Depression

Question 1

What did Hippocrates believe about the four humours?

Answer 1

Blood, black bile, yellow bile, and phlegm determined health and temperament.

Question 2

Which classification systems are currently used for mental disorders?

Answer 2

ICD-11 (WHO, used in UK) and DSM-5 (APA, used in US).

Question 3

How is depression classified in ICD-11?

Answer 3

As a mood (affective) disorder.

Question 4

According to ICD-11, how is a depressive episode defined?

Answer 4

At least five symptoms, present most of the day nearly every day for ≥ 2 weeks, causing functional impairment not due to bereavement, with at least one affective symptom.

Question 5

What are the key affective symptoms of depression?

Answer 5

Depressed mood (may appear tearful, defeated; irritability in children/adolescents)

Loss of interest or pleasure (anhedonia), including decreased sexual desire

Question 6

Name core cognitive-behavioural symptoms of depression.

Answer 6

Poor concentration or indecisiveness

Low self-worth or delusional guilt

Hopelessness about the future

Suicidal ideation or attempts

Question 7

What are the neurovegetative symptoms of depression?

Answer 7

Sleep disturbance (insomnia or hypersomnia)

Appetite/weight change

Psychomotor agitation or retardation

Fatigue or low energy

Question 8

How common is depression globally?

Answer 8

One of the leading causes of disability worldwide (WHO).

Question 9

When are the two peaks in prevalence of depression?

Answer 9

2nd–3rd decades, and smaller peak in 5th–6th decades.

Question 10

What is the female-to-male depression ratio?

Answer 10

2 : 1.

Question 11

What are the four major categories of aetiological factors of depression?

Answer 11

Genetic, biochemical, psychological, and social.

Question 12

What is the monoamine theory of depression?

Answer 12

Low monoamine (particularly serotonin) levels in the brain lead to depression.

Question 13

What is the neuroendocrine theory of depression?

Answer 13

Hormonal disturbances (e.g. cortisol, thyroid) increase depression risk.

Question 14

What is Beck’s cognitive triad in depression?

Answer 14

Negative thoughts about self, world, and future.

Question 15

What social vulnerability factors did Brown & Harris identify for women with depression?

Answer 15

≥ 3 children under 15 at home

Not employed outside home

No confidant or poor relationship

Loss of mother before 11 years old

Major life stressors or difficulties

Question 16

How does depression typically present in adults?

Answer 16

As per ICD-11 criteria: affective, cognitive, and neurovegetative symptoms.

Question 17

How can depression present in children?

Answer 17

Somatic complaints (e.g. stomach pain, headaches), whining, separation anxiety, crying.

Question 18

How can depression present in adolescents?

Answer 18

Irritability, hypersomnia, hyperphagia.

Question 19

How can depression present in older adults?

Answer 19

Cognitive impairment or memory problems (“pseudodementia”).

Question 20

What are the ICD-11 categories of depressive episodes?

Answer 20

Mild

Moderate (± psychotic features)

Severe (± psychotic features).

Question 21

What counts as psychotic symptoms?

Answer 21

Delusions and/or hallucinations.

Question 22

Name common comorbid conditions with depression.

Answer 22

Anxiety, psychosis, mania (mixed states), substance misuse.

Question 23

Is depression a clinical or laboratory diagnosis?

Answer 23

Clinical (based on history and mental-state exam).

Question 24

Which organic causes must be ruled out before diagnosing depression?

Answer 24

Hypothyroidism, hypercortisolism, substance misuse.

Question 25

What tests may help exclude organic causes of low mood?

Answer 25

Thyroid function tests, cortisol, urine drug screen.

Question 26

Name some differentials for depression

Answer 26

Anxiety disorders ADHD (in children) Bipolar affective disorder Adjustment disorder Grief reaction Dementia (in elderly) Substance misuse

Question 27

What are the three pillars of depression management?

Answer 27

Biological, psychological, and social interventions.

Question 28

First-line medication for depression?

Answer 28

Antidepressants (e.g. SSRIs).

Question 29

When are antipsychotics used in depression?

Answer 29

In depression with psychotic symptoms.

Question 30

Name two first-line psychological therapies used in depression.

Answer 30

Cognitive-Behavioural Therapy (CBT) and Interpersonal Therapy (IPT).

Question 31

Give examples of social interventions in depression.

Answer 31

Address financial or housing issues Strengthen support systems or confiding relationships

Question 32

Define treatment-resistant depression.

Answer 32

Failure to respond to two antidepressants at therapeutic doses for ≥ 6 weeks.

Question 33

What steps should be taken in treatment resistant depression?

Answer 33

Re-evaluate diagnosis Rule out organic causes Combine antidepressants or augment with lithium Combine pharmacological and psychological therapy Consider electroconvulsive therapy (ECT)

Question 34

What is the usual course of depression?

Answer 34

Episodic, with recovery between episodes.

Question 35

How long do episodes typically last with treatment?

Answer 35

3–6 months; most recover within 12 months.

Question 36

Which groups have poorer prognosis in depression?

Answer 36

Children and elderly patients.

Question 37

In a typical monoamine pathway diagram, which neurotransmitters are shown as reduced in depression?

Answer 37

Serotonin (5-HT), noradrenaline (NA), and dopamine (DA).

Question 38

What happens to postsynaptic receptor density according to the monoamine hypothesis?

Answer 38

Upregulation of receptors due to chronic low monoamine levels.

Question 39

In a neuroendocrine axis diagram, which hormone is often elevated in depression?

Answer 39

Cortisol, due to overactivation of the hypothalamic–pituitary–adrenal (HPA) axis.

Question 40

What structural brain changes are often depicted in neuroimaging of depression?

Answer 40

Reduced hippocampal volume, amygdala hyperactivity, and prefrontal hypoactivity.

Question 41

Why must clinicians screen for thyroid dysfunction in depression?

Answer 41

Hypothyroidism can mimic or worsen depressive symptoms.

Question 42

Why are alcohol and cannabis use relevant in depression?

Answer 42

They can precipitate or exacerbate depressive episodes.

Question 43

What physical symptoms can mask depression in older adults?

Answer 43

Fatigue, weight change, sleep disturbance, cognitive impairment.