Depression Flashcards

1
Q

Risks

A
  1. Female
  2. 15-45
  3. Childhood Trauma
  4. Family History
  5. Hormonal Changes
  6. Chronic Medical conditions
  7. Poor social supports
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2
Q

What tests do you want to order

A
  1. CBC for hbg
  2. Creat
  3. Lytes (Na K)
  4. TSH
  5. ALP, AST
  6. A1C
  7. B12
  8. Folate
  9. Ferritin
  10. ECG
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3
Q

Suicide risks

A
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
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4
Q

What risk tool can you use for suicide risk

A

Convergent Functional Assessment for suicide

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5
Q

Someone you put on antidepressants. When should you cehck in about the effect

A

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

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6
Q

If a teen is doing self harm, wat risks would you worry about for increased mortality

A
Female 
Older
Serious complex mental illness
Substance misuse 
History of TBI
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7
Q

DDX for depression

A
Thyroid
Cortisol
Grief
Withdrawl
Drug use
Bipolar
Tumor
Delirum
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8
Q

When should you add an adjunct medication

A

If they have tried at least 2 antidepressants

If they are tolderating medication well and had good initial partial response

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9
Q

How long should someone stay on their treatment for depression

A

6-9 months of remission

2 years if they are high risk or have previous episodes

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10
Q

Discontinuation symptoms of SSRI and SNRI

A
FINISH
Flu symptoms 
Insomnia
Nausea
Imbalance
Sensory disturbance 
Hyperarousal
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11
Q

Which medications have the most FINISH symptoms and the least

A

Most: Paroxetine and venlafaxine

Fluoxatine and vortioxetine

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12
Q

What questionaire to use in elderly for depression
Worse effects of medications
Which medication to use first and second line

A
  1. Geriatric depression scale
  2. Increased falls, decreased sodium, GI bleeds, QT prolongation (escitalopram and citalopram), bone loss
  3. Duloxetine and sertaline and mirtazpine first
    Nortriptyline, quetiapine, trazodone, and bupropion second line
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13
Q

List five features that make you consider bipolar in someone presenting with depression

A
Onset <25
>5 episodes
Hamily history 
Hypersomnia
Hyperphagia
Lability
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14
Q

Whats the difference between BP1 and BP2

A

BP2 is hypomania which presents with no psychosis

Lasts 4-7 days with functional effects but no hospitalization and no psychotic features

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15
Q

List seven symptoms of mania

A
Distractibility
Indiscretion 
Gradiosity
Flight of ideas
Activity increased
Sleep deficit
Talkative
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16
Q

Acute management of bipolar

A

Second generation antipsychotic( Risperidone or aripiprazoel)
Quetiapine*** Good even if depressive episode of BP2
Lithium
Divalproex

17
Q

Maintenance of BP

A

Lamotragine
Lithium
Quetiapine
Divalproex

18
Q

Management of depression in bipolar

A

1st line=Quetiapine

2nd line=Lithium, SSRI

19
Q

What to add for augmentation for partial response to SSRI/SNRI etc.

A
  1. Aripiprazone, quetiapine (lower doses)

2. Bupropion, lithium