Case: Depression

Question 1

What are the 3 core symptoms of depression?

Answer 1

1. Low Mood
2. Anhedonia = A complete inability to feel pleasure
3. Low Energy

Question 2

The 3 core symptoms of depression are;

1. Low Mood
2. Anhedonia = A complete inability to feel pleasure
3. Low Energy

What are the other symptoms of depression?

Answer 2

• poor appetite
• poor sleep
• poor concentration
• reduced libido
• tearfulness
• negative thoughts
• suicidal thoughts

Question 3

Severely depressed patients may also experience psychotic symptoms.

What is psychosis?

Answer 3

a mental disorder characterized by symptoms such as delusions or hallucinations, that indicate impaired contact with reality

Question 4

What are delusions?

Answer 4

• Usually negative or guilty in nature
• e.g. “My body is rotting”, “I have committed a great crime and am being punished

Question 5

What are hallucinations?

Answer 5

• Usually Auditory
• Second Person (talking directly to the patient)
  
  • e.g. A voice telling them they are ‘worthless’, that they smell bad or criticising what they are wearing
• Can also be:
  
  • visual (e.g. spiders)
  • tactile (e.g. feeling things crawling on their skin)
  • olfactory (e.g. smelling rotting flesh)
  • gustatory (e.g. bad taste in mouth)

Question 6

Beyond the presenting complaint, what are some important things to ask a depressed patient in the history?

Answer 6

Medical history

• e.g. thyroid disorders (hypothyroidism can mimic depression)
• e.g. chronic illness/pain

Psychiatric history

• e.g. admissions, suicide attempts

Family history

• e.g. psychiatric disorders, suicide

Medications

• e.g. prescribed drugs such as beta-blockers can cause depression

Social history

• current social or financial difficulties
• use of alcohol/drugs

Personal history

• e.g. adverse experiences which may have affected their ways of thinking

Question 7

What are the features of the Mental State Examination?

Answer 7

ASEPTIC

1) Appearance
* Poor self-care, Reduced range of facial expressions

Behaviour

• Psychomotor retardation or agitation
• Reduced Eye Contact

2) Speech
* Slow, Quiet, Monotonous
3) (Emotion)Mood and Affect

• Subjectively and Objectively depressed mood
• Reduced range and intensity of affects

4) Perceptions

• Possible auditory hallucinations if psychotic
• Reduced Eye Contact

5) Thought

• Form
  
  • Thoughts may be slowed
• Content
  
  • Negative, guilty or suicidal thoughts
  • Depressive delusions if psychotic

6) Insight
* Usually present
7) Cognition
* Not usually impaired

Question 8

What are the 3 broad treatment of depression?

Answer 8

1) Biological

• Antidepressants
• Electro-Convulsive Therapy

2) Psychological

• Cognitive Behavioural Therapy (CBT)
• Interpersonal Psychotherapy (IPT)

3) Social

• No specific treatments but modification of lifestyle factors may be helpful

Question 9

Antidepressant medication should be continued for __________ months in normal circumstances

Answer 9

six to twelve months

Question 10

Antidepressants can be continued long-term in the case of?

Answer 10

• Chronic depression
• Prophylaxis where depressive episodes have been
  
  • Frequent or severe
  • Psychotic
  • Or involved a significant suicide attempt

Question 11

What happens if we don’t treat depression?

Answer 11

• Untreated, depression usually lasts six to twelve months
• However it can become chronic
• Even if it resolves without treatment, the patient may be left with some symptoms e.g. insomnia
• Robust treatment is said to be protective for further episodes

Question 12

What are the complications of depression?

Answer 12

• Suicide
• Psychosis
• Social and Occupational dysfunction
  
  • Unemployment or problems at work
  • Family and relationship problems
  • Socially isolation