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Résidence - FM Learner > 25. Depression (87%) / Suicide (14%) > Flashcards

25. Depression (87%) / Suicide (14%) Flashcards

1
Q

La décision de prise en charge en hospitalisation ou suivi étroit dépend de quoi ?

A
  • la sévérité des symptômes
  • les caractéristiques psychotiques
  • le risque suicidaire
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2
Q

Nommez les patients à risque élevé de dépression

A
  • certains groupes socioéconomiques
  • toxicomanie
  • les femmes en post-partum
  • douleur chronique
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3
Q

près avoir posé un diagnostic de dépression, recherchez et diagnostiquez les affections psychiatriques coexistantes.

Nommez des exemples.

A
  • anxiété
  • trouble bipolaire
  • trouble de la personnalité
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4
Q

Chez les patients qui consultent pour dépression, informez-vous de la possibilité de quoi ? (2)

A
  • Violence sexuelle, physique et psychologique (passée et actuelle, avec témoins ou infligée).
  • Addiction (p. ex., usage ou abus de substances, problèmes de jeu)
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5
Q

Advenant l’échec du traitement approprié chez un patient déprimé, considérez d’autres diagnostics, comme quoi ? (3)

A
  • trouble bipolaire
  • trouble schizoaffectif
  • maladie organique
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6
Q

Chez les patients très jeunes et âgés qui consultent pour un changement de comportement, envisagez le diagnostic de quoi ?

A

Dépression

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7
Q

Durant l’élaboration d’un plan de retour au travail pour un patient traité pour dépression, il faut faire quoi?

A
  • Évaluez l’impact des symptômes résiduels sur la tolérance au travail, le rendement et la sécurité.
  • Communiquez avec le patient et l’employeur pour vous assurer que le plan est réaliste et clair
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8
Q

Devant un patient suicidaire, il faut évaluer quoi ?

A

évaluez le degré de risque (p. ex., pensées, plans précis, accès à des moyens, impulsivité) afin de déterminer une intervention et un plan de suivi appropriés (COQ)

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9
Q

Chez les patients qui se sont automutilés (p. ex. coupures), il faut faire quoi?

A
  • Évaluez le risque de suicide, mais ne présumez pas qu’il s’agit d’un geste suicidaire (les personnes qui se coupent ne sont pas toutes suicidaires, mais certaines d’entre elles le sont.)
  • Explorez la détresse émotionnelle sous-jacente.
  • Discutez d’autres stratégies d’adaptation.
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10
Q

Décrire plan pour les patients à faible risque de suicide que vous suivez dans la communauté (2)

A
  • Fournissez des instructions précises pour le suivi
  • Concevez un plan d’urgence approprié avec le patient en cas où les idées suicidaires augmenteraient.
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11
Q

Describe tx if : Persistent subthreshold depressive symptoms or mild-moderate depression

A
  • CBT
  • CCBT (computerized)
  • structured group physical activity program
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12
Q

When to tx depression with pharmaco ? (4)

A
  • Past history of moderate/severe depression
  • Long period (>2y) of subthreshold depressive symptoms
  • Persistent symptoms after other interventions
  • Moderate/severe depression in combination with CBT or IPT
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13
Q

Name possible tx for depression with : Anxious feature (4)

A
  • Mirtazapine
  • paroxetine
  • sertraline
  • venlafaxine
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14
Q

Name possible tx for depression with : Catatonic features (1)

A

Benzodiazepines

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15
Q

Name possible tx for depression with : Cognitive dysfunction (4)

A
  • Vortioxetine
  • Bupropion
  • Duloxetine
  • SSRI
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16
Q

Name possible tx for depression with : Melancholic features (2)

A
  • Paroxetine
  • Venlafaxine
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17
Q

Name possible tx for depression with : Mixed features (1)

A

Luprasidone (Latuda)

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18
Q

Name possible tx for depression with : Peripartum onset (2)

A
  • Fluoxetine in pregnancy
  • Sertraline in breastfeeding
19
Q

Name possible tx for depression with : Psychotic features (3)

A

ECT, Antipsychotic and antidepressant cotreatment)

20
Q

Name possible tx for depression with : Seasonal pattern (1)

A

Luminothérapie

21
Q

Name possible tx for depression with : Sleep disturbance (3)

A
  • Mirtazapine
  • Quetiapine
  • Trazodone
22
Q

Name possible tx for depression with : Somatic sx (2)

A
  • Duloxetine for pain/energy,
  • Bupropion for fatigue
23
Q

Name psychiatric DDX for depression (8)

A
  • Bipolar (≥1w of energy/activity with ≥3 GST PAID)
  • Depressive disorder due to another medical condition
  • Persistent Depressive Disorder (>2y of 2SIGECAPS, with no MDE)
  • Adjustment disorder with depressed mood (stressor <3mo, resolves in <6mo)
  • Grief reaction (loss, usually <3mo)
  • Schizoaffective
  • Anxiety
  • ADHD
24
Q

Name MEDICAL DDX for depression (8)

A
  • Insuffisance surrénalienne, hypercortisolisme, hypothyroïdie,
  • Mononucleosis,
  • Sclérose en plaques, maladie de Huntington, maladie de Parkinson, lupus érythémateux disséminé
  • Apnée du sommeil
  • AVC, traumatisme crânien
  • Vitamin B12 insufficiency
  • Médicaments : corticostéroïdes, interféron, antirétroviraux
  • Substance-induced
25
Name investigations for depression (9)
* CBC (anemia) * Electrolytes (creat), * TSH * B12/folate * Bilan lipidique * B-hCG * UA, urine toxicology * EKG (QT) * Neuroimaging if focal neurological sign or elderly
26
How to evaluate suicidal risk ?
* Sex (male) * Age>60yo * Depression * **Previous attempts** * **Ethanol abuse** * Rational thinking loss (psychosis) * Suicide in family * Organize plan * No spouse/support * Serious illness/pain
27
Name questions to ask in suicide evaluation (5)
* Passive vs. Active ideation * Plan (time/place), Intent (would you actually carry out this plan) * Past Attempts (Practiced/Aborted) * Access to means * Provocative/Protective factors
28
If low risk of suicide, consider safety plan. Describe possible safety plan. (5)
* Keep home environment safe (remove access to weapons) * Recognize early warning signs * Coming up with ways to cope personally with suicidal thoughts * Identify people to contact for help/distraction * Identify place to go to for safety (eg. hospital)
29
Consider framing depression as an ___ , rather than a disease, can lead to better patient outcomes
Adaptation
30
Describe lifestyle recommendations in depression
* Regular exercise, adequate food, housing, sleep * Stress management (mindfulness-based stress reduction, engaging in ≥1 pleasurable activity per day) * Avoiding substance abuse
31
How to choose antidepressant ? What to consider ?
Choose based on comorbid, previously used antidepressants, interactions
32
How to monitor depression ?
Use objective scales (eg. PHQ-9) to monitor improvement * If >20% improvement at 2-4w continue treatment and reassess at 6-8w * If <20% improvement at 2-4w -> Increase dose OR Switch to another medication OR Adjunct/Augment
33
When to adjunct/augment antidepressants ? What to use?
* If ≥ 2 antidepressant trials, well tolerated, partial response, specific symptoms to target, less time to wait (severe, functional impairment), patient preference) * Consider Aripripazole, Quetiapine, Risperidone * Other options may include lithium, thyroid hormone
34
How long to use antidepressants ?
* Maintenance until 6-9 months minimum after remission * Consider 2y minimum especially if high risk (frequent/recurrent episodes, severe, chronic, comorbid, residual symptoms, difficult to treat)
35
What happens if you stop antidepressants abruntly ?
Antidepressant discontinuation syndrome (Syndrome d'arrêt des antidépresseurs)
36
Describe : Antidepressant discontinuation syndrome (Syndrome d'arrêt des antidépresseurs)
* Symptoms include FINISH (Flu-like symptoms, Insomnia, Nausea, Imbalance, Sensory disturbance, Hyperarousal) * Typically resolves in 1-2 weeks
37
Name types of Neurostimulation
* Repetitive transcranial magnetic stimulation (rTMS) if failed ≥1 antidepressant * ECT
38
When to consider ECT ? (4)
* if severe (active suicidal ideation), psychotic, treatment-resistant * medication intoleranc * catatonic feature * rapidly deteriorating physical status (eg. malnutrition due to food refusal)
39
Name complementary tx to depression
* Light therapy (phototherapy) * Acupuncture * Sleep deprivation (total for 40h or partial allowing 3-4h of sleep per night, employed 2-4 times over one week) * Natural health products
40
Describe phototherapy (2)
* 10,000 lux for 30 minutes per day during early morning up to 6 weeks (response usually within 3 weeks) * Consider especially in seasonal, shift work, sleep dysregulation
41
Name natural health products that could be used in depression (4)
* St John's Wort (millepertuis) (care for medication interactions) * Omega-3 fatty acids (3-9g/day) or 1-2g of EPA + 1-2g of DHA per day * SAM-e * Zinc
42
Describe tx of depression in Children/Adolescents
* First line : CBT/IPT or internet-based psychotherapy * Second line : **Fluoxetine** (level 1 evidence) OR Escitalopram, sertraline, citalopram (level 2 evidence
43
Name tx for depressive sx in Perimenopausal (2)
* Desvenlafaxine (Pristiq) * CBT
44
Name tx for late-life (> 60 yo) in depression
* Level 1 evidence: Duloxetine, mirtazapine, nortriptyline * Level 2 evidence: Buproprion, citalopram/escitalopram, desvenlafaxine, sertraline, venlafaxine, vortioxetine

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