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Anxiety And Depression > Anxiety And Depression > Flashcards

Anxiety And Depression Flashcards

Review anxiety, depression, non pharmacological and pharmacological txt

1
Q

DSM Criteria for depression

A

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%

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2
Q

What 3 psychological core symptoms are most pathanomonic of depression?

A

Anhedonia
Dysphoria
Pessissim

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3
Q

What is in your differential when thinking of depression (psychological dx).

A

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

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4
Q

What is WTHD?

A

Wish to hasten death: a reaction to suffering in which the patient considers accelerating his or her death.

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5
Q

WTHD:
Ensure you differentiate between other psychological disorders. Name two.

A

1) depression
2) demoralization syndrome

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6
Q

Does the risk of suicidality increase in cancer patients compared to general population?

A

Yes. Among cancer patients, it is 4x higher.

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7
Q

A patient wishes to hasten death (WTHD), what communicaiton methods would be used?

A

1) acknowleding
2) validation
3) Listening

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8
Q

What assessment tool can be used to assess suicide?

A

SAFE-T:
Suicide Assessment Five Step Evaluation and Triage

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9
Q

Source CBM Table 13.1

Name 8 biological factors that could contribute to anxiety and depression.

A
  1. Hypothyroidism
  2. Vitamin B12 deficiency
  3. Electrolyte abmormalities (hypercalcemia, glucose)
  4. Pain, nausea
  5. Delirium
  6. Dyspnea
  7. Corticosteroids
  8. Substance use/withdrawal
  9. Alcohol
  10. Nicotene
  11. Street drugs

Others include Anemia, malnutrition, fatigue, insomnia, medication use/withdrawal, dyspnea

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10
Q

Which class of drugs are considered to be first line pharmacolgocial treatment for depression in PC.

Provide examples for each.

A
  1. Selective Serotonin Reuptake Inhibitors (SSRI)- i.e: citalopram, escitalopram, sertraline
  2. SNRI- selective norepinephrine reuptake inhibitor; venlafaxine, duloxitine
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11
Q

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?

A

Serotonin Syndrome

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12
Q

What are the symptoms of serotonin syndrome?

A
Also included in CBM: sweating, dilated pupils, confusion
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13
Q

What two psychosocial treatments have evidence in reducing depression?

A

Meaning-centered therapy (MCT)

Managing cancer and living meaningfully (CALM)

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14
Q

How is adjustment disorder different from anxiety or depression?

A

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.

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15
Q

How is adjustment disorder treated?

A

Supportive counseling:
-Listen
-Validate
-Empathize
-Explore feelings, fears and goals
-Reframe hope
-Dignity conserving care
-Provide ongoing support

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16
Q

Generalized Anxiety Disorder

A

Characterized by ongoing, unrealistic & excessive worry out of proportion to the situation.

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17
Q

What are some side effects of anticholinergics like TCAs?

A

constipation
blurred vision
orthostatic hypotension
cardiac dysrrhythmias
dry mouth
urinary retention
sexual dysfunction

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18
Q

Medications SSRIs

What are side effects of SSRIs?

A

nausea
somnolence & insomnia
serotonergic s/e may include: headache, nervousness, akathesia and sweating

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19
Q

SSRIS

SSRI withdrawal syndrome

A

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

20
Q

Examples of SSRIs

A

Citalopram (celexa)
Escitalopram (cipralex)

21
Q

SNRI

Examples of SNRIs

A

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

22
Q

How does demoralization syndrome differ from depression?

A

Absence of anhedonia.

It is a form of existential distress, in which meaninglessness, hopelessness and helplessness predominate

Txt with supportive care

23
Q

Define panic disorder

A

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.

24
Q

Generalized anxiety disorder

A

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.

25
Q

Other than medications, what techniques can be used to abort panic attacks?

A

Deep breathing
Visual imagery
Progressive relaxation strategies

26
Q

Fot patients with anticipatory nausea and vomiting, what non pharmacologcial techniques are beneficial?

A

CBT
Relaxation techniques

27
Q

Depression (Oxford)

What comorbidites associated with depression increase the risk for malignancies?

A

Obesity
Smoking
Alcohol
Physical inactivity

depression inc risk of obesity in F; inc risk breast & endometrial ca

28
Q

Depression (Oxford)

True or False:
Depression affects treatment adherence

A

True

Depressed pts were 3x as likely to be non adherent than non-depressed

29
Q

Depression (Oxford)

Name 9 risk factors for depression in palliative medicine

A
  1. Female Sex
  2. Younger Age
  3. Past hx and family hx of depression
  4. Poor social support, including family dysfunction
  5. Pain and poor symptom control
  6. Illness and treatment related factors, including medications
  7. Perception of poor prognosis
  8. Declining functional status
  9. Unaddressed existential concerns
30
Q

Depression (Oxford)

Name some depression screening tools that can be used in palliative medicine.

A
  1. The Patient Health Questionnaire- 9 (PHQ-9)
  2. Distress Themometer (single question- ‘are you depressed?’
  3. Beck Depression Inventory (BDI)
  4. General Health Questionnaire-28 (GHQ-28)
31
Q

Demoralization syndrome (Oxford Table 13.2.3))

What is the diagnostic criteria for demoralization syndrome?

A
  1. Loss of meaning or purpose in life
  2. Loss of hope for a worthwhile future
  3. Sense of being trapped or pessimistic
  4. Feel like giving up
  5. Unable to cope with the predicament
  6. Socially isolated or alienated
  7. Potential for desire to die
  8. Phenomena persist for more than 2 wks; may be comorbid or distinct from depressive disorders
32
Q

Demoralization (Oxford)

What screening tools are available to identify demoralization syndrome?

A

-1. 24- Item Demoralization Scale (DS)
2. 16-Item Demoralization Scale II (DS II)

33
Q

Suicide (Oxford)

What are risk factors for suicide?

A

Depression
Demoralization
Pain
Poor Symptom control
Loss of self worth and control
Social isolation
Delirium
Alcohol or other substance abuse
Past hx of psychiatric disorder

Lung & H&N ca are assoc with greater morbidity & inc rates suicide

34
Q
A
35
Q

Suicide (Oxford)

Which has greater risk of suicidal thinking: depression or demoralization syndrome?

A

Demoralization syndrome

36
Q

Depression (Oxford)

What is considered to be first line medication treatment for depression?

A

SSRI

Citalopram, escitalopram, sertraline,(zoloft) paroxetine (paxil), fluoxe

37
Q

Depression

Trazodone, belongs to what class of antidepressants?

A

SARI (serotonin antagonist and reuptake inhibitor)

Target 5HT (serotonin)

38
Q

Duloxetine, Venlafaxine belong to what class of antidepressants?

A

SNRI (Serotonin, noradrenaline reuptake inhibitor)

Targets serotonin (5HT3) & noradrenaline (NA)

39
Q

Depression

Buproprion belongs to what class of antidepressants?

A

NDRI (noradrenaline dopamine reuptake inhibitor)

Targets noradrenaline (NA) and dopamine (DA)

40
Q

Depression

What class of antidepressants does amitriptyline, doxepin and nortriptyline belong?

A

Tricyclic antidepressants

Targets H1, alpha 1, M, 5HT, NA

41
Q

What class of antidepressant does mirtazapine belong?

A

NaSSA (noradrenaline serotonin specific antidepressant)

H1, alpha 2

42
Q

Depression

Tamoxifen is a selective estrogen receptor modulator

Abiraterone reduces testosterone in men with prostate ca

Why do you need to be cautious in starting an antidepressant in patients on either or these medications?

Used in estrogen receptor positive bresast ca

A

Most common antidepressants induce inhibition of CYP2D6- the enzyme catalysing the conversion of tamoxifen and abiraterone to its active form.

Citalopram and escitalopram are less potent inhibitors of CYP2D6- so favor these over the other SSRIs.

43
Q

Antidepressants are relatively contradicted in what chemotherapy agent?

A

procarbazine

Alkylating agent
Used to txt Hodgkins Lymphoma & brain Ca.

44
Q

Depression (Oxford)

When would medication be indicated for management of demorazlization syndrome?

A

If comorbid major depression exists. When demoralization occurs without comorbid depression, the mainstay of txt is psychotherapeutic.

45
Q

Demoralization (Oxford)

Name two psychological treatments for demoralization.

A

1) Dignity therapy
2) Meaning Centered therapies

Dignity therapy seeks to celebrate life & affirm the worth of each lived person.

46
Q
A

Anxiety And Depression (2 decks)

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