Depression

Question 1

What are the 3 core symptoms of depression?

Answer 1

• Low mood
• Anergia
• Anhedonia

Question 2

What are the 3 biological symptoms of depression?

Answer 2

• Disturbed sleep
• Low libido
• Low appetite

Question 3

What are the 3 cognitive symptoms of depression?

Answer 3

• The world
• One-self
• The future

Question 4

What is involved in a Mental state examination (MSE) (7)?

Answer 4

• Appearance and behaviour
• Speech
• Mood / Affect
• Thought
• Perceptions
• Cognition
• Insight

Question 5

What is involved in psychiatric history (6)?

Answer 5

• History of Presenting Complaint
• Past psychiatric history
• Family history
• Treatment history
• Substance misuse
• Risk assessment

Question 6

What are the differentials of depression (6)?

Answer 6

• Bipolar disorder vs unipolar depression
• Bipolar disorder vs borderline personality disorder/EUPD
• Depression vs psychotic prodrome
• Psychotic depression vs schizoaffective disorder (depressive type)
• Mania vs schizoaffective disorder (manic type)
• Mania vs Attention Deficit Hyperactivity Disorder

Question 7

What are the organic differential causes of depression (7)?

Answer 7

• Endocrine: (Hyper- and) hypothyroidism, hyper- and hypoparathyroidism, hyper- and hypoadreno-corticism, hypoglycaemia, Cushing’s syndrome, Addison’s disease
• Other systemic conditions incl. infections; Viral infections, systemic lupus erythematosus, HIV infection, pancreatic (and other) cancer. [Cytokines manifested in systemic diseases are considered to be a cause of depression]
• Deficiencies incl. vitamin B12 or folic acid
• Neurological conditions, incl. Multiple Sclerosis, Alzheimer’s, Parkinson’s
• Medications; incl Beta-blockers, steroids, anti-Parkinson’s, anti-cholinergics (e.g. for irritable bowel syndrome (IBS) with such as dicyclomine), some antibiotics (incl. ciprofloxacin), statins, oestrogen, opiate pain killers, acne medications
• Vascular Depression or early sub-cortical dementia is common in late life depression. Vascular depression is associated withWhite Matter Hyperintensities. These can impact on cognitive function making the individual more vulnerable to stressors. It is important to treat vascular risk factors such as Diabetes, Hypertension and address smoking and alcohol use.
• Poststroke depression sometimes becomes persistent. Retardation in thinking and behaviour is prominent. It has been reported that lesions in the left frontal lobe or basal ganglia are apt to cause depression, with the tendency that the more frontal the lesion, the more severe the symptoms