DEPRESSION – INTRODUCTION & SYMPTOMS

Ans:A-Female 

Risk factors of suicide in depression are:

• At end( involutional) or beginning of depression
• Mood disorders , personality disorders , psychosis , hypochondriac
• >45yrs male, unemployed, single, divorced, chronically ill, widowed, recently bereaved
• Family history

Ans:A-Formal thought disorder

• Depression is associated with disturbances in stream of thought.There is inhibition or slow thinking in depression which results in decrease in stream and also progression of thought.
• Schizophrenia is associated with disturbances in form of thought.

Ans:B-Middle age female

• Sex ratio of depression-M:F=1:2
• Mean age of onset -40 years.Quite common in younger individuals also

Ans:B-Serotonin & Noradrenaline (Nor epinephrine)

Ans:C-Third person hallucination

The symptoms of endogenous depression are similar to those of MDD. They include:

• persistent feelings of sadness or hopelessness
• loss of interest in activities or hobbies that were once pleasurable, including sex
• fatigue
• lack of motivation
• trouble concentrating, thinking, or making decisions
• difficulty falling asleep or staying asleep
• social isolation
• thoughts of suicide
• headaches
• muscle aches
• loss of appetite or overeating

Ans:A-Major depression

• Depression is present in at least 50% of all suicides.
• Those suffering from depression are at 25 times greater risk for suicide than the general population (American Association of Suicidology, 2014).
• 50-80% of older adults who die by suicide have been shown to have major depression.

Ans:C- Vague body aches

Multiple physical symptoms (such as heaviness of head, vague body aches) are particularly common in the elderly depressives and depressed patients from the developing countries (such as India)

Depression:

• MC psychiatric disorder in India: Depression
• Neurotransmitter involved: Serotonin and norepinephrine
• MC cause of suicide: Depression
• Risk features of suicide in depression:
• Endogenous type of depression
• Psychotic depression
• MC type of post-puerperal psychosis: Depression
• Nihilistic ideas: Seen in depression

Ans. A- 28°C

• A person’s core body temperature usually hovers around 98.6 degrees Fahrenheit (37 degrees Celsius). Hypothermia occurs when core body temperature dips to around 95 F (35 C) or lower. Surprisingly, people can experience hypothermia in relatively cool, but not freezing, air temperatures — around 30 to 50 F (minus 1 to 10 C) — particularly if they are wet, such as from rain, sweat, or submersion in cold water, according to the National Weather Service. The body loses heat about 25 times faster in water than in air.
• Symptoms of mild hypothermia, such as shivering, weakness, and confusion, set in when core body temperature reaches about 95 F. 
  • At 91 F (33 C), you can experience amnesia.
  • At 82 F (28 C) you can lose consciousness.
  • Below 70 F (21 C), you are said to have profound hypothermia and death can occur.

• The record for the lowest body temperature at which an adult has been known to survive is 56.7 F (13.7 C), which occurred after the person was submerged in cold, icy water for quite some time

Ans.B- 2 weeks

DSM-IV Criteria for Major Depressive Disorder (MDD)

• Depressed mood or a loss of interest or pleasure in daily activities for more than two weeks. • Mood represents a change from the person’s baseline

• Impaired function: social, occupational, educational.

• Specific symptoms, at least 5 of these 9, present nearly every day:

1. Depressed mood or irritable most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).

2. Decreased interest or pleasure in most activities, most of each day

3. Significant weight change (5%) or change in appetite

4. Change in sleep: Insomnia or hypersomnia

5. Change in activity: Psychomotor agitation or retardation

6. Fatigue or loss of energy

7. Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt

8. Concentration: diminished ability to think or concentrate, or more indecisiveness

9. Suicidality: Thoughts of death or suicide, or has suicide plan

Ans:C-Cognitive behavior therapy

The evidence-based psychological therapy of choice for depression is cognitive behavior therapy.

“Cognitive Behavioral Therapy (CBT) developed by Aron Beck, is an extremely useful and evidence-based non-pharmacological intervention for depression. This therapy involves the identification of cognitive errors (thinking errors) in an individual and replacing the same with alternative thoughts, which are more adaptive and healthy in nature. It is most useful in patients suffering from mild to moderate depression.”- Kaplan and Sadock 10/e pe p553

Cognitive (Behaviour) Therapy

• It was developed by Beck and Meichenbaum, for the treatment of depression, anxiety disorder, panic disorder, phobias, eating disorders, anticipatory anxiety, and also for teaching problem-solving skills (methods).
• It involves:
• Cognitive techniques (e.g. recognizing and correcting negative thoughts, teaching reattribution techniques, increasing objectivity in perceptions, identifying and testing maladaptive assumptions, and decentering) Behaviour techniques (activity schedules, homework assignment, graded task assignment, behavioral rehearsal, role-playing, and diversion technique).

Ans. is ‘d’ i.e., All of the above

• All the given drugs are SSRI antidepressants.

Antidepressants

• Typical

a. Tricyclic antidepressants

1. NA + 5HT reuptake inhibitors:- Imipramine, Trimipramine, Amitriptyline, Clomipramine.
2. Predominantly NA reuptake inhibitors:- Desipramine, Nortriptyline, Amoxapine, Reboxetine.

b. Selective serotonin reuptake inhibitors:- Fluoxetine, Paroxetine, Sertaline, Citalopram, Scitalopram.

B. Atypical :- Trazodone, Mianserine, Mitrazapine, Venalafaxin, Duloxetine, Tianeptine, Amineptine, Bupropion.

C. MAO inhibitors :– Tranylcypramine, Meclobemide, Clorgyline

Ans:C- Nihilistic ideas

Diagnostic criteria for major depression

• 5 or more of the following symptoms should be present most of the day for at least 2 weeks: ‑

1. Depressed mood
2. Loss of interest or pleasure in all activities.
3. Decrease/increase appetite or loss/gain of weight.
4. Insomnia or hypersomnia (Increased or decreased sleep).
5. Psychomotor retardation or agitation (decreased or increased psychomotor activity).
6. Fatigue or loss of energy (weakness or lethargy).
7. Feelings of worthlessness or excessive guilt.
8. Diminished concentration
9. Recurrent thoughts of death or recurrent suicidal ideation or suicidal attempt.

• At least one of the symptoms should be either:‑

Depressed mood or Loss of interest or pleasure —) These two (1 & 2) are essential criteria. Therefore 1 essential criterion and 4 other criteria (total 5) should be present

Ans. is ‘c’ i.e., Distractibility

Clinical features of depression

• The classical triad of depression is depressed mood, psychomotor retardation, and slowed-down thinking.

1. Mood : Mood is characteriztically low and sad. There is loss of interest and pleasure in almost all activities, which result in social withdrawal, avolition,occupational dysfunction. In severe cases there may be anhedonia (inability to experience pleasure).
2. Thoughts (Thinking) : – Pesimistic thoughts conerning the patients past, present and future occur which results in Hopelessness, Helplessness, and worthlessness. Other thought problems may be guilt-feeling, Loss of self esteem, Suicidal ideas, Delusion of nihlism (World has come to an end, Intestines has been rotated away, No brain in head), Hypochondriacal delusions [Patient believes that he has severe (cancer) or incurable disease (eg. AIDS)]. Other delusions that may occur in elderly include paranoid or persecutory delusion, and delusional jealousy.
3.  Psychomotor activity : – There is psychomotor retardation —> Movements are sluggish & laboured, lack of initiative & energy, Easy fatiguability. In severe form, the patient becomes stuporous (depressive stupor). In older patient there may be agitation and restlessness.
4. Cognition : – There is poor concentration, which may lead the patient to think (mistakenly) that the memory is also impaired (However, memory is normal). In old patients depression may present similar to dementia, i.e., Pseudodementia.
5. Somatic symptoms & biological disturbances : – Multiple physical symptoms are common in elderly patient. Symptoms include heaviness of head, generalized ache & pain, Loss of sexual drive and amenorrhea, severe disturbance in biological function is called somatic syndrome (melancholia). Somatic syndrome (melanocholia) is characterized by :-

• Decrease in appetite or weight
• Early morning awakening, at least 2 hours before usual time.
• Diurnal variation, depession is worse in morning
• Loss of interest and loss of reactivity to pleasurable stimuli, and loss of pleasure in all activities.
• Psychomotor agitation or retardation.
• Excessive or inappropriate guilt.

6. Psychotic symptoms (Psychotic depression) : – Occur in 15-20% of patients. Symptoms include 2″^a person auditory hallucinations, delusions, grossly inappropriate behavior. These symptoms may be mood congruent (e.g., nihilistic delusions, delusions of poverty or guilt) which are understandable in the light of depressed mood or can be mood incongruent (e.g., delusion of control) which are not directly related to depressive mood. Psychotic depression usually occur later in life and is associated with severe depression.

Ans: A-Melancholia

Melancholic depression, or depression with melancholic features, is a DSM-IV subtype of clinical depression.

The causes of melancholic-type major depressive disorder are believed to be mostly biological factors; some may have inherited the disorder from their parents.

Sometimes stressful situations can trigger episodes of melancholic depression, though this is a contributing cause rather than a necessary or sufficient cause.

Ans:A-Cerebro-vascular disorder

Important causes of depression

• General medical/neurological/endocrine disorders: – Cerebrovascular disorders, CNS infection, Parkinson’s disease, Dementia (Alzheimer’s disease), Hyperthyroidism, Hypothyroidism,Cushing’s disease or Addison’s disease, Hypopituitarism, Acromegaly, Hyperparathyroidism, Hypoparathyroidism, Postpartum period, Menses related disorders, Cancer, Tuberculosis

Ans. A.Self, B.Future & D.World and environment.

• Aaron Beck postulated a cognitive triad of depression.

Consists of-

Views about the self-a negative self precept.

About environment-a tendency to experience the world as hostile and demanding.

About future – expectation of suffering and failure.

Therapy consists of modifying these distortions.

• Cognitive triad :Beliefs about oneself, the world, and the future.

Ans. A. Delusion of grandeur

Diagnostic criteria for major depression

• 5 or more of the following symptoms should be present most of the day for at least 2 weeks: –
• Depressed mood
• Loss of interest or pleasure in all activities.
• Decrease/increase appetite or loss/gain of weight.
• Insomnia or hypersomnia (Increased or decreased sleep).
• Psychomotor retardation or agitation (decreased or increased psychomotor activity).
• Fatigue or loss of energy (weakness or lethargy).
• Feelings of worthlessness or excessive guilt.
• Diminished concentration
• Recurrent thoughts of death or recurrent suicidal ideation or suicidal attempt.