Depression Flashcards
Risks
- Female
- 15-45
- Childhood Trauma
- Family History
- Hormonal Changes
- Chronic Medical conditions
- Poor social supports
What tests do you want to order
- CBC for hbg
- Creat
- Lytes (Na K)
- TSH
- ALP, AST
- A1C
- B12
- Folate
- Ferritin
- ECG
Suicide risks
Precipitating factors: Alcohol and drugs Access to means Life events New chronic disease Media effects
Predisposing factors: Neuropsychiatric disorders Family history Previous attempts Adverse childhood experiences Socioeconomic status
SADPERSONS Sex male Age <19 or >45 Depression Previous attempts or psychiatric care EtOH/Drugs Rational thinking loss Separated Organized or serious attempt No supports States organized plan
What risk tool can you use for suicide risk
Convergent Functional Assessment for suicide
Someone you put on antidepressants. When should you cehck in about the effect
About 6 weeks
Not earlier because 1/3 who don’t show early response will have response at 6 weeks
Should see about 20% improvement in objective scale by about 4 weeks
If not can increase dose or switch
If a teen is doing self harm, wat risks would you worry about for increased mortality
Female Older Serious complex mental illness Substance misuse History of TBI
DDX for depression
Thyroid Cortisol Grief Withdrawl Drug use Bipolar Tumor Delirum
When should you add an adjunct medication
If they have tried at least 2 antidepressants
If they are tolderating medication well and had good initial partial response
How long should someone stay on their treatment for depression
6-9 months of remission
2 years if they are high risk or have previous episodes
Discontinuation symptoms of SSRI and SNRI
FINISH Flu symptoms Insomnia Nausea Imbalance Sensory disturbance Hyperarousal
Which medications have the most FINISH symptoms and the least
Most: Paroxetine and venlafaxine
Fluoxatine and vortioxetine
What questionaire to use in elderly for depression
Worse effects of medications
Which medication to use first and second line
- Geriatric depression scale
- Increased falls, decreased sodium, GI bleeds, QT prolongation (escitalopram and citalopram), bone loss
- Duloxetine and sertaline and mirtazpine first
Nortriptyline, quetiapine, trazodone, and bupropion second line
List five features that make you consider bipolar in someone presenting with depression
Onset <25 >5 episodes Hamily history Hypersomnia Hyperphagia Lability
Whats the difference between BP1 and BP2
BP2 is hypomania which presents with no psychosis
Lasts 4-7 days with functional effects but no hospitalization and no psychotic features
List seven symptoms of mania
Distractibility Indiscretion Gradiosity Flight of ideas Activity increased Sleep deficit Talkative
