CSI 11- Depression Flashcards
What is the DSM criteria for diagnosing depression
One CORE symptom AND/OR 5 other minopr symptoms.
Must be persistent on most days for 2 weeks.
Symptoms are:
what is framework for assesing pt with mental health conditions (like depression) on whether they are at most risk.
always ask about THOUGHTS and ACTIONS
what is parasuicide
Taking your own life WITHOUT THE INTENTION OF IT.
Explain the biopsychosocial model for the aetiology of depression.
draw the diagram wiht examples
There could be a lot of crossover and most use holsitic approach to deal with it. E.g. stress in mother could cause epigenetics changes in baby which could increase chance of depression.
in how many pts with depression is serotonin present in
onlky 50% in which there’s a low amount.
there are clinical history to fall back on
Using the adverse childhood experience model, which condtions/living states are they STATISTICALLY more likely to develop?
- Binge drinking
- Heavy drinking
- Current smoking status
- High risk HIV incidence
- Depression
- Disability caused by poor mental health
- Use of special equipment due to disability
in research what kind of bias must we look for and why?
Bias camn occur anywhere from study design to colleciton, analysis and publicaiton of data.
E.g are:
- confirmation
- recall
- selection bias
Below is a serotonin neuron, give the number and what they do
- SSRI- most common
- Post synaptic serotonin receptor agonist
- Tryphotan hydroxylase inhbitor- DOES NOT HELP WITH DEPRESSION
- Monoamine oxidase inhibitor
- Serotonin auto-receptor antagonist- decrease serotonin release normally due to negative feedback.
Anti-depressant drugs try to increase serotonin receptors in synaptic cleft
What does a TCA do?
it inhibits reuptake of serotonin AND Noradrenaline and hence has worse side effects than SSRI.
Give as much Mechnaistic antidpressant drugs
- Monoamine oxidase inhibitors
- TCS
- SSRI
- NDRI
- Noradrenaline and dopamine releasing agents
- SNRI
What do studies say is the relationship between glutamate and depression.
How about the hippocampus ?
Glutamate- NEGATIVE relationship
hippocampus- it reduces with depression, serotonin increases it but it takes time. Hence pt won’t feel better for sometime after taking the drugs.
What crucial information must pts know who are going on antidepressant drugs
what do you give pts who are resistant to normal antidepressants drugs
ACT
KETAMINE (faster timing of effects and it’s a depressant): glutamate NMDA receptor blocker
Why are the 6-8 weeks after starting antidepressants crucial;
The drugs are starting to work at this time and as they are coming out of this mental state, this is the time period where they could start having suicidal tendencies.
It is important to monitor and ASK questions
Explain the concept of social prescribing
What could you get from the video of Am?
- fiddling with hoodies
- stay away from friends
- self harm thoughts
- eats too much when low
what is CBT?
Cognitive behavioural therapy (CBT) is a type of talking treatment which focuses on how your thoughts, beliefs and attitudes affect your feelings and behaviour, and teaches you coping skills for dealing with different problems.
It combines (examining the things you think) AND (examining the things you do).
What other mental health issues can CBT be used to treat?
anxiety, depression, bipolar, OCD or schizophrenia.
what theory is CBT based on?
if you have negative thioughts then it’d affect your behaviour. it can elad to a vicious cycle.
How does CBT work?
In CBT you work with a therapist to identify and challenge any negative thinking patterns and behaviour (now or in the past) which may be causing you difficulties. In turn this can change the way you feel about situations, and enable you to change your behaviour in future.
what can cause depression
It could be a life changing event.
Maybe family history or maybe no obvious reason.
Biopsychosocial model.
What are the different therapeutic methods to help with depression
For MILD: do “watchful waiting” to see if it goes. You could go to self help[ groups and exercise.
For MILD that isn’t improving: CBT and antidepressants.
Moderate to severe- combiantion of CBT and antidepressants
Severe: specialist mental heatlh team.
What lifestyle changes can you make to help wiht depression
- getting more exercise
- cutting down on alcohol,
- giving up smoking and
- eating healthily
- Reading self help book
- Join support group
What are SOME of the PHYSICAL symptoms of depression?
- feeling constantly tired
- sleeping badly
- having no appetite or sex drive
- various aches and pains.
what are some of the reasons for the monoamine hypothesis?
Why isn’t this prevalent anymore
- Effects of reserpin e(vascular disease drug) on bofy
- Pharamacological mechanisms of antidepressant drugs
Not exciting anymore as monoamine depletion didn’t precipitate depression in healthy patients.
Hence Monoamine could play modualtory roles such that is affects other biological systems (intracellurlar signals ) or must be oin context of stressors.
where does TCA act on?
- inhibiting presynaptic norepinephrine reuptake transporters
- inhibiting presynaptic serotonin reuptake transporters
- blocking postsynaptic adrenergic α1 and α2 receptors -SIDE EFFECTS
- blocking postsynaptic muscarinic receptors- side effects
- blocking postsynaptic histamine H1 receptors- side effects
what are the some of the side effects of TCA
dizziness, memory impairments, and drowsiness,
Explain the pharmacology of SSRI and give side effects.
20-1500 fold for inhibitng serotonin over noradrenaline at their repsective re-uptake proteins.
Doesn’t bind to other post-synaptic receptors even serotoinin,
MOST COMMON Side effects are:
- nausea,
- insomnia,
- sexual dysfunction.
Explain the pharmacology of SNRI.
affects BOTH serotonin and noradrenaline reuptake proteins.
what questions are asked to get a sense of Adverse childhood experience?
Why was MOA oxidase inhibitors reduced in prescriptions for pts with depression
Restricitve diet - so much that pts hate it and go off it.
Also too much side effects.
Can still be use if pts is very resistant to other treatments
Whats Amy pt persona
- likes art
- likes fried chicken
- takes 40mg citalopram a day and sumitrapin for migraines
- locket- from dead grand-mum
- exercise
