaneous, reduced volume and tone.
Mood: low (subjectively) and depressed (objectively).
Thought: pessimistic, guilty, worthless, helpless, suicide and delusions (if psychotic).
Perception: second person auditory hallucination (often derogatory).
Cognition: imparied concentration.
Insight: usually good.
What are the investigations for depression?
Investigations are used to exclude organic causes for depression. They are not mandatory and should be used according to clinical judgement:
- Diagnostic questionnaires: e.g. PHQ-9 , HADS and Beck’s depression inventory.
- Blood tests: FBC (e.g. to check for anaemia), TFTs (e.g. to test for hypothyroidism), U&Es , LFTs , calcium levels (biochemical abnormalities may cause physical symptoms which can mimic some depressive symptoms), glucose (diabetes can cause anergia).
- Imaging: MRI or CT scan may be required where presentation or examination is atypical or where there are features suspicious of an intracranial lesion e.g. unexplained headache or personality change.
Give examples of other depressive disorders
- Recurrent depressive episode
- Seasonal affective disorder
- Masked depression
- Atypical depression
- Dysthymia
- Cyclothymia
- Baby blues
- Postnatal depression
What is recurrent depressive disorder?
A recurrent depressive episode refers to when a patient has another depressive episode after their first.
What is seasonal affective disorder?
Characterised by depressive episodes recurring annually at the same time each year, usually during the winter months.
What is masked depression?
A state in which depressed mood is not particularly prominent, but other deatures of depressive disorder are e.g. sleep disturbance and diurnal variation in mood.
What is atypical depression?
This typically occurs with mild-moderate depression with reversal of symptoms e.g. overeating, weight gain and hypersomnia. There is a relationship between atypical depression and seasonal affective disorder.
