History Taking - Depression

Question 1

What are the first 2 questions that should be asked to screen for depression?

Answer 1

During the last month have you often been bothered by:

i) Feeling down, depressed or hopeless?
ii) Having little interest or pleasure in doing things?

If yes to either question, full assessment made of functional, interpersonal and social difficulties

Question 2

What is a mnemonic to assess for the symptoms of depression?

Answer 2

DEAD SWAMP

i) Depressions – Hx?
ii) Energy levels
iii) Anhedonia
iv) Death – suicidal ideation, planning, attempts; DSH
v) Sleep disturbance
vi) Worthlessness, guilt
vii) Appetite disturbance
viii) Mentation (mental activity) – low i.e. thinking and concentration
ix) Psychomotor agitation and retardation

Question 3

What else needs assessing?

Answer 3

Symptoms
i) Any periods of elation/mania? – change diagnosis

Time course

Severity – loss of function

Hx of depression/mental health problem/chronic health problem
i) Treatment of and efficacy of such

Interpersonal relationship quality, living conditions

Risk assessment

i) Neglect
ii) Diet
iii) Self harm and suicidal ideation/planning

Question 4

What might be some findings on an MSE of depression?

Answer 4

Appearance and behaviour-
poor self care, lack of eye contact, does not ‘engage’ in conversation, little movement or lots of fidgeting

Speech - monotone, slow, hesitant

Emotional state - negative emotions, disengaged; possible suicidal ideation/intent

Perceptual abnormalities - psychotic depression?

Thought abnormalities - depressive rumination; psychotic symptoms?

Insight - attitudes to treatment

Cognitive and intellectual function - poor/decrease in memory