31 - mood problem / 35 - sleep disturbance Flashcards
Core sx of depression
persistent sadness or low mood;and/or
loss of interests or pleasure
fatigue or low energy
Name 2 screening tools for depression
Hospital anxiety and depression score
Patient health questionnaire
Beck depression inventory
What should you always ask about in someone presenting with depression
suicide
1/2/3rd line for depression mx?
1st line: psychotherapy such as cognitive behavioural therapy. Add an SSRI such as fluoxetine if moderate to severe.
2nd line: consider a different SSRI or a tricylic antidepressant
3rd line: try an ‘exotic’ antidepressant: venlafaxine, monoamine inhibitor etc. Continue talking therapy!
What treatment might you consider in severe depression?
Electroconvulsive therapy very effective in severe depression. Consider if not eating/sleeping
difference between mania and hypomania?
psychotic features eg delusions
Name some sx of mania
euphoria, increased feelings of self-worth, overactivity, decreased appetite, increased energy, irritability, fast speech, flight of ideas. May include delusions of grandiosity and mood congruent hallucinations.
Mx of bipolar ? Manic / depressed / maintenance
Manage mania with acute anti-psychotic (olanzapine, risperidone, quetiapine), try lithium or sodium valproate if unsuccessful.
In depressive episodes avoid non-SSRI antidepressants, be aware or inducing mania or rapid cycling. Consider anti-psychotics as above.
For maintenance use lithium as a mood stabiliser (blood test of levels to avoid kidney damage). Control of eating and sleeping patterns.
Some sx of baby blues
weepy, irritable, Transient mood lability, difficulty sleeping, disconnection with baby and anxiety.
Mx of baby blues
reassurance and counselling
medication not needed
Postnatal depression.
Sx?
How long?
Classic depressive symptoms: hopelessness, sadness, anhedonia, etc.
Last two weeks or longer.
(Dads get it too)
Rfs for postnatal depression?
baby blues, previous mental illness, usual risks for depression, unplanned pregnancy, no support network, abuse,
mx of post natal depression?
psychosocial are best
SSRIs
Refer to specialist services
Which scale for postatal depression?
edinburgh scale
…in the past days have you : felt more anxious for no good reason etc.
How long is normal grieving
6/12 - consider medication past this
