Anxiety And Depression Flashcards
Review anxiety, depression, non pharmacological and pharmacological txt
DSM Criteria for depression
A depressed mood or loss of interest or pleasure in most activities (anhedonia); occurs daily and >2 wks. Must also include 2 of the following:
Changes in weight or appetite
Insomnia or hypersomnia
Psycomotor agitation or retardation
Decreased energey
Feelings of worthlessness or guilt
Difficulties concentrating
Recurrent suicidal ideation or suicidal attempt
Prevalence of depression spectrum disorders may be as high as 38%
What 3 psychological core symptoms are most pathanomonic of depression?
Anhedonia
Dysphoria
Pessissim
What is in your differential when thinking of depression (psychological dx).
1) Persistent depressive disorder: chronic, low grade depressive symptoms of MDE continuously present for at least 2 yrs.
2) Depressive disorder due to another medical condition
3) Substance/medication induced depressive disorfer
4) Adjustment disorder
What is WTHD?
Wish to hasten death: a reaction to suffering in which the patient considers accelerating his or her death.
WTHD:
Ensure you differentiate between other psychological disorders. Name two.
1) depression
2) demoralization syndrome
Does the risk of suicidality increase in cancer patients compared to general population?
Yes. Among cancer patients, it is 4x higher.
A patient wishes to hasten death (WTHD), what communicaiton methods would be used?
1) acknowleding
2) validation
3) Listening
What assessment tool can be used to assess suicide?
SAFE-T:
Suicide Assessment Five Step Evaluation and Triage
Source CBM Table 13.1
Name 8 biological factors that could contribute to anxiety and depression.
- Hypothyroidism
- Vitamin B12 deficiency
- Electrolyte abmormalities (hypercalcemia, glucose)
- Pain, nausea
- Delirium
- Dyspnea
- Corticosteroids
- Substance use/withdrawal
- Alcohol
- Nicotene
- Street drugs
Others include Anemia, malnutrition, fatigue, insomnia, medication use/withdrawal, dyspnea
Which class of drugs are considered to be first line pharmacolgocial treatment for depression in PC.
Provide examples for each.
- Selective Serotonin Reuptake Inhibitors (SSRI)- i.e: citalopram, escitalopram, sertraline
- SNRI- selective norepinephrine reuptake inhibitor; venlafaxine, duloxitine
You are about to rx an SSRI or SNRI, for depression but note the patient is also on:
-ondansetron and metoclopramide for nausea
-fentanyl and tramadol for pain
What do you need to be cautious of?
Serotonin Syndrome
What are the symptoms of serotonin syndrome?
What two psychosocial treatments have evidence in reducing depression?
Meaning-centered therapy (MCT)
Managing cancer and living meaningfully (CALM)
How is adjustment disorder different from anxiety or depression?
Adjustment disroder present for more than 2 wks and disruption to normal functioning. In the case of adjustment disorder, the anxiety or depression is mild to moderate where it fluctuates- in anxiety and depression it is pervasive.
How is adjustment disorder treated?
Supportive counseling:
-Listen
-Validate
-Empathize
-Explore feelings, fears and goals
-Reframe hope
-Dignity conserving care
-Provide ongoing support
Generalized Anxiety Disorder
Characterized by ongoing, unrealistic & excessive worry out of proportion to the situation.
What are some side effects of anticholinergics like TCAs?
constipation
blurred vision
orthostatic hypotension
cardiac dysrrhythmias
dry mouth
urinary retention
sexual dysfunction
Medications SSRIs
What are side effects of SSRIs?
nausea
somnolence & insomnia
serotonergic s/e may include: headache, nervousness, akathesia and sweating
SSRIS
SSRI withdrawal syndrome
Abrupt discontinuation or signficant dose reduction: lightheadedness, sensory abnormalities (dysesthesias, shock like sensations), anxiety, agitation, flu like sx, sleep disturbance and delirium.
F- flu like
I- insomnia
N- nausea
I- imbalance
S- sensory
H-hyperarousal
FINISH
Examples of SSRIs
Citalopram (celexa)
Escitalopram (cipralex)
SNRI
Examples of SNRIs
Venlafaxine (Effexor) monitor BP occasionally, has short 1/2 life, half dose in renal impairment. B/C of its short half life, patients are at inc risk of withdrawal syndrome when no longer able to take oral meds.
Duloxetine (Cymbalta)- also indicated as an adjuvant analgesic in the management of neuropathic pain
How does demoralization syndrome differ from depression?
Absence of anhedonia.
It is a form of existential distress, in which meaninglessness, hopelessness and helplessness predominate
Txt with supportive care
Define panic disorder
The presence of recurrent and unexpected panic attacks with at least 1 month of persistent worry about having another panic attack, or worry about the consequences of having another panic attack or a significant change in the individual’s behavior due to the panic attack.
Panic attacks are distinct episodes of intense anxiety, lasting minutes, peak within 10mins and are characterized by 4 or more of the following:
chills
diaphoresis
derealization/depersonilzation
fear of loss of control or sanity
fear of dying
shaking
paresthesia
lightheaded
nausea
SOB
chest tightness
choking
palpitations.
Generalized anxiety disorder
Characterized by excessive and uncontrollable worry about many different things on most days for a least 6 months, associated with restlessness, fatigue, difficulty concentrating, muscle tension, or sleep disturbance.
