Mood disorders 1 Flashcards
(26 cards)
What is the lifetime prevalence of depression?
10-20%
What percentage of depressed patients will commit suicide?
5-15%
What percentage of depressed patients will recover in 1 year?
50-60%
What percentage of depressed patients are still unwell at 2 years?
10-25%
What are the core symptoms of depressions? (remember this pls)
Depressed mood
Loss of interest/enjoyment
Reduced energy
What are the biological (somatic) symptoms of depression?
Reduced appetite
Weight loss (5% loss in the last month)
Psychomotor S+S
Loss of libido (often accompanied with guilt)
Loss of emotional reactivity
Early morning wakening (at least 2 hours before normal time)
Depression worse in the morning
What are the psychomotor S+S?
Agitation or Retardation
Agitation = can't sit still and fidgeting Retardation = slow movements, slow speech, blunted effect
What are the cognitive symptoms of depression?
Reduced concentration and attention Reduced self esteem Guilt, unworthiness Pessimism, bleak outlook Suicidal thoughts, self harm
What are the psychotic symptoms associated with depression?
3 main ones to remember
Delusions - e.g. sin, poverty, impending disasters, guilt, nihilistic or persecutory
Hallucinations - e.g. defamatory or accusatory voices, smelling rotting filth or decomposing flesh
Depressive stupor - must differentiate from catatonia in schizophrenia. Extreme unresponsiveness and lack of voluntary movement (akinesia)
What is dysthymia?
very long standing MILD depression
What is cyclothermia?
persistent instability of mood
numerous periods of mild depression and mild elation
chronic course
no episodes fulfil criteria of bipolar or recurrent depression
How is a mild episode classified?
At least 2 core symptoms + at least 2 others
Minimum 2 weeks duration
May have some difficulty continuing ordinary work or social activities but won’t stop completely
+/- somatic syndrome
How is a moderate episode classified?
at least 2 core symptoms + at least 3-4 others
considerable difficulty continuing normal activities
+/- somatic syndrome
How is a severe episode classified?
all 3 core symptoms + at least 4 others
2 weeks no longer of value - high risk group
very unlikely to complete normal activities
What are the physical conditions that present with psychiatric symptoms?
NEUROLOGICAL
MS Parkinson's Huntington's Spinal Cord Injury CVA Head injury Cerebral tumour
What are the physical conditions that present with psychiatric symptoms?
ENDOCRINE
Thyroid or parathyroid esp. hypothyroid
Cushing’s or Addison’s
What are the physical conditions that present with psychiatric symptoms?
INFECTIOUS
HIV/AIDS Syphilis Typhoid EBV HSV
What are the physical conditions that present with psychiatric symptoms?
IATROGENIC
Opiates
L-dopa
Steroids (corticosteroids and OC)
Anti HTNs
What are the physical conditions that present with psychiatric symptoms?
OTHERS
Malignancy SLE RA Renal failure Porphyria
How should you assess psychiatric physical conditions?
Hx
Neuro and endos system examination to exclude organic cause
Examinations and investigations to help assess baseline values for medications
How do you manage depression?
Biopsychosocial approach
What is the BIO aspect of management?
SSRIs = 1st line
Lithium, antipsychotic or triiodothyronine (T3) augmentation if treatment resistant
ECT
What is the PSYCH aspect of managing depression?
Psychoeducation
CBT
Interpersonal therapy
Self-help materials
What is the SOCIAL aspect of managing depression?
CPN/OPD follow-ups Work on social inclusion Support for education, training and employment Support with housing and benefits Carer support
