Depression

Question 1

Risks

Answer 1

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

Question 2

What tests do you want to order

Answer 2

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

Question 3

Suicide risks

Answer 3

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

Question 4

What risk tool can you use for suicide risk

Answer 4

Convergent Functional Assessment for suicide

Question 5

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

Answer 5

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

Question 6

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

Answer 6

Female
Older
Serious complex mental illness
Substance misuse
History of TBI

Question 7

DDX for depression

Answer 7

Thyroid
Cortisol
Grief
Withdrawl
Drug use
Bipolar
Tumor
Delirum

Question 8

When should you add an adjunct medication

Answer 8

If they have tried at least 2 antidepressants
If they are tolderating medication well and had good initial partial response

Question 9

How long should someone stay on their treatment for depression

Answer 9

6-9 months of remission
2 years if they are high risk or have previous episodes

Question 10

Discontinuation symptoms of SSRI and SNRI

Answer 10

FINISH
Flu symptoms
Insomnia
Nausea
Imbalance
Sensory disturbance
Hyperarousal

Question 11

Which medications have the most FINISH symptoms and the least

Answer 11

Most: Paroxetine and venlafaxine
Fluoxatine and vortioxetine

Question 12

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

Answer 12

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

Question 13

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

Answer 13

Onset <25
>5 episodes
Hamily history
Hypersomnia
Hyperphagia
Lability

Question 14

Whats the difference between BP1 and BP2

Answer 14

BP2 is hypomania which presents with no psychosis

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

Question 15

List seven symptoms of mania

Answer 15

Distractibility
Indiscretion
Gradiosity
Flight of ideas
Activity increased
Sleep deficit
Talkative

Question 16

Acute management of bipolar

Answer 16

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

Question 17

Maintenance of BP

Answer 17

Lamotragine
Lithium
Quetiapine
Divalproex

Question 18

Management of depression in bipolar

Answer 18

1st line=Quetiapine
2nd line=Lithium, SSRI

Question 19

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

Answer 19

1. Aripiprazone, quetiapine (lower doses)
2. Bupropion, lithium