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Y2 - CSI > Amy - Depression > Flashcards

Amy - Depression Flashcards

1
Q

What does the case video with Amy discuss in terms of her symptoms, and what she is doing currently?

A

Situation = better, injunction against ex, ex no longer in the picture
Feels rubbish - ongoing
Support from mum and dog, her and her mum get along okay
Texts friends, don’t talk about troubles with friends
Doesn’t get out much - can’t be bothered, too much effort, doesn’t think she’ll enjoy herself
Working at the salon
Couple days off in the last month
Poor sleep - wakes up early even when she’s tired
Over-eat during her lows - junk food
Self harm thoughts - but no actions taken
Cetanoprem everyday - anti-depressant (best one for her)
Couple of courses and 1 a year ago in psychotherapy

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2
Q

What is clinical depression?

A

Persistent low mood

Illness of the mind

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3
Q

What are the psychological, physical and social symptoms of depression?

A 
Psychological: Lasting feelings of unhappiness and hopelessness
Low self-esteem 
Feeling guilt-ridden
Feeling irritable / intolerant of others
Finding it difficult to make decisions 
Feeling anxious / worried 
Having suicidal thoughts / self-harm

Physical: Constant tiredness, poor sleep, loss of appetite / sex drive, various aches / pains

Social: Losing interest in hobbies, avoiding friends / social contact, difficulties in your home or work life

Co-morbid with anxiety, stress etc.

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4
Q

What are the 3 severities of depression?

A

Mild depression – has some impact on your daily life
Moderate depression – has a significant impact on your daily life
Severe depression – makes it almost impossible to get through daily life; a few people with severe depression may have psychotic symptoms

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5
Q

How can grief and depression be distinguished?

A

Grief - natural process to loss, they can let go of their sadness and loss to look forward to the future
Depression - constantly feel sad, difficulty finding enjoyment / happiness about the future

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6
Q

What are some other types of depression?

A

Post-natal depression - new mothers or fathers after having a baby
Bipolar disorder - spells of depression followed by excessively high mood (mania)
SAD (seasonal affective disorder) - winter depression

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7
Q

What causes depression?

A

Sometimes there is a trigger
Family history of depression = risk factor
Personality traits e.g. low self-esteem, self-critical etc. Loneliness
Giving birth
Alcohol and drugs
Illness - life threatening or longstanding diseases, hypothyroidism
Sometimes there is no obvious reason or trigger

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8
Q

When is the time to seek help .g. speaking to the GP?

A

If experiencing symptoms of depression most of the day, every day, for 2 weeks
Find your mood is affecting daily life e.g. work, relationships
Having suicidal or self-harming thoughts

GP can ask about your general health and things affecting you mentally to diagnose you with depression and let you know how severe it is

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9
Q

How can depression be treated?

A

Lifestyle changes = self-help groups, exercising, cutting down alcohol, smoking, eating more healthily
Talking therapies = CBT
Medications = anti-depressants

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10
Q

What are the treatments recommended for mild depression?

A

Exercise, self-help groups / books / online forums, mental health apps

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11
Q

What are the treatments recommended for mild to moderate depression?

A

Talking therapy / CBT / counselling

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12
Q

What are the treatments recommended for moderate to severe depression?

A

Anti-depressants
Combination therapy - antidepressants plus talking therapy
Referral so a team of psychologists, psychiatrists, specialist nurses and occupational therapists can help

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13
Q

What are the different types of talking therapy and briefly explain each one?

A

CBT - concentrates on challenging and eventually changing thought patterns, behaviours

Online CBT - CBT delivered through a computer rather than ftf with a therapist

Interpersonal therapy (IPT) - focuses on relationships with others ad problems within those relationships

Psychodynamic psychotherapy - psychoanalytic therapist encourages you to say whatever is on your mind

Counselling - helps you think of the problems in your life and how to deal with them

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14
Q

How should anti-depressants be taken?

A

Need to try different types until one works
See GP or specialist nurse every week for at least 4 weeks to see how they’reworking
Need to take up to 4-6 months after symptoms have eased
Some take up to 5 years or more
Not addictive, may get withdrawal symptoms

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15
Q

What are SSRIs and how do they work?

A

Selective serotonin reuptake inhibitors = antidepressants e.g. paroxetine (Seroxat), fluoxetine (Prozac) and citalopram (Cipramil)
Increase serotonin levels
Work as well as older anti-depressants but with fewer side effects e.g. headaches, dry mouth

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16
Q

What are TCAs and how do they work?

A

Tricyclic antidepressants - e.g. imipramine (Imipramil) and amitriptyline
Raising serotonin and noradrenaline levels in the brain
Side effects include dry mouth, blurred vision, constipation, problems passing urine, sweating, feeling lightheaded and excessive drowsiness but ease within 10 days

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17
Q

What are SNRIs and how do they work?

A

Serotonin-noradrenaline reuptake inhibitors - antidepressants
e.g. Venlafaxine and duloxetine
SNRI can be more effective than an SSRI, but not routinely prescribed because they can lead to a rise in blood pressure

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18
Q

What are the withdrawal symptoms of antidepressants?

A

Usually mild, resolves in 1-2 weeks

An upset stomach, flu-like symptoms, anxiety, dizziness, vivid dreams at night, sensations in the body that feel like electric shocks

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19
Q

What is Mindfulness?

A

Paying closer attention to the moment

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20
Q

What is St. John’s Wort?

A

Herbal treatment, not recommended by doctors

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21
Q

What is Brain Stimulation?

What are the 3 main brain stimulations used to treat depression?

A

Electromagnetic currents used to stimulate certain areas of the brain to try and improve symptoms of depression

Transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT)

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22
Q

What is tDCS?

A

Transcranial direct current stimulation delivers low constant current through 2 electrodes placed on the head

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23
Q

What is rTMS?

A

Repetitive transcranial magnetic stimulation - place electromagnetic coil against head and it sends repetitive magnetic energy impulses

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24
Q

What is ECT?

A

Electroconvulsive therapy - more invasive type of brain stimulation, carefully calculated electric current is passed to the brain through electrodes placed on the head

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25
Q

What is lithium and why does it help with depression?

A

2 forms, usually take one: either lithium carbonate and lithium citrate, tagets CNS and balances mood

26
Q

What do you do if you’re living with depression?

A 
Take your medications as prescribed
Healthy diet and exercise regularly 
Mindfulness
Talk out your problems 
Smoking, drugs and alcohol cessation 
Try get back to work ASAP
27
Q

What are some warning signs for self-harm / suicide?

A

Making final arrangements, such as giving away possessions, making a will or saying goodbye to friends
Talking about death or suicide
Self-harm, such as cutting their arms or legs, or burning themselves with cigarettes
A sudden lifting of mood, perhaps decision to attempt suicide makes them feel better

28
Q

What are the symptoms of severe depression?

A 
Sad and hopeless for most of the day, every day 
Fatigue (exhaustion)
Loss of pleasure in things
Disturbed sleep
Changes in appetite
Feeling worthless and guilty
Being unable to concentrate or being indecisive
Thoughts of death or suicide
29
Q

What is psychotic depression and what causes it?

What are some symptoms of psychosis?

A

Severe depression alongside episodes of psychosis - usually triggered by a traumatic event

Delusions - thoughts or beliefs unlikely to be true
Hallucinations - hearing or seeing things that are not actually there

30
Q

What are the treatment options for psychotic depression?

A

Medicine – a combination of antipsychotics and antidepressants

Psychological therapies – the 1-to-1 CBT has proved effective in helping some people with psychosis

Social support – support with social needs, such as education, employment or accommodation

ECT

31
Q

What is the biopsychosocial model?

A

Suggests biological, psychological and social factors are interlinked to promoting health or causing disease
Mind and body are interdependent

32
Q

How can the biopsychosocial model b applied to depression?

A 
Bio = disturbed endocrine (hormone), immune, and neurotransmitter system functioning, genetic vulnerability
Psych = negative patterns of thinking, deficits in coping skills, judgment problems, and impaired emotional intelligence
Social = traumatic situations, early separation, lack of social support, or harassment (bullying)
33
Q

What are the symptoms of depression shown in Amy?

A 
Slow speaking
Disturbed sleep
Avoiding friends contact / social withdrawal 
Anhedonia - lack of enjoyment in hobbies
Overeating 
Work difficulties - couple days off
Nervous fiddle 
Apathy 
Low mood
34
Q

What other symptoms of depression may we wish to ask about for Amy?

A

Ask about physical symptoms e.g. bowel movements, libido, menstrual cycle
Suicidal thoughts?
Relationships?
Weight loss or gain?

35
Q

What is major depressive disorder? (MDD) How is it categorised?

How can MDD be diagnosed (using NICE guidelines)? What symptoms are required?

A

Clinical depression
Mild, Moderate, Severe

At least 1 core symptom - persistent sadness or low mood, or anhedonia daily for 2 weeks

And then an additional 5 associated symptoms: poor concentration, indecisveness, fatigue, disturbed sleep, feelins of worthlessness, suicidal thoughts or acts, appetite changes

36
Q

What does the NICE framework use?

A

The DSM

37
Q

What are 3 other risk factors that manifest as thoughts and/or actions?

How relevant is it in depression? Which are more common in what demographic?

A
  1. Self-harm
  2. Suicide
  3. Harm to others

1 and 3 more important in psychotic disorders, 2 important equally in depression and psychotic disorders

1 = females aged 17-19
2 = males aged 40-59
38
Q

What factors in the patient’s environment could be affecting the likelihood of the 3 risk factors, and vice versa?

A 
Occupation
Alcoholism
Smoking 
Drug abuse
Family 
Relationships 
Abuse 
Where in the world?
Demographics (sex, culture, etc.)
39
Q

What are some facts about self harm?

  1. History self-harm is associated with…?
  2. Self-harm is a way of…?
  3. Other forms of self-harm include…?
  4. Self-harm can involve…?
  5. Suicide is…?
A
  1. History of self-harm is associated with an increased risk of suicide
  2. Self-harm is usually a way of coping or expressing difficult feelings
  3. May take other forms such as punching a wall, banging one’s head against a wall, or even getting into fights
  4. Can involve cutting, hair-pulling, scratching etc.
  5. Suicide is a fatal act of self-harm initiated with the intention of ending one’s own life
40
Q

Place the factors below into Bio, Biopsych, Psych, Biosocial, Psychosocial or Social categories:

Genetic vulnerability
Physical health
Sleep
Diet/lifestyle
Self-esteem
Attitudes / beliefs
Trauma 
Family circumstance 
Financial Security
A

Bio = Genetic vulnerability
Physical health

Biopsych = Sleep

Psych = Self-esteem

Biosocial = Diet and lifestyle

Psychsocial = Trauma, attitudes / beliefs

Social = Family circumstance, financial Security

41
Q

What are ACEs?

A

Adverse childhood experiences

ACEs = potentially traumatic events during childhood that affects development and perceiving of the world

42
Q

Which of the adult behaviours below are highly linked to ACE influence according to the study we looked at?

Binge drinking
Heavy drinking
Smoking status
High risk HIV behaviour
Obesity
Diabetes
MI 
CHD 
Stroke
Depression
Disability caused by poor health
Use of special equipment because of disability
A 
Binge drinking 
Heavy drinking 
Smoking status 
High risk HIV behaviour 
Depression 
Disability caused by poor health 
Use of special equipment because of disability
43
Q

What is BRFSS?

A

Questionnaire that asks about traumatic events in childhood, comprised of 11 questions

44
Q

What is the difference between heavy drinking and binge drinking?

A

Binge drinking: large alcohol consumption within a set time. More than 8 units in a single session for males, more than 6 units in a single session for females

Heavy drinking: pattern of binge drinking that occurs frequently

45
Q

What is the difference between statistical and clinical significance?

A

May not show statistical significance, but there may be improvement etc. at the end of the trial (clinical significance)

Or perhaps there is statistical significance, but the value added clinically is very minimal and is not economically feasible

46
Q

Which drugs would have anti-depressant effects?

Which of these would not?

SSRIs
Post-synaptic serotonin receptor agonist
Tryptophan hydroxylase inhibitor 
Monoamine oxidase inhibitor 
Serotonin auto-receptor antagonist
A

Anti-depressant effects:
SSRIs - prevents reuptake of serotonin, leaves serotonin in synapse longer
Serotonin auto-receptor antagonist - receptor decreases serotonin release
Monoamine oxidase inhibitor - serotonin builds up in the pre-synaptic terminal, conc. gradient affected so serotonin leaves at a slower rate

No anti-depressant effects:
Tryptophan hydroxylase inhibitor - inhibits serotonin production in presynaptic neuron
Post-synaptic serotonin receptor agonist - acts as serotonin and activates same receptors

47
Q

What is the monoamine hypothesis?

A

Developed for TB - noticed it has anti-depressant properties
Blocks monoamine oxidase

Began theory that serotonin is involved in depression

48
Q

What should patients be told before starting anti-depressants?

A

Suicidal thoughts
Serotonin syndrome (high levels of serotonin left in the synapse leading to tremors, parkinson’s like symptoms)
Nausea
Drowsiness
Lowered libido / sexual dysfunction
Drugs may not work, usually takes several weeks to kick in
Sudden stop = side effects; wean drugs slowly
Serotonin = hippocampal regrowth = takes time
Careful with interactions of other medications
Symptoms may worsen initially - anxiety and agitation in the first few week
Need to continue until 6mo after symptoms ease

49
Q

What is social prescribing?

A

Recognises health is holistic (social, economic, environmental factors) - addresses patient’s needs in a holistic manner

Refer patients to local, non-clinical services

Prescribing activity schemes e.g. support groups (e.g. family issues, finance issues), exercise groups, cooking classes, art sessions etc.

50
Q

Christina’s story - Depression?
What depressive symptoms did she experience?

What did the doctor prescribe her?

What did she do on her own that helped?

What helped her?

A

Fear, panic, lack of concentration, feeling isolated even when around people, feeling disintegrated, rashes, headaches, exhaustion, emotionally dead, sleeping problems

Benzodiazepines (found them v. helpful), sleeping tablets

Self-help group, other forms of expression e.g. with art

Talking with people who are accepting and understanding

51
Q

How do monoamine oxidase inhibitors (MAOIs) work as anti-depressants?

A

Inhibits the enzyme monoamine oxidase = increases the amount serotonin released into the synapse

52
Q

How do tricyclics (TCAs) work as anti-depressants?

A

All have a 3 ring structures

Block norepinephrine and serotonin reuptake channels so they stay in the synapse for longer

53
Q

How do SSRIs work as antidepressants?

A

Similar to TCA, except only block serotonin reuptake channels on very specific receptors

54
Q

How can you decide which anti-depressant to give, if they are all more or less equally effective?

A

Decide based on side effects
MAOIs and TCAs = 1st generation anti-depressants = more side effects
SSRIs = 2nd generation = fewer side effects

55
Q

What are the side effects for MAOIs?

A

Monoamine NTs = epinephrine, norepinephrine, serotonin, dopamine
Drugs increase NT availability all over the body
Drug interactions - MAOIs also inhibit enzyme in liver that helps metabolise medications
MAOIs can also prevent some food breakdowns - restrictive diet

56
Q

What are the side effects of TCAs?

A

Only act on some monoamine NTs - norepinephrine and serotonin
Can affect histamines = sluggishness
Higher levels = toxicity = cardiac arrest (suicide attempt)
Prescribed for bipolar disorders (rather than SSRIs which can trigger manic episodes)

57
Q

What are the side effects of

A

First choice - effective but fewer side effects
Most selective on what they act on - only serotonin but still act everywhere in the body
Sleeping problems, weight gain, sexual dysfunction
Serotonin syndrome

58
Q

What are some new types of anti-depressants / anti-depressant combos?

A

SSRIs and SNRIs (like more selective TCAs)
NDRIs (norepinephrine and dopamine reuptake inhibitors)
NDRAs (norepinephrine and dopamine releasing agents)

59
Q

CBT reading:

A

Same as A level psychology notes

60
Q

What is social prescribing?

A

Enables primary care professionals to refer people to a range of local, non-clinical services
Designed to support people with a wide range of social, emotional or practical needs, and many schemes are focused on improving mental health and physical well-being

61
Q

Effectiveness of social prescribing?

Issues with evidence supporting social prescribing?

A

Can lead to a range of positive health and well-being outcomes - improvement in quality of life and emotional wellbeing

However, many studies are small scale, outcomes difficult to measure (qual instead of quan), do not have a control group and focus on progress rather than outcomes

Determining the cost, resource implications and cost effectiveness of social prescribing is difficult

Y2 - CSI (8 decks)

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