Psychiatry > Depression > Flashcards

Depression Flashcards

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1
Q

Biological, cognitive and psychotic features

A 
1. Biological
Early morning awakening
Loss of libido
Reduced appetite and weight loss
Psychomotor retardation
Worse in the morning
2. Cognitive
Poor concentration and memory
Poor self esteem
Guilt
Hopelessness
Suicide or self harm
3. Psychotic
Generally mood congruent
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2
Q

Differential diagnosis

A 
1. Mood disorders
Depression
Recurrent
Dysthymia
BAD
Cyclothymia
2. Schizoaffective
3. GMC
4. Psychoactive substance
5. Psychiatric (other)
Psychotic
Anxiety
Adjustment
Eating
Personality
Dementia
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3
Q

Prescribed drugs causing low mood

A 
1. AntiHTN
Beta blockers
Methyl dopa
2. Steroids
CS
Oral contraceptives
3. Neurological
L-Dopa
Carbamazepine
4. Analgesics
Opioid
Indomethacin
5. Other
Antipsychotics
Interferon
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4
Q

Medical conditions causing low mood

A 
1. Neurological
Parkinsons
MS
Huntingtons
Spinal cord
Stroke
Head injury
Cerebral tumors
2. Endocrinological
Cushing
Addisons
Thyroid
Parathyroid
Menstrual related
3. Infectious
Hepatitis
EBV
HSV
Brucella
Typhoid HIV
Syphillis
4. Other
Malignancy->panreatits
Chronic pain
SLE
RA
Renal failure
Porphyria
Vitamin
IHD
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5
Q

History

A
  1. Cheerful or low in modd
  2. Enjoy things
  3. Very tired
    Biological
  4. Worse in morning, wake up early, restless/slow, poor sex drive
    Cognitive
  5. How do you see things in the future, feel life’s not worth living, concentrate
    Suicidal risk
    Associated symptoms
    Substance use
    Features of an underlying medical condition
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6
Q

Examination

A
  1. General
  2. Features of underlying endocrine, infection
  3. Neurological
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7
Q

Investigations

A
  1. K10
  2. Collateral
  3. Mood diary
  4. FBC->anemia, infection, alcohol, thyroid, liver
  5. UEC->baseline
  6. LFTs->baseline, alcohol, infection
  7. TSH
  8. CMP
  9. CRP/ESR
  10. Vitamin B12
  11. UDS
  12. ECG
    13 CT
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8
Q

Purpose of physical investigation

A
  1. Exclude possible medical / substance related causes
  2. Establish baseline before administering treatment
  3. Assess renal and liver->metabolism
  4. Screen for physical consequences
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9
Q

Depression criteria

A

Five or more symptoms during same 2 week perior, change from previous functioning and one has to be either depressed mood or loss of interest/pleasure

  1. Depressed mood most of the day, nearly every day
  2. Diminished interest/pleasure
  3. Poor concentration
  4. Insomnia or hypersomnia
  5. Reduced appetite with weight loss/weight gain
  6. Inappropriate feelings of guilt
  7. Fatigue
  8. Recurrent thoughts of death or self harm
  9. Psychomotor agitation or retardation

+Causes functional impairment
+Not explained by anything else

Mild= few beyond 5
Moderate= >5
Severe= >>5 + intense functional impairment
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10
Q

Etiology

A
  1. Genetics
  2. Early life experience
    Parental separation
    Neglect
    Abuse
    Post natal depression in mother
  3. Acute stress
  4. Chronic stress
  5. Neurobiology
    ->Malfunctioning between brain regions->hippocampus, amygdala, frontal cortex
    ->decreased activity of 5HT, NE and DA at the level of the
    synapse; changes in GABA and glutamate; changes in brain circuitry
    ->ƒƒneuroendocrine dysfunction: increased production of corticotropin causing excessive HPA axis activity
    ->ƒƒneuroanatomy: smaller frontal lobes and hippocampal volume; increased ventricle sizes
    ->ƒƒneurophysiologic: decreased REM latency and slow-wave sleep; increased REM length secondary to GMC
  6. Personality
    Neuroticism
    BPD
    OCD
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11
Q

Management of major depressive episode

A 
1. Treatment setting
Most will be in-home
\++Psychotic, suicidal, self neglect->Admission
2. Lifestyle
Sleep hygeine
Diet, exercise
Alcohol and smoking, substance cesssation
3. Suicide risk management

Mild:

  1. Psychosocial: CBT, IPT, psychodynamic, family/marital. mindfullness
  2. Self help CBT
  3. Structured group therapy
  4. Social->vocational, social skills training

Moderate/severe:

  1. May need admission
  2. Psychosocial
  3. Individual CBT, social skills training
  4. Interpersonal therapy
  5. Antidepressant
  6. ECT
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12
Q

Considerations when choosing an anti-depressant

A
  1. Side effects
  2. Previous response
  3. Safety in overdose
  4. Atypical depression->MAOI?
  5. Associated psychiatric
  6. Concomitant physical illness
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13
Q

How long with antidepressants until effect, persist with and for at least

A

Takes 2-3 weeks before effect, continue for 4-6 weeks to determine response before changing
Continue for at least 6 months

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14
Q

Not responding to correct drug, dose and time

A
  1. Reassess diagnosis
  2. Consider psychological therapy
  3. Increase dose
  4. Change to another one->same class or different
  5. Augmenting with lithium or another antiD, antipsychotic
  6. Consider ECT
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15
Q

Prognosis in depression

A
  1. Self limiting
  2. Without treatment will usually remit in 6 months
  3. Often relapsing->80%
  4. Important risk factor for suicide 20X greater risk

one year after diagnosis of a MDE without treatment: 40% of individuals still have symptoms
that are sufficiently severe to meet criteria for a full MDE, 20% continue to have some symptoms
that no longer meet criteria for a MDE, 40% have no mood disorder

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16
Q

Algorithm for antidepressants

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A
  1. Prescribe first line->SSRI, SNRI, mirtazepine
  2. Reassess response after 2-4 weeks
  3. No response? Increase dose, reassess in 2-4 weeks
  4. Still no response->change
  5. Partial response-can increase dose within range
17
Q

Specifiers in depression

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A
  1. Psychotic: mood congruent/incongruent
  2. Chronic >2 years
  3. Catatonic->motor immobility, ++activity, negativism, mutism, echolalia, echopraxia
  4. Melancholic->+++depressed, psychoM retardation, EMA, ++weight loss/guilt
  5. Atypical->+sleep/weight gain, leaden paralysis, rejection hypersensitivity
  6. Postpartum
  7. Seasonal
  8. Anxious distress
  9. Mixed
18
Q

Lifetime prevalence

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A

Between 2-5% M/F

Peaks 15-25, 2X in females

19
Q

Risk factors

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A 
Female
Age
FHx->depression, alcohol, sociopathy
Child experiences
Personality->dependant, obsessional, insecure
Recent stressors
Post-partum 
Lack of relationships, isolation
20
Q

Non-pharmacological management

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A 
1. Psychotherapy
CBT
IPT
Psychodynamic
Family therapy
Mindfullness
2. Social support groups
Beyond blue
Blackdog institute
SANE
3. Other
•	Get enough sleep.
•	Follow a healthy, nutritious diet.
•	Exercise regularly.
•	Avoid alcohol, marijuana, and other recreational drugs.
•	Get involved in activities that make you happy, even if you don't feel like it.
•	Spend time with family and friends.
•	Try talking to clergy or spiritual advisors who may help give meaning to painful experiences.
•	Consider prayer, meditation, tai chi, or biofeedback as ways to relax or draw on your inner strengths.
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