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2. General adult psychiatry > Depression > Flashcards

Depression Flashcards

1
Q

Lifetime prevalence of depression

A

13%

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2
Q

One year prevalence of depression

A

5.3%

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3
Q

Mean age of onset of depression

A

30 years

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4
Q

Mean number of episodes of depression in patients with lifetime major depressive disorder

A

5

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5
Q

Percentage of patients with major depressive disorder who attempt suicide

A

9%

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6
Q

Most common change of diagnosis from an initial diagnosis of depressive disorder

A

Schizophrenia and related disorders

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7
Q

Percentage of patients who have had a depressive episode who have an episode of mania within 10 years

A

10%

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8
Q

Percentage of seriously depressed hospitalised patients who develop an episode of mania within 10 years

A

Nearly 50%

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9
Q

Factors associated with an increased chance of change from unipolar depression to bipolar disorder

A

Younger age
Family history of bipolar disorder
Anti-depressant induced hypomania
Hypersomnia
Psychotic depression
Postpartum depression

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10
Q

Average length of time of an untreated depressive episode

A

6-13 months

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11
Q

Average length of time of a treated depressive episode

A

3 months

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12
Q

Percentage chance of recurrence after a depressive episode

A

50%

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13
Q

Percentage chance of recurrence after two depressive episodes

A

70%

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14
Q

Percentage chance of recurrence after three depressive episodes

A

80-95%

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15
Q

Percentage reduction in symptoms of depression for someone to have a treatment response

A

50%

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16
Q

Percentage reduction in symptoms of depression for someone to have a partial treatment response

A

26-49%

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17
Q

Criteria required to be in remission from depression

A

No scales can detect meaningful measure of depression
No symptoms after the natural period of a treated episode is over (3 months)

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18
Q

Criteria for a relapse of depression

A

Further depressive episode after remission has been achieved but before recovery has been achieved

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19
Q

Criteria for a recurrence of depression

A

Further depressive episode after recovery has been achieved

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20
Q

Treatment options for mild depression

A

Watch and wait

CBT or other talking therapies

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21
Q

Time frame for review if adopting watch and wait strategy for mild depression

A

Within 2 weeks

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22
Q

First line of antidepressants

A

SSRIs

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23
Q

First line treatment for an initial presentation of severe depression

A

Antidepressants along with CBT

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24
Q

Length of time to continue antidepressants for patients with a moderate or severe episode

A

At least 6 months after remission

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25
Q

Length of time to continue antidepressants for patients with an episode of depression who have residual symptoms

A

At least two years

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26
Q

Length of time to continue antidepressants for patients with an episode of depression who have had >2 episodes in the recent past

A

At least two years

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27
Q

Criteria for using ECT in depression

A

After an adequate trial of other treatments has been ineffective
OR
If the condition is potentially life threatening

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28
Q

Number needed to treat for an antidepressant response in adults

A

4-5

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28
Q

Three phases of depression treatment as per Hirschfield

A

Acute
Continuation
Maintenance

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29
Q

Time frame and aim of the acute phase of depression treatment

A

Stabilisation of acute symptoms
For up to three months

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30
Q

Time frame of the continuation phase of depression treatment

A

6-12 months, to cover the natural (if untreated) course of a depressive episode

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31
Q

Time frame of the maintenance phase of depression treatment

A

From 12 months onwards, aiming to prevent recurrences

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32
Q

Percentage rate of relapse of depression on placebo vs. on active treatment, once the initial episode had finished

A

41% on placebo
18% on active treatment

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33
Q

Largest antidepressant study carried out

A

STAR*D

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34
Q

Year in which the STAR*D trial was completed

A

2006

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35
Q

Level 1 treatment in the STAR*D study

A

Patients given citalopram for up to 12 weeks

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36
Q

Level 2 treatment in the STAR*D study

A

Four different options:

  1. Citalopram was switched to an alternative antidepressant (bupriopion, sertraline, or venlafaxine XL)
  2. Citalopram was augmented with another antidepressant (bupropion or buspirone)
  3. Citalopram was switched to cognitive therapy
  4. Cognitive therapy was added to citalopram
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37
Q

Level 3 treatment in the STAR*D study

A

Four different options:

  1. Patients were switched to mirtazapine
  2. Patients were switched to nortriptyline
  3. Treatment was augmented with lithium
  4. Treatment was augmented with thyroid medication
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38
Q

Level 4 treatment in the STAR*D study

A

Two options:

  1. Patients were switched to tranylcypromine
  2. Patients were switched to a combination of venlafaxine XL and mirtazapine
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39
Q

Criteria for moving patients up a level on the STAR*D study

A

If they had not achieved remission by 12 weeks of the previous level’s treatment

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40
Q

Method to decide which treatment option each patient received within each level of the STAR*D study

A

Patient choice

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41
Q

Percentage of patients on level 1 of the STAR*D study who achieved remission from their depression symptoms

A

37%

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42
Q

Cumulative remission rate of all patients in the STAR*D study

A

67%

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43
Q

Factors associated with immediate drop out of the STAR*D study

A

Younger age
Lower education level
Higher perceived mental health functioning

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44
Q

Class of antidepressants that carry a black box warning for suicidality in under 18s

A

SSRIs

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45
Q

Risk of suicidal behaviour associated with antidepressants in patients aged <25

A

Increased

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46
Q

Risk of suicidal behaviour associated with antidepressants in patients aged 25-64

A

Neutral

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47
Q

Risk of suicidal behaviour associated with antidepressants in patients aged >64

A

Decreased

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48
Q

Class of antidepressant which shows the highest toxicity in overdose

A

TCAs

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49
Q

Class of antidepressant which shows the lowest toxicity in overdose

A

SSRIs

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50
Q

‘5 As’ which can lead to an apparent resistance to antidepressant treatment

A

Alcoholism
Adequate dosage (lack of)
Adherence (lack of)
Axis 2 disorders (personality disorders)
Alternate diagnosis

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51
Q

Two classes of antidepressant which combined have the highest risk for serotonin syndrome

A

SSRIs and MAOIs

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52
Q

Combination of antidepressants which is known as Californian rocket fuel due to its perceived efficacy in treatment resistant depression

A

Venlafaxine and mirtazapine

53
Q

Pharmacokinetic method by which SSRI and TCA combination can improve treatment efficacy

A

SSRIs inhibit TCA metabolism

54
Q

Two most common comorbidities of depression

A

Anxiety
Alcohol use disorder

55
Q

Percentage of patients with depression who receive antidepressants in a year

56
Q

Increased risk of suicide among patients with mood disorder compared to the general population

A

14x higher

57
Q

Number of episodes experienced by patients with bipolar compared to unipolar depression

A

2x higher in patients with bipolar

58
Q

SSRI with the highest toxicity in overdose

A

Citalopram

59
Q

Mechanism of action of agomelatine

A

5HT2c antagonist

60
Q

Options for treatment of sexual side effects from antidepressants

A

Add sildenafil or tadafinil
Add bupropion
Switch of antidepressant
Reduce dose of antidepressant

61
Q

Plant which St John’s Wort is derived from

A

Hypericum perforatum

62
Q

Mechanism of action of ketamine as an antidepressant

A

Blocks glutamatergic NMDA receptors
Upregulates AMPA receptors

63
Q

Speed of action of ketamine as an antidepressant

A

Rapid - better than placebo at 24 hours

64
Q

Mechanism of action of SSRI related sexual dysfunction

A

5HT2 stimulation

65
Q

Factors associated with treatment discontinuation in depression

A

Younger age
Ethnic minority status
Male sex
Unemployment
Lower educational level
Lower income
Greater depressive symptom burden
Higher anxiety levels

66
Q

Effect of previous depressive episodes on treatment drop out rates

A

Lowers likelihood of treatment drop out

67
Q

In comorbid anxiety and depression, illness which should usually be treated first

A

Depression

68
Q

Number needed to treat for antidepressants

69
Q

Treatment status of most patients with depression who attempt suicide

A

Unmedicated

70
Q

Length of time over which treatment emergent suicidal ideation associated with antidepressants disappears in adults

71
Q

Herbal remedy with evidence for its use to treat depression

A

St John’s Wort (Hypericum perforatum)

72
Q

Most common psychiatric diagnosis in patients with chronic fatigue syndrome

A

Depression

73
Q

Time required after stopping phenelzine and before starting fluoxetine

74
Q

Symptoms of the first stage of bereavement

A

Disbelief
Numbness
Searching behaviour

75
Q

Symptoms of the second stage of bereavemenet

A

Withdrawal
Somatic symptoms
Preoccupation
Guilt
Anger

76
Q

Symptoms of the third stage of bereavement

A

Resuming old roles
Returning to work
Acquiring new roles
Experiencing pleasure again
Seeking companionship in others

77
Q

Class of antidepressants which can cause peripheral neuropathy

78
Q

Most common neurological side effect of SSRIs

79
Q

SSRI most likely to cause headaches

A

Fluoxetine

80
Q

Male:female ratio for major depression

81
Q

Antidepressant most likely to cause priapism

82
Q

Antidepressant most likely to cause vaginismus

A

Paroxetine

83
Q

Symptom inventory which measures symptoms of both anxiety and depression

A

Hopkins symptoms checklist

84
Q

Antidepressant most likely to cause urinary hesitancy

A

Reboxetine

85
Q

UK licensed dose for treatment of depression with mirtazapine

A

15-45mg daily

86
Q

UK licensed dose for treatment of depression with venlafaxine

A

75-375mg daily

87
Q

UK licensed dose for treatment of depression with duloxetine

A

60-120mg daily

88
Q

UK licensed dose for treatment of depression with citalopram

A

20-60mg daily

89
Q

UK licensed dose for treatment of depression with sertraline

A

50-200mg daily

90
Q

UK licensed dose for treatment of depression with escitalopram

A

10-20mg daily

91
Q

Best way to switch antidepressants from fluoxetine to moclobemide

A

Stop fluoxetine
Wait five weeks before starting moclobemide

92
Q

Best way to switch antidepressants from a MAOI to an SSRI

A

Stop MAOI
Wait two weeks before starting SSRI

93
Q

Best way to switch antidepressants between SSRIs

A

Cross taper cautiously

94
Q

Best way to switch antidepressants from an SSRI/SNRI to mirtazapine

A

Cross taper cautiously

95
Q

Treatment options for antidepressant induced hyponatraemia

A

Change class of antidepressant from SSRI e.g. to reboxetine, lofepramine or a MAOI
Demeclocycline

96
Q

First line antidepressant in hepatic impairment

A

Imipramine

97
Q

Likely safest antidepressants in renal impairment

A

Sertraline
Citalopram

98
Q

Safest antidepressants for patients with epilepsy

A

SSRIs
Moclobemide

99
Q

Antidepressants which should be avoided in patients with epilepsy

A

Amitryptyline
Dothiepin

100
Q

Phase one in a normal grief reaction

A

Shock and protest
Disbelief

101
Q

Phase two in a normal grief reaction

A

Preoccupation
Yearning and searching

102
Q

Phase three in a normal grief reaction

A

Disorganisation
Despair and then acceptance of loss

103
Q

Phase four in a normal grief reaction

A

Resolution

104
Q

Features of inhibited grief

A

Absence of expected grief symptoms at any time

105
Q

Features of delayed grief

A

Avoidance of painful symptoms within two weeks of the loss

106
Q

Features of chronic grief

A

Ongoing significant grief symptoms more than six months after the loss

107
Q

Nutritional causes of depression

A

Pellagra (niacin deficiency)
Vitamin B12 deficiency

108
Q

Alternative name for pathological crying

A

Pseudobulbar affect

109
Q

Features of pathological crying

A

Frequent, sudden loss of emotional control
Occurs in response to small or inappropriate stimuli
Not associated with the patient’s background mood

110
Q

Medical conditions most often associated with pathological crying

111
Q

Medication options for pathological crying

A

Citalopram
Sertraline
Sodium valproate
Combination of dextromethorphan and low dose quinidine
Amitryptyline
Fluoxetine

112
Q

Medication advised if an antidepressant switch is required due to antidepressant induced prolactinaemia

A

Mirtazapine

113
Q

Length of time after starting an antidepressant that a patient should be reviewed in clinic

A

2 weeks
1 week if <30 or suicide risk identified

114
Q

Medication licensed for self mutilating behaviour

115
Q

Medication shown to improve confusion after ECT

116
Q

Length of time an antidepressant should be trialled before considering a switch if there is no benefit seen

117
Q

First choice treatments for refractory depression

A

Lithium + AD
Olanzapine + fluoxetine
Quetiapine + SSRI/SNRI
Aripiprazole + AD
Bupropion + SSRI
SSRI/venlafaxine + mirtazapine/mianserin
ECT only if specific risk factors

118
Q

General accepted definition of refractory depression

A

Depression which has not responded to two attempts at treatment adequate dose/length of time

119
Q

Medications advised for pathological crying post stroke

A

Citalopram
Sertraline

120
Q

Antidepressants which should be avoided in combination with tamoxifen

A

Fluoxetine
Paroxetine

121
Q

Least effective antidepressant class for atypical depression

122
Q

Most effective antidepressant class for atypical depresson

123
Q

First line treatment for psychotic depression

A

TCA plus antipsychotic - either olanzapine or quetiapine

124
Q

Antipsychotic said to have an antidepressant effect when used at low doses

A

Flupentixol

125
Q

Condition for which phototherapy has the most evidence for efficacy

126
Q

Number of times an SSRI should usually be tried for depression before another class of drug is considered

127
Q

Type of epilepsy where depression is most often comorbid

A

Complex partial seizures

128
Q

Class of antidepressant which can cause HTN

129
Q

TCA safest in overdose

A

Lofepramine

130
Q

Antidepressant recommended for a woman also taking tamoxifen

A

Venlafaxine

2. General adult psychiatry (9 decks)

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