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Year Three - Psychiatry > Depression > Flashcards

Depression Flashcards

1
Q

What is depression?

A

It is a defined as a condition in which individuals experience persistent low mood, anergia and anhedonia

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2
Q

What is anergia?

A

It is defined as low energy

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3
Q

What is anhedonia?

A

It is defined as a loss of interest/enjoyment in everyday activities

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4
Q

What are the two neurochemical imbalances associated with depression?

A

Decreased serotonin

Decreased noradrenaline

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5
Q

What are the four classifications of depression?

A

Mild Depression

Moderate Depression

Severe Depression

Recurrent Depression

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6
Q

What is mild depression?

A

It is defined as the presentation of two core features plus two cognitive features

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7
Q

What is moderate depression?

A

It is defined as the presentation of two core features plus at least three cognitive features

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8
Q

What is severe depression?

A

It is defined as the presentation of three core features plus at least four cognitive features

There is usually the presence of psychotic features.

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9
Q

What is recurrent depression?

A

It is defined as the presentation of more than two depressive episodes

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10
Q

What are the twelve risk factors associated with depression?

A

Female Gender

Young Age, 18 – 40 Years Old

Family History

Childhood Trauma

Traumatic Life Events

Personality Traits

Chronic Disease

Co-Morbid Substance Use

Drug Administration

Lack of Social Support

Separated/Divorced Marital Status

Poor Economic Status

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11
Q

What six chronic diseases are associated with depression?

A

Parkinson’s Disease

Multiple Sclerosis

Hypothyroidism

Psoriasis

Addison’s disease

Wilson’s disease

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12
Q

What four drugs are associated with depression?

A

Beta-blockers

Steroids

Levodopa

Isotretinoin

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13
Q

What are the three protective factors of depression?

A

Employment

Good Social Support

Married

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14
Q

What are the three core symptoms of depression?

A

Persistent Low Mood

Anhedonia

Anergia

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15
Q

What are the eight cognitive clincial features of depression?

A

Weight Changes

Disturbed Sleep

Psychomotor Retardation/Agitation

Reduced Libido

Feelings of Worthlessness/Guilt

Decreased Concentration

Psychotic Features

Suicidal/Self-Harm Thoughts

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16
Q

What are the two psychotic features of depression?

A

Delusions of Guilt & Personal Inadequacy

Hallucinations

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17
Q

What are the seven somatic/biological features of depression?

A

Anhedonia

Loss of Emotional Reactivity

Diurnal Mood Changes

Early Morning Wakening

Psychomotor Agitation/Retardation

Appetite Loss

Weight Loss

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18
Q

Describe the diurnal mood changes in depression

A

The mood tends to be worse in the morning

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19
Q

Describe the early morning waking in depression

A

Individuals wake 2 - 3 hours earlier than usual

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20
Q

What though disorder is associated with severe depression?

A

Cotard syndrome

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21
Q

What is cotard syndrome?

A

It is defined as a condition in which individuals believe that they are dead or non-existent

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22
Q

What are the four investigations used to diagnose depression?

A

Patient Health Questionnaire (PHQ-9)

Hospital Anxiety & Depression (HAD) Scale

Blood Tests

CT Scans

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23
Q

What is the most common depression screening tool?

A

PHQ-9

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24
Q

What is PHQ-9?

A

It involves asking questions whether they have experienced nine clinical features over the last two weeks – which are scored 0 – 3 in terms of severity

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25
What PHQ-9 score defines mild depression?
5 - 9
26
What PHQ-9 score defines moderate depression?
10 - 14
27
What PHQ-9 score defines moderately severe depression?
15 - 19
28
What PHQ-9 score defines severe depression?
20 - 27
29
What is the HAD scale?
It involves asking 7 questions screening for depression and 7 questions screening for anxiety – which are scored 0 – 3 in terms of severity This provides a score for both depression and anxiety
30
What HAD scale score is considered normal?
0 - 7
31
What HAD scale score is considered borderline for anxiety and depression diagnosis?
8 - 10
32
What HAD scale score defines a diagnosis of depression/anxiety?
> 11
33
How are blood tests used to diagnose depression?
They are used to exclude organic causes to the patient’s presentation
34
What five blood tests are used to investigate depression?
Full Blood Count Urea & Electrolytes Liver Function Tests Thyroid Function Test Vitamin B12 Deficiency
35
How are CT scans used to investigate depression?
They are used to exclude organic causes
36
When are CT scans used to investigate depression?
In cases where patient’s present with atypical features – such as low mood associated with a sudden loss of memory or change in personality
37
What are the three diagnostic criteria of depression?
The clinical features must be present for at least 2 weeks The clinical features are not attributable to other organic or substance causes – normal bereavement, etc. The clinical features result in functional impairment and cause significant distress
38
What five psychological therapies are used to treat depression?
Psychoeducation Cognitive Behaviour Therapy (CBT) Behavioural Activation Interpersonal Psychotherapy (IPT) Psychodynamic Psychotherapy
39
What is psychoeducation?
It involves providing patients with information about depression and ways in which they can control and minimise it
40
What is CBT?
It is a talking therapy used to manage the way in which patients think, feel and behave
41
What is behavioural activation?
It is a talking therapy that encourages patients to use behaviour in influencing their emotional state
42
What is IPT?
It is a talking therapy used to identify and address problems in the patients’ relationship with family, partners and friends
43
What is psychodynamic psychotherapy?
It is talking therapy which focuses on the psychological roots of emotional suffering
44
What five pharmacological management options are used for depression?
Selective Serotonin Reuptake Inhibitors (SSRIs) Serotonin Noradrenaline Reuptake Inhibitors (SNRIs) Tricyclic Antidepressants (TCAs) Monamine Oxidase Inhibitors (MAOIs) Antipsychotics
45
When are SSRIs used to manage depression?
They are the first line pharmacological management option
46
Name five SSRIs used to manage depression
Sertraline Fluoxetine Citalopram Escitalopram Paroxetine
47
What SSRI is prescribed to patients with depression, alongside other chronic health problems? Why?
Sertraline There is a reduced risk of drug interactions
48
How long does it usually take for SSRIs to become effective?
4 - 6 weeks
49
When are SNRIs used to manage depression?
They are the second line pharmacological management option
50
Name two SNRIs used to manage depression
Duloxetine Venlafaxine
51
In which patient group is SNRIs the first line anti-depressant drug class?
Children Adolescents
52
When are TCAs used to manage depression?
They are the third line pharmacological management option – which should be administered under psychiatric advice
53
Name four TCAs used to manage depression
Amitriptyline Desipramine Imipramine Nortriptyline
54
When are MAOIs used to manage depression?
They are the fourth line pharmacological management option – which should be administered under psychiatric advice
55
Name three MAOIs used to manage depression
Selegiline Isocarboxazid Phenelzine
56
When are antipsychotics used to manage depression?
They are recommended in severe depressive episodes with psychotic features
57
Name four antipsychotics used to manage depression
Olanzapine Risperidone Quetiapine Aripiprazole
58
How do we switch individuals from an SSRI (citalopram, escitalopram, sertraline, paroxetine) to another SSRI?
The first SSRI should be withdrawn, through a gradual dose reduction then stopped, before the alternative SRRI is started
59
How do we switch individuals from an fluoxetine to another SSRI? Why is fluoxetine different to other SSRIs?
It should be withdrawn, through a gradual dose reduction then stopped, leave a gap of 4 - 7 days before starting a low dose of the alternative SSRI It has a longer half life
60
How do we switch individuals from SSRIs (citalopram, escitalopram, sertraline, paroxetine) to TCAs?
There should be cross-tapering, which is when the current dose drug is reduced slowly whilst the dose of the new drug is slowly increased
61
How do we switch individuals from fluoxetine to a TCA? Why is fluoxetine different to the other SSRIs?
It should be withdrawn, through a gradual dose reduction then stopped, before starting a TCA It has a longer half life
62
How do we switch individuals from SSRIs (citalopram, escitalopram, sertraline, paroxetine) to venlafaxine?
There should be cross-tapering cautiously, which is when the current dose drug is reduced slowly whilst the dose of the new drug is slowly increased Venlafaxine should be started at 37.5mg daily and increased very slowly
63
How do we switch individuals from fluoxetine to venlafaxine? Why is fluoxetine different to the other SSRIs?
It should be withdrawn, through a gradual dose reduction then stopped, before starting venlafaxine It has a longer half life
64
When are physical management options used to treat depression?
When depression is unresponsive to other treatment options
65
What are the four physical management options used in depression?
Electroconvulsive Therapy (ECT) Deep Brain Stimulation (DBS) Vagus Nerve Stimulation (VNS) Psychosurgery
66
In which four circumstances is ECT considered to manage depression?
The patient has a strong preference to ECT Rapid treatment is required due to the patient not eating or drinking When multiple other treatment have been trialled unsuccessfully There is severe depression, with catatonia features
67
What is ECT?
A procedure in which small electric currents are passed through the brain, intentionally triggering a brief seizure This leads to neurochemical changes, which can reverse the clinical features of depression
68
How do we modify antidepressant medication prior to ECT?
We reduce the daily dose, however it should not be stopped Towards the end of the ECT course, an increase dose of antidepressant may be added
69
What are the five short term side effects of ECT?
Headache Nausea Short Term Memory Impairment Retrograde Amnesia Cardiac Arrythmia
70
What is a long term side effect of ECT?
Impaired Memory
71
What is an absolute contraindication of ECT?
Raised ICP
72
What is DBS?
It involves implanting electrodes within certain areas of the brain These electrodes produce electrical impulses that regulate abnormal impulses or can affect certain cells and chemicals within the brain
73
What is VNS?
It involves the use of a device to stimulate the left vagus nerve with electrical impulses When stimulated, the left vagus nerve will send electrical signals to the brainstem, which are then transmitted to certain areas in the brain
74
What is psychosurgery?
It is the selective surgical removal or destruction of nerve pathways in order to influence psychiatric disorders
75
What are the eleven management options recommended in mild depression - in order of preference?
Self-Guided Cognitive Behavioural Therapy Group Cognitive Behavioural Therapy Group Behavioural Activation Individual Cognitive Behavioural Therapy Individual Behavioural Activation Structured Group Physical Activity Programme Group Mindfulness & Mediation Interpersonal Psychotherapy Selective Serotonin Reuptake Inhibitors Psychological Counselling Short-Term Psychodynamic Psychotherapy
76
It is recommended that antidepressant medication should not be routinely offered as first line management of mild depression. In which four circumstances are there exceptions to this rule?
Moderate/Severe Depression History Mild Depression For At Least 2 Years Mild Depression That Is Resistant To Psychological Interventions Patient Preference
77
What are the ten management options recommended in moderate/severe depression - in order of preference?
Individual Cognitive Behavioural Therapy & Antidepressant Individual CBT Individual Behavioural Activation Antidepressant Medication Individual Problem Solving Psychological Counselling Short Term Psychodynamic Therapy Interpersonal Psychotherapy Self-Guided Cognitive Behaviour Therapy Structured Group Physical Activity Programme
78
Following initial presentation of depression, when should a follow up appointment be arranged?
2 weeks Then monthly for 3 months
79
In which patient group should weekly follow up appointments be arranged following intial presentation of depression?
Those who are at high suicide risk
80
What are the six risk factors of suicidal attempt?
Male Age< 30 Previous Suicidal Attempt Alcohol/Drug Use No Spouse Or Other Social Support Stated Future Intent
81
What is the strongest risk factor of suicide?
Previous Suicidal Attempt
82
How long does it usually take patients with depression to recover?
4 - 6 months

Year Three - Psychiatry (23 decks)

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