NEUROLOGY > Depression > Flashcards

Depression Flashcards

(51 cards)

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1
Q

What is Anhedonia?

A

loss of pleasure/enjoyment

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2
Q

What does it mean to have diurnal variation depression?

A
  • mood varies over the day

- mood is worse in the Morning —gets better throughout the day

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3
Q

What is psychomotor retardation?

A

the subjective or objective SLOWING of thoughts and/or movements

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4
Q

What occurs in Stupor?

A
  • pt locks down; absence of action and speech
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5
Q

How may one be treated if conditioned with Stupor?

A
  • ECT (electroconvulsive therapy)
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6
Q

How may a depressed person appear?

A
  • reduced facial expression
  • furrowed brows
  • reduced eye contact
  • slow/absent movements (limited gesturing)
  • hard to build rapport
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7
Q

How may speech change with mood depression?

A
  • slow speech
  • low pitch
  • reduced VOLUME
  • monotonous
  • increased speech latencies (takes a while for them to reply)
  • limited content (short answers, brief)
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8
Q

Distinguish Mood vs Affect.

A

Mood- how the patient feels

Affect- how the patient reacts (demeanour)

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9
Q

What is considered as having a “low affect”?

A
  • means very limited reactivity to changes in CONTEXT, subject or emotion
  • emotional paralysis
  • —low through out the convo
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10
Q

How different is thought processing when one is depressed?

A
  • slow thoughts (pondering)
  • content: negative, self-accusatory
  • Delusions
  • suicidal thinking
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11
Q

What is psychosis?

A
  • a mental health problem that cause people to perceive or interpret things differently
  • involves HALLUCINATIONS and DELUSIONS
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12
Q

DIstinguish an Halluccination from a Illusion!

A
  • a halluccination; perception experienced as real in the absence of an EXTERNAL stimulus
  • Illusion: MISPERCEPTION of an external stimulus (shadow mistaken for a person in the room)
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13
Q

What form do hallucinations usually occur?

A
  • almost always AUDITORY
  • usually in second person
  • most psychiatric cases
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14
Q

When do visual hallucinations occur?

A

-with “organic” problems of the brain

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15
Q

How is cognition impaired in Depression?

A
  • slow with complains of POOR memory (mainly d/t inattention)
  • compounded with ANXIETY
  • issues with planning. working memory, attention
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16
Q

Are depressed patients aware of their condition?

A
  • insight in depression is PRESERVED

- however, attribution is affected by illness (think poorly of themselves)

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17
Q

What is the behaviour like with depressed individuals?

A
  • fiddling with fingers, tissues
  • defeated posture
    -exhausted
    worrying
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18
Q

What is the course of depression?

A
  • usually recurrent and often chronic
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19
Q

What are the 2 criterias mental illnesses?

A
  • DSM-5 (USA)

- ICD-10 (eu)

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20
Q

Depression involves at least 2 of 3 symptoms. State them.

A
  1. Depressed mood (present MOST of the day, and almost every day)
  2. Loss of Interest and pleasure
  3. decreased energy
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21
Q

How is grief not deemed an illness?

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A
  • because it does not impair one’s functionality to the extent of how depression does
22
Q

What is in the criteria for MDD to be dx?

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A
  • should last at least 2 WEEKS

- no hypomanic or manic symptoms that has ever occurred in the person’s life

23
Q

M.E.E. for depressive sx ?

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A

mood-enjoyment-energy

24
Q

What are other (additional) symptoms that may be present?

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A
  • loss of confidence
  • Guilt
  • suicidal behaviour
  • inability to concentrate
  • AGITATION
  • sleep disturbance
  • change in appetite+ Wgt loss
25
How is the severity assessed for depression?
- HRSD, HAM-D - MADRS - BDI
26
When is it considered to be a moderate depressive episode?
2 core symptoms+ 4 additionals= 6 | ----every symptom should be present for MOST of everyday
27
Severe Depressive episode SCORE
3 core symptoms+ 5 additionals = (having 7 or more)
28
What is the management plan intended for mild depression?
- should get better on its on | - meds are no better than placebo
29
What are the subtypes of Depression?
1. somatic Syndrome 2. Atypical Depression 3. Psychotic depression
30
What are the distinct fts of Somatic $ Depression?
- early morning wakening (2hrs or more than usual time) | - depression in the morning (DIURNAL VARIATION of MOOD)
31
How is atypical depression different?
1. they have MOOD REACTIVITY (mood brightens in resp. to + things) 2. Two or more atypical depression symptoms
32
What are the additional symptoms seen in Atypical Depression?
- WGT GAIN and INCREASED appetite - hypersomnia - LEADEN paralysis (leaden feelings in limbs) - interpersonal rejection
33
What is psychotic depression like?
- usually paranoia - mood congruent (if you're happy in that moment; you will remember all the happy things in your life) - hypochondriacal
34
What is Cotard's Syndrome?
- seen in ELDERLY - nihilistic delusions - body is rotting; organs are dead (constipation)
35
When may depression become chronic?
- when it is treatment refractory - d/t POOR ADHERENCE - INADEQUATE dose or duration
36
When is it accounted as chronic depression by the DSM-5?
-full criteria for MAJOR DEPRESSIVE EPISODE was met for at least 2 years
37
What are the 5 Rs for depression?
-response -remission (momentary bliss) relapse recovery recurrence
38
What is mild depression classified as having?
- just 4 symptoms
39
How to manage mild-moderate depression?
CBT+ Active monitoring of pt | - consider ANTIDEPRESSANTS if pt is not responding to CBT or HAS a hx of MOOD disorders
40
How to manage moderate-severe depression?
1. Antidepressants (SSRIs) - SERTRALINE; follow-up in 2 weeks
41
When could you adjust the dose of Fluoxetine ?
- after 4-6 weeks | - (optimum action is only at this time period)
42
If 1 SSRi does not work, what next?
- another ssri (Check after 2 weeks) | - still no improvement, change class of drug (SNRI)
43
How long should the pt take anti-depressants, if she had only 1 depressive episode?
6 months- 1 year
44
How long should one take anti-depressants , if they had 2 episodes?
- 12-24 months
45
If very severe depressive d.o?
continue AD | psych consultation review
46
What is the risk of NOT tapering down SSRIs?
- SSRI DISCONTINUATION SYNDROME | - ---must taper over 4-6 weeks
47
WHat occurs with SSRI discontinuation syndrome?
- N.V.D - sweating - headaches - Sleep disturbances, Vertigo and tremors
48
How to prevent SSRI discontinuations syndrome?
Switch the short half-lives to LONG HALF-LIVES ( FLUOXETINE & CITALOPRAM) ----manage symptoms symptomatically
49
What serotonin syndrome?
- occurs with the use of MULTIPLE serotonergic meds (COCAINE with SSRIs
50
What occurs with Serotonin syndrome?
1. high body temp./ Agitation 2. incr. REFKEXES./ TREMORS 3. sweating/ DILATED pupils and diarrhea
51
How to manage atypical depression?
Phenelzine/ Moclobemide | ----alternatives (SSRIs and NARI--reboxetine)
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