Depression

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Author:
trincam2008
ID:
275144
Filename:
Depression
Updated:
2014-05-28 19:31:53
Tags:
psy depression
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Description:
Clinical presentation, DDx, Ix, Mx ( psychological, pharmacological, non-drug options)
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  1. Clinical presentation categories
    • 1. core symptoms, >2 weeks
    • 2. cognitive
    • 3. biological
    • 4. psychotic
    • 5. risk
    • a) to self
    • b) to others
  2. Clinical presentation - core symptoms
    • 1. mood - low
    • (also irritability, anxiety, or tearfulness. Diurnal variation of mood, classically worse in morning)
    • 2. energy - low (anergia)
    • 3. interest/enjoyment - low ( anhedonia)
  3. Clinical presentation - cognitive (5 cat)
    • 1. Self  (worthless, decreased confidence, guilty)
    • 2. World (helpless, the world feels overwhelming)
    • 3. Future (hopeless, pessimistic)
    • 4. Concentration  (poor)
    • 5. Memory  (sometimes impaired)
  4. Clinical presentation - biological
    • 1. sleep - usu. decreased
    • (initial insomnia, or early morning wakening)
    • 2. apetite & weight - usu. decreased
    • 3. libido - low
    • 4. Other physical symptoms: constipation, aches and pains, and dysmenorrhoea may be prob.
  5. Clinical presentation - psychotic
    • 1. Auditory (>visual) - oft unpleasant, derogratory
    • 2. Delusion - persecutory, nihilistic
  6. DDx (8)
    Organic, common reactions, then illness
    • 1. Physical causes
    • (hypothyroidism, head injury, cancer, 'quiet' delirium)


    • 2. Adjustment disorders
    • (unpleasant but mild affective symptoms follow a life event, not reach the severity)
    • 3. Normal sadness
    • 4. Bereavement
    • (normal grief: 4 stages numbness, pining, depression, recovery)

    • 5. BPAD/schizoaffective disorder/schiz
    • (look for prev manic or psychotic features)


    • 6. Subtance misuse
    • (alcohol and drugs may cause depression or be a form of self-medication)
    • 7. Postnatal depression/puerperal illness
    • 8. Dementia
    • (depression can affect memory so badly that pt appears to have dementia i.e. pseudo- dementia); dementia can begin with affective change)
  7. Ix
    • 1. Collateral history
    • 2. Physical examination
    • 3. Blood tests: routine, TFT (to rule out hypothyroidism), FBC, G or HbA1C (anaemia / diabetes cause fatigue)
    • 4. Rating scales
    • (measure severity or monitor treatment response
    • BDI (Beck Depression Inventory), HADS (hospital anxiety and depression scale)
    • 5. CT or MRI
    • (not routine, help to rule out suspected cerebral path)
  8. Mx
    • 1. Psycho
    • CBT
    • 2. Pharm
    • 3. Non-drug
    • (P38-40)
  9. Aetiology x4
    4. a) Physical illnesses b) Medications c) drugs that cause i) depression ii) mania
    • 1. Genetics
    • - Part. serotonin transporter gene -> genetic susceptibility to stress. S (short) and L (long) allele versions of promoter region. With S, trebles risk of D if suffering 3 or more life events. No effects on risk with L.
    • - strong family history

    • 2. Childhood and life experience
    • - adverse childhood asso. with later D, operating thru impact on confidence, trust and self-esteem e.g. include childhood abuse, relentless criticism, parental loss, and perceived lack of affection
    • - in adults: vulnerability factors increase risk, by reducing resilience to adverse situation. Inc. unemployment, lack of a confiding relationship, lower socio-economic status, and social isolation.

    • 3. Life events
    • - degree of stressfulness
    • death of spouse, divorce, marital separation, jail term, death of a close relative
    • - 'loss events' imp, wide ranges inc. loss of role, or autonomy
    • - both -ve and +ve can prec mania


    • 4. Physical causes
    • i) Depression
    • - Physical illness is associated with depression. Chronic pain can precipitate D & is linked with increased suicide risk
    • - Physical illnesses directly cause D:
    • Cushing's syndrome, hypothyroidism, stroke, Parkinson's disease, multiple sclerosis and hyperparathyroidism (process not understood)
    • - Some meds: beta-blockers and antihypertensives
    • - Illicit drugs such as stimulants e.g. cocaine

    • ii) Mania
    • - Can be caused by: Cushing's syndrome, head injury, or multiple sclerosis.
    • - Steroids, antidepressants, and stimulants can all trigger mania
  10. Beck's negative cognitive triad
    • Self, world, future
    • -negative->
    • worthless, guilty; helpless; hopeless
  11. Subtypes of depression
    • - SAD - seasonal affective disorder
    • (predictably low mood in winter, us. reversed biological symptoms of overeating and oversleeping)
    • - Atypical depression
    • (no seasonal variation but reversed bio symp and may retain mood reac)
    • - Agitated depression
    • (D with psychomotor agitation intes of retardation e.g. restlessness, pacing, hand-wringing)
    • - Depressive depression
    • (profound psychomotor retardation, becomes mute, stop eating, drinking or moving)

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