Depression Flashcards
Introduction
- *W**ash hands
- *I**ntroduce yourself
- *P**atient’s consent
- *E**xplain procedure/purpose for Hx
PC
“What brought you in today?”
HPC
Let’s patient tell their story:
Loss of motivation / energy / enjoyment - “do you find it hard to be motivated?”, “do you feel like you lack energy each day?”, “do you find it hard to enjoy the things that you once used to enjoy?”
Sleep/early morning waking - “do you find it hard to go to sleep?”, “are you finding that you’re waking up early in the morning?”
Weight changes/Appetite - “has there been any changes in your weight?”, “how’s your appetite?”
Memory / concentration changes - “are you have any problems with your memory?”, “have you had any changes in your concentration levels?”
ICE
Explores her understanding of what is wrong
Ideas - “what do you think could have caused your low mood?”
Concerns - “is there anything that your worried about regarding your low mood?”
Expectations - “what were you hoping we would do for you today?”
Ask why the patient decides to present now and not earlier - “did anything influence your decision to come now and not earlier?”
Elicits reason for attending today and not sooner (recent death of friend)
PMH
“Do you have any medical conditions like depression or anxiety?”
DH
- “Are you on any medications that have been prescribed by your doctor?”, “do you take any over the counter medications?”*
- “Do you have any allergies to any medications? What happens when you take the medication?”*
SH
Alcohol, smoking, recreational drugs (including IVDU) - “do you smoke?”, “how much do you smoke each day?”, “how long have you smoked for?”, “have you ever smoked? How much did you smoke and for how long?”(if the patient said they don’t smoke),”do you drink?”, “how much/what do you drink each day?”, “do you use recreational drugs?”, “have you ever injected drugs or shared needles with other people?”
Occupation - “do you work?”, “what do you do for work?”
Home situation - “what’s your home situation like?”, “do you need help with things like cooking, washing/cleaning yourself?”
FH
“Do you have any FHx of low mood, bipolar disorder or suicide?”
Pyschiatric assessment
Excludes psychotic symptoms:
Has she heard voices or acted in a way that other people thought was out of character? - “have you heard voices that other people couldn’t hear and which they thought was strange?”
Explores suicidal ideation:
Previous history / ideas / thoughts of self-harm - “have you ever had thoughts or harming yourself?”, “have you ever actually harmed yourself in the past?”
Plans - “have you ever had plans on how to kill yourself?”, “have you ever tried to go through with those plans?”
What stops her - “did anything stop you from going through with plans to kill yourself?”
Examination
Asks to examine patient with examples (e.g. pulse, BP)
“I’d like to examine you now by taking your pulse and measuring your blood pressure. Is this ok with you?”
DDx
Discuss likely diagnosis of depression - “from what we’ve discussed today, I feel that your symptoms could be due to depression.”
Explains need for PHQ-9 to diagnose depression in GP - “But in GP we need to use a questionnaire called the PHQ-9 to formally diagnose this. Would you be alright with filling in this questionnaire once we’ve finished our discussion?”
Counselling
Takes practical steps to take problem forward:
Establishes patient’s trust - “Thanks for sharing that with me. I’d like to assure you that everything you say will be kept confidential.”
Seeks patients’ agreement to meet again ( e.g. in one week) - “I’d like to see you again in 1 week”
Mentions options to consider at next meeting social support/ counselling/antidepressants or blood tests (e.g. Hb/TFTs) - “and at the next meeting we’ll do some blood tests to monitor your iron levels and see how well your thyroids are working. We can also go over the next steps of managment and discuss whether you want some social support, counselling or some antidepressants. Does this sound ok?”
Amends paracetamol prescription/Considers ways of retrieving any old meds from home (E.g. seeking agreement to hand in tablets at reception) - “Just to ask have you got lots of medications at home. Ok thanks for letting me know. I understand that this is a difficult time for you, but we can work together to make sure that you’re safe during this time, including helping to reduce your risk of suicide. From what you’ve told me, you seem to have a lot of pills at home. If this is ok with you, are you able to drop them at reception so that we can look after them for you?”
Makes practical suggestions, e.g. skype to contact family, social activities, online support - “Have you got Facetime or Google Duo? That’s great. We’d advise that from time to time you call family members or friends so you don’t feel too lonely at home.”
Safety netting
Safetynetting: See GP if urge to harm self, provide out of hours number
“If you ever get the urge to self harm, it’s really important that you come back to see us, or see the out-of-hours GP. I’ll write their number on a piece of paper for you to take home.”
Close consultation
“Thank you so much for speaking with me today. Before you go I’d like to give you a patient information leaflet. A great website to go to is Samaritans UK. They also have a helpline you can call to speak to someone if you ever need to. I’ll write their details on a piece of paper for you to take home with you.”
