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MRCPSYCH_Paper B_MENTOR & More_Dr. ART > Depression - 1 > Flashcards

Depression - 1 Flashcards

1
Q

what are depression types recognised by ICD11?

A

Single depressive Episode
Recurrent Depressive Disorder
Dysthymic Disorder
Mixed depressive and anxiety disorder

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2
Q

What are depression types recognised by DSM-5?

A

Disruptive mood dysregulation disorder (temper outburst)
Major Depressive disorder
Persistent depressive disorder (dysthymia)
Premenstrual Dysphoric disorder

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3
Q

Where is “Mixed depression with anxiety disorder is located in DSM-5?

A

It is coded by the ‘with anxious distress’ qualifier.

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4
Q

Biological Symptoms of depression?

A

Neurovegetative
Somatic
Vital
Melancholic
Endogenomorphic

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5
Q

what is difference between dsm5- and icd 11 when it comes to psychotic symptoms of depression?

A

In ICD-11, only moderative and severe can have psychotic symptoms
In DSM-5 psychotic symptoms are independent of severity

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6
Q

How long ICD-11 requires Depressive episodes and DSM 5 requires MDD to last?

A

2 weeks at least

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7
Q

Symptom clusters in ICD-11 depressive episodes

A

Affective
Cognitive behavioural
Neurovegetative

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8
Q

Symptoms in affective cluster of ICD 11 depressive episode

A

Depressed mood
Lack of interest or inability to experience pleasure ( including sex)

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9
Q

Symptoms in cognitive behavioural cluster of the ICD 11 depressive episode

A

Self worthless ness
Lack of concentration
Hopelessness
Suicidal ideation and thoughts of dying

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10
Q

Symptoms in neurovegetative cluster of the ICD 11 depressive episode

A

sleep disturbance
appetite disturbance
aggitation/irritability
lack of energy

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11
Q

how many symptoms are required in total to qualify in icd 11 depressive disorder

A

5 at least

one must be from affective

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12
Q

Difference between DSM 5 and ICD 11 for MDD/Depressive episodes?

A

Almost the same, although ICD 11 uses clusters for the same nine symptoms on DSM 5.

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13
Q

Difference between DSM 5 and ICD 11 for recurrent depressive disorder

A

ICD 11 requires at least 2 episode of depressive episodes separated by several months (not specified) without significant mood disturbance

DSM -5 requires at least two episodes separated by precisely two consecutive months without meeting criteria for MDD

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14
Q

Dysthymic disorder in ICD11

A
  • Recurrent depressive mood (feeling down) for at least 2 years with individual 9 symptoms of depressive episode without having 2 weeks of sufficient symptoms to meet depressive episode criteria.
  • No longer than 2 consecutive months of symptom-free reported.
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15
Q

Dysthymic disorder difference between ICD 11 - DSM 5

A

DSM 5 - specifies 1 year for children and adolescents (both say it this group there is more irritability for mood)

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16
Q

Mixed depressive and anxiety disorder

A

at least 2 weeks of several symptoms of depression and anxiety, but none meet the criteria for depressive episodes or anxiety or fear-related disorders.

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17
Q

How does NICE guidlines (ng222) grades derpession?

A

MOre severe and less severe

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18
Q

should you offer antidepressant for less severe cases routinely?

A

no, unless preferred by patient

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19
Q

what are first line of antidepressants for less severe cases who request medication?

A

SSRIs

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20
Q

for less severe depression what antidepressant should be avoided and why?

A

TCA (except lofepramine) because they’re easy to overdose

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21
Q

which TCA is not easy to overdose?

A

Lofepramine

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22
Q

what if there was no response to first SSRI?

A

1st - switch to another medication in the same class or another like SNRI ( or TCA and MAOIs in 2ndary care)
2nd - vortioxetine
or
3rd- antipsychotic + SSRI, Or Mirtazapine + SSRI or Lithium + SSRI
4th- Consider augmentation of SSRI with ECT or lamotrigine

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23
Q

when can a clinician consider vortioxetine?

A

when two antidepressant did not work at all or properly

24
Q

Treatment based on PHQ- 9 <16 (Less severe; Mild and subthreshold)

A
  • Self-help (Guided)
    -Group or indie CBT
    -Group or indie Behavioural activation
    -Group Exercise
    -Group Mindfulness and meditation
    -IPT
    -SSRI
    -Counselling
    -STPP (short term psychodynamic psychotherapy)
    -Combined CBT + Antidepressant
25
Q

Treatment based on PHQ- 9 >16 (Less severe; Moderate and severe)

A

-Combined CBT plus antidepressant
-Individual CBT
-Individual behavioural activation
-Antidepressants
-Individual problem solving
-Counselling
-Short-term psychodynamic psychotherapy (STPP)
-Interpersonal psychotherapy (IPT)
-Guided self-help
-Group exercise

26
Q

after the prescription of antidepressants, when should the treatment be reviewed?

A

if 18-25 in 1 week
or if there is a concern about suicide.

Otherwise in 2 weeks

27
Q

how long antidepressants should be taken after remission achieved?

A

6 months to prevent relapse

Or longer if there is higher risk for relapse

28
Q

How long you should wait before considering changing the meds?

A

4-6 weeks

29
Q

suitable antidepressant for patient on NSAIDs?

A

Mirtazapine
Reboxetine
Trazodone
Moclobemide

30
Q

antidepressant that should be avoided in patient on NSAIDs?

A

SSRIs/ SNRIs due to GI bleeding

31
Q

when can SSRI/SNRI be used in patients on NSAIDs and how?

A

when there is no suitable alternative

Use gastroprotection e.g. PPIs

32
Q

Suitable antideprssant for patients on warfarin

A

Mirtazapine
Reboxetine
Trazodone

33
Q

antidepressant that should be avoided in patient on Warfarin?

A

SSRI/SNRI, TCAs

34
Q

Suitable SSRIs for patients on Heparin

A

Citalopram, Sertraline and escitalopram

35
Q

other suitable antidepressant for patients on heparin?

A

Mirtazapine
Trazodone (SARI)
Reboxetine (SNRI)

36
Q

antidepressant that should be avoided in patient on Heparin?

A

Other SSRIs and SNRIs (except citalopram, escitalopram and sertraline ::: Reboxetine and Trazadone)

37
Q

antidepressant that should be avoided in patient on Anti-epileptic drugs?

A

all antidepressants reduce seizure threshold

38
Q

Suitable antideprssant for patients on anti-epileptic drugs

A

SNRI: Duloxetine

39
Q

Suitable antideprssant for patients on Clozapine/Methadone/Tizanidine/Theophyline

A

citalopram or sertraline

40
Q

Antidepressant that should be avoided in patient on Clozapine/Methadone/Tizanidine/Theophyline

A

Fluvoxamine

41
Q

Suitable antidepressant for patients on atomoxetine

A

Not Fluoxetine, Paroxetine, Citalopram or escitalopram …so any otherr

42
Q

antidepressant that should be avoided in patient on atomoxetine

A

Fluoxetine, Paroxetine, Citalopram or escitalopram

43
Q

rate of 2nd episode after 1st depression episode?

A

half of the cases

44
Q

rate of 3rd episode after 2nd depressive episode

A

70%

45
Q

Rate of further episodes after 3rd depressive episode

A

90%

46
Q

Risks for recurrent in depression?

A

Female
Lack of confiding relationship
Cyclothymic episodes
Family history
Longer episode duration
Chronic medical illness
non-affective psychiatric comorbidity

47
Q

Risk for relapse of depression

A

Older age at onset
Hx of recurrent episodes
Incomplete response to Rx
Unhelpful coping styles
Hx of severe depression
chronic mental or physical illness
ongoing personal, social or environmental factors

48
Q

what is refractory depression?

A

two successive failed attempts at treatment despite good compliance and adequate doses

49
Q

Options to treat refractory derpession

A
  • Add lithium
  • quetiapine and ssri/SNRI
    -Olanzapine and Fluoxetine
    -aripiprazole to antidepressant
    -bupropion + SSRI
    -SSRI 0r venlafaxine + Mianserin or mirtazapine
50
Q

NICE guidline on refractory depression?

A
  • Vortioxetine

Or
-Combination
+++ Mirtazapine or trazodone to SSRI
+++ combined antidepressant to 2nd generation antipsychotic (olan + fluoxetine e.g)
+++ augmenting antidepressant with ECT, Lamotrigine or triiodothyronine)

51
Q

which medication is considered to have lowest risk of causing manic switch in depression?

A

Bupropion

52
Q

Which medication is considered to have highest risk of causing manic switch in depression

A

TCAs
MAOI
Venlafaxine

53
Q

Medications that cause depression

A

RIBLeD SHOc

Rerserpin
Interferon alpha
Beta Blockers
Levadopa
Digoxin
Steroid, anabolic
Oral contraceptives

54
Q

acronym for medications that cause depression

A

RIBLeD SHOc

55
Q

Drug abuses cause depression

A

Alcohol
Amphetamine
Cocaine
Hypnotic

56
Q

criteria for post-schizophrenic depression in ICD 11

A

Patient met schizo criteria within past 12 month
Positive symptoms might remain but less dominant
Depressive symptoms are distressing and prominent
Depressive symptoms meet the criteria for depressive symptoms
Present for at least 2 weeks

MRCPSYCH_Paper B_MENTOR & More_Dr. ART (69 decks)

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