Depression

Question 1

DEPRESSIVE SYMPTOMS

i) what are the three core features? how long do these last for?
ii) name two bio, cognitive and psyshcological symptoms?
iii) three screening questions that should be asked
iv) what is adjustment disorder?

Answer 1

i) low mood, anhedonia, lack of energy
- for at least 2 weeks

ii) bio - inc/dec sleep, inc/loss of appetite, reduced energy
cognitive - difficult concentrating, memory loss, attention impair
psych - worthless, guilt, hopeless, suicidal ideation

iii) do you have suicidal thoughts/intent?
have you seen/heard anything unusual that others cant?
do you ever feel high or elated?
do you ever have anxious thoughts?

iv) impaired function and maladaptive response to a stressor - often associated with self harm and difficult to treat

Question 2

PSYCHOLOGICAL THERAPY

i) name three psych therapy that may be helpful?
ii) name three lifestyle changes that may be beneficial

Answer 2

i) self help, mindfulness, counselling, family therapy, interpersonal therapy
ii) time off/adjusting work, sleep hygiene, regular exercise, support of family and friends, psychoeducation

Question 3

NICE GUIDELINES

i) what is step one in all depression presentations?
ii) what is step 2 for mild to mod depression (2)
iii) what is step 3 for mod to severe depression (3)
iv) what is step 4 for severe and complex depression? (4)

Answer 3

i) psychoeducation, support, monitoring
ii) low intesity psych intervention, medication
iii) medication, high intes psych intervention, collaborative care
iv) medication, high intes psych interven, ECT, crisis team, inpatient care

Question 4

PSYCHOTIC SYMPTOMS OF DEPRESSION

i) what are the two types?
ii) name three types of delusions that may be seen?
iii) what is there a higher risk of? what may psychotic symptoms be associated with?

Answer 4

i) mood congruent vs non mood congruent
ii) delusions of guilt, poverty, illness, nihilistic

iii) higher risk of self harm/suicide
- psych symptoms > poorer outcomes

Question 5

ECT

i) what is it? what anaes is given?
ii) name two conditions it may be useful in?
iii) what is the response rate for severe depression?
iv) name an immed, medium and long term side effect

Answer 5

i) electroconvulsive therapy > induced seizure under GA
ii) useful in severe depression, catatonia (lack of mobility), prolonged mania
iii) 70% response rate

iv) immed - heaache, fatigue, confusion, nausea
medium - short term memory loss
long term - memory loss (changes in perosnality reported)

Question 6

CRISIS RESOLUTION AND HOME TX TEAM

i) how long are patients under their care? what is the aim?
ii) who is part of the team?
iii) where can they visit people?
iv) what do they act as?

Answer 6

i) short term care
- aim to reduce number and length of hospital stays

ii) mixed MDT
iii) can visit at home, crisis centres, or in hospital if due to be discharged
iv) act as a gatekeeper to acute mental health services

Question 7

ASKING DIFFICULT QUESTIONS

i) how can you ask about suicidiality?
ii) how can you establish intent?
iii) how may you ask about traumatic events

Answer 7

i) have you ever thought of ending your life or its not worth living
ii) would you act on these thoughts? have you made plans? whats stopping you?
iii) any stressful or difficult experiences? do you have flashbacks? did you have a happy childhood?

Question 8

MEDICATION - SSRIs

i) name three side effects? what sodium levels can be seen? name three things seen in serotonin syndrome
ii) how long may they take to work initially? how long does full action take? how long does full action take in anxiety
iii) when should it be stopped after symptom resolving? when may this be longer?
iv) what are the symptoms of SSRI discontinuation syndrome? FFINISH
v) which SSRI has the longest half life?

Answer 8

i) N+V, diarrhoea, initially anxiogenic, drowsy, dry mouth, insomia
- may see hyponatremia - tired, confusion, headache
- serotnin syndrome - agitation, restless, tremor, confusion, autonomic duysfunction eg inc HR, sweating, confusion

ii) initially see improvement in 2 weeks
- full action in 4-6 weeks (8 weeks in anxiety)

iii) stopped 6 months post symptom resolve
- if recurrent depressive disorder then stay on for two year post resol

iv) flu like symptoms, fatigue, insomia, nausea, imlbalance, sensory disturbance (paraes, electric shock, vis disturb), hyper arousal (anx agitated)
v) fluoxetine - 14 days (less likely to get discont syndrome if you miss doses)