Depression Flashcards
Associated symptoms of depression
Disturbed sleep Decreased/increased appetite/weight Fatigue Poor concentration Feelings of worthlessness Suicidal thoughts
When is seasonal affective disorder diagnosed
If the person has episodes of depression which recur annually at the same time each year with remission in between
Which factors may affect the development, course and severity of depression
Hx of mental illness Past history of mood elevation Living conditions and social isolation Family history Domestic violence/sexual abuse Employment and immigration status
Co-morbid conditions associated with depression
Alcohol or substance abuse Anxiety Eating disorders Psychotic symptoms Dementia
Which questions are important to ask when assessing the risk of suicide
Any thoughts about death or suicide?
Do you feel life is not worth living?
Have you made a previous suicide attempt?
Is there a family history of suicide?
What questions should be asked if an individual has said yes to any of the initial suicide assessment questions
Have you considered a method?
Do you have access to the materials?
Have you made any preparations?
Risk factors which increase the risk of suicide
Previous suicide attempts Active mental illness Family history of mental disorder Male gender Being unemployed Physical health problems Drug/alcohol abuse
Recommended questionnaires for detecting depression and assessing severity
PHQ-9
HADS
BDI-II
Interpretation of PHQ-9
Max score of 27
Scores of 5, 10, 15 and 20 represent cut off points for mild, moderate, moderately severe and severe depression, respectively
General management of depression in primary care
Manage suicide risk
Manage safeguarding concerns
Manage any co-morbid condition associated with depression
Useful contact for managing suicide risk in primary care
Crisis Resolution and Home Treatment(CRHT) team for urgent assessment
When should antidepressants be considered for mild-to-moderate depression
Avoid routine use
Consider in:
History of moderate or severe depression
Subthreshold depressive symptoms that have persists for a long period
Mild depression that is complicating the care of a chronic physical health problem
Management of mild-to-moderate depression in primary care
Low-intensity psychosocial intervention
CBT
What should be evaluated before starting an antidepressant
Suicide risk and toxicity in overdose
Risk of anxiety worsening
Explain that antidepressants take time to work and should be continued for at least 6 months following remission of symptoms to reduce risk of relapse
Who does the mental health act allow compulsory admission for
People who:
Have a mental disorder of a nature or degree that warrants assessment or treatment in hospital, and
Need to be admitted in the interests of their own health or safety, or for the protection of other people
How long does section 2 allow compulsory admission for
Up to 28 days for assessment
How long does section 3 allow compulsory admission for
Up to 6 months for treatment
Who does section 2 and 3 of the mental health act require approval from
Approved mental health professional, or the person’s nearest relative
Written recommendations from two doctors; one of whom is section 12 approved(psychiatrist) and one who has previous acquaintance with the individual(usually GP)
When is section 4 of the mental health act used and how long does it allow for compulsory admission for?
Used in exceptional cases to permit compulsory admission for up to 72 hours if there is urgent necessity, and undesirable delay
Who does section 4 require approval from
Requires application from an AMHP(or person’s nearest relative) and just one medical recommendation
Who can use section 136 of the mental health act
Used by the police to take people from a public place to a place of safety so they can be assessed
Can young people who have capacity to consent be admitted on the basis of their parents’ consent
Young people aged 16 or 17 who have capacity to consent, but refuse to do so, cannot be admitted or kept in hospital for treatment on the basis of parents’ consent
They will need to be formally detained under MHA
