Depression Flashcards
What are the Core Features of Depression?
Low Mood
Anhedonia
Fatigue
How long does it need to last for? (core features of depression)
At least 2 weeks
Depressive Symptoms - Non-core symptoms (biological, psychological, cognitive)
BIOLOGICAL - 4
COGNITIVE - 3
PSYCHOLOGICAL - 4

Depressive Symptoms - Non-core symptoms (biological, psychological, cognitive)

- Sleep
- Appetite
- Libido
- Reduced energy
- All examples of what types of depressive symptoms?
biological
- Difficulty concentrating
- Memory loss
- Attention impairment
- All examples of what types of depressive symptoms?
cognitive
- Worthlessness
- Guilt
- Hopelessness
- Suicidal Ideation
- All examples of what types of depressive symptoms?
psychological
GP Consultation - Depression example
How do we treat?

cbt - 6weeks

What other psychological therapies options might there be in addition to CBT?
- Self-help services
- Mindfulness/online courses/apps
- Counselling
- Interpersonal therapy
- Family therapy
- Psychodynamic Psychotherapy
What else may be helpful for Samir that the GP can support him with?

- Work - time off/support/adjustments
- Finances/benefits
- Sleep Hygiene
- Exercise and regular activity
- Support to recruit the help of family and friends
- Psychoeducation
- Support Groups
Medication example for mild/moderate depression?
sertaline 50mg for 4 weeks
What are the side effects of SSRIs Samir may be experiencing?
- agitation, nausea, dizziness, low sex drive, constipation or diarrhoea, suicidal thoughts can increase, particularly in <25s.
- Sometimes patients don’t disclose sexual side effects – these can persist and contribute to relationship issues – need to ask directly.
Side effects of SSRIS?
agitation, nausea, dizziness, low sex drive, constipation or diarrhoea, suicidal thoughts can increase, particularly in <25s.
NICE Guidelines - Depression
- Fill in table

- Note; medication only comes in from step 2 onwards – Rx for mild depression is psychological/psychosocial!
- Important to reiterate to students here that for mild depression, low intensity psychological intervention is the treatment option, and not straight to pharmacological input. We are treating a ?moderate depressive episode, hence use of both SSRI and CBT.
- We may not see many mild cases of depression that are treated within primary care.

NICE Guidelines - Depression
- Fill in table

- Note; medication only comes in from step 2 onwards – Rx for mild depression is psychological/psychosocial!
- Important to reiterate to students here that for mild depression, low intensity psychological intervention is the treatment option, and not straight to pharmacological input. We are treating a ?moderate depressive episode, hence use of both SSRI and CBT.
- We may not see many mild cases of depression that are treated within primary care.

NICE Guidelines - Depression
- Fill in table

- Note; medication only comes in from step 2 onwards – Rx for mild depression is psychological/psychosocial!
- Important to reiterate to students here that for mild depression, low intensity psychological intervention is the treatment option, and not straight to pharmacological input. We are treating a ?moderate depressive episode, hence use of both SSRI and CBT.
- We may not see many mild cases of depression that are treated within primary care.

NICE Guidelines - Depression
- Fill in table

- Note; medication only comes in from step 2 onwards – Rx for mild depression is psychological/psychosocial!
- Important to reiterate to students here that for mild depression, low intensity psychological intervention is the treatment option, and not straight to pharmacological input. We are treating a ?moderate depressive episode, hence use of both SSRI and CBT.
- We may not see many mild cases of depression that are treated within primary care.

Samir goes back to GP after 6 months… - what is the next steps? (plan)

Try alternative SSRI - citalopram 20mg 1 tablet for 4 weeks

Samir - 3 months later…..
- Samir books urgent appointment with GP as he feels his mood has deteriorated further
- He has lost his job
- Expressing suicidal thoughts although he has no current intent or active plans
- What would the plan be?
- Samir books urgent appointment with GP as he feels his mood has deteriorated further
- He has lost his job
- Expressing suicidal thoughts although he has no current intent or active plans
- Agreed with plan for urgent referral to Community Mental Health Team and safety-netting
What specific parts of a history might Samir be asked if seen in secondary care?
- Presenting complaint and history of presenting complaint
- Past medical history
- Drug history + allergies
- Family history
- Drug and Alcohol History
- Social history - home life, education, work, social support, finances
- Personal and developmental history
- Forensic history
- Pre-morbid personality
- Risk
What is important to include in psych history? 4 things - (different from normal hx)
- Personal and developmental history
- Forensic history
- Pre-morbid personality
- Risk (suicide/self-harm/harm to others etc…)
Samir struggles to cope at home and presents to A+E with suicidal ideation and self-harm (lacerations to wrists) before he can attend his Community Mental Health Team (CMHT) appointment - Which team is Samir likely to see in A+E?
-
Mental Heath Liaison Team
- See people presenting to A+E in acute mental health crisis
- Multidisciplinary Team made up of variety of professionals
- Also provide care for those admitted to a general hospital
Mental Heath Liaison Team
- Who do they see?
- Who is in the team?
- Who else do they provide care for?
- See people presenting to A+E in acute mental health crisis
- Multidisciplinary Team made up of variety of professionals
- Also provide care for those admitted to a general hospital
Mental Health Liaison Team Risk Assessment (Samir)
- The 5 Ps….
- 1. Presenting: Low mood, self-harm wounds, suicidal ideation. Displaying psychotic symptoms - paranoia; believes he is being watched and that his family are going to get hurt or killed as a punishment. Thinks if he kills himself this will stop.
- 2. Predisposing: History of moderate to severe depression.
- 3. Precipitating: Loss of job, relationship breakdown.
- 4. Perpetuating: Little social support, has struggled living alone during lockdown
- 5. Protective: His family and a few friends, wanting to gain employment.

