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C. Year 3 MLA Neurology/Behaviour Conditions/Diseases > Depression > Flashcards

Depression Flashcards

1
Q

In affective disorder terminology what does euthymia mean?

1 - bad mood
2 - upset
3 - angry
4 - normal mood

A

4 - normal mood

- greek for happy and well

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2
Q

In affective disorders terminology what are the 3 disorders of mood we need to be aware of that have a pervasive (an unwelcome influence on our mood or physical effect) that can affect patients friends, family etc..?

1 - depression, hypomania, mania
2 - depression, euthymia, mania
3 - depression, hypomania, euthymia
4 - euthymia, hypomania, mania

A

1 - depression, hypomania, mania

  • Depression (low mood)
  • Hypomania (elevation of mood)
  • Mania (further elevation of mood)
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3
Q

In affective disorders terminology Depression, Hypomania and Mania are all disorders of mood that have a pervasive (an unwelcome influence on our mood or physical effect) affect that can affect a patients friends, family etc. What is common in patients with mood disorders such as these?

1 - free from other illness
2 - co-morbid physical disorders
3 - co-morbid psychological disorders
4 - co-morbid physical and psychological disorders

A

4 - co-morbid physical and psychological disorders

- metabolic syndrome and anxiety for example

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4
Q

What are subsyndromal mood disorders?

1 - mood disorders that are elevated above the diagnostic criteria, such as depression and mania
2 - mood disorders that are similar but not severe enough to reach diagnostic criteria, such as depression and mania
3 - patient moves from euthymia (normal mood) to depression on and off
4 -patients symptoms range from depressive through mania (really elevated mood)

A

2 - mood disorders that are similar but not severe enough to reach diagnostic criteria, such as depression and mania

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5
Q

What is dysthymia?

1 - low mood (but not sufficient for diagnosis of depression)
2 - cycling between low mood and elevated mood, but insufficient for manic/depressive diagnosis
3 - patient moves from euthymia (normal mood) to depression on and off
4 -patients symptoms range from depressive through mania (really elevated mood)

A

1 - low mood (but not sufficient for diagnosis of depression)

  • greek for bad low mood
  • chronic low mood
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6
Q

What is Cyclothymia? (cyclo looks like cycling)

1 - low mood (but not sufficient for diagnosis of depression)
2 - cycling between low mood and elevated mood, but insufficient for manic/depressive diagnosis
3 - patient moves from euthymia (normal mood) to depression on and off
4 -patients symptoms range from depressive through mania (really elevated mood)

A

2 - cycling between low mood and elevated mood, but insufficient for manic/depressive diagnosis

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7
Q

In patients with depression (low mood) and hypomania (elevated mood) what other disorder can the symptoms present as?

1 - psychosis
2 - schizophrenia
3 - generalised anxiety disorder
4 - phobia

A

1 - psychosis

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8
Q

What is recurrent depressive disorder?

1 - low mood (but not sufficient for diagnosis of depression)
2 - cycling between low mood and elevated mood, but insufficient for manic/depressive diagnosis
3 - patient moves from euthymia (normal mood) to depression on and off
4 -patients symptoms range from depressive through mania (really elevated mood)

A

3 - patient moves from euthymia (normal mood) to depression on and off
- depression is diagnosed here

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9
Q

What is the lifetime risk of developing depression?

1 - 15-18%
2 - 30-45%
3 - 60-70%
4 - >70%

A

1 - 15-18%

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10
Q

What is the 12 month prevalence of depression?

1 - 0.6%
2 - 6%
3 - 16%
4 - 60%

A

2 - 6%

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11
Q

What % of patients that attend primary care have depression?

1 - 10%
2 - 15%
3 - 20%
4 - 40%

A

4 - 40%

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12
Q

What is the average age onset and peak of a depressive disorder?

1 - <16 y/o
2 - 40-60s
3 - 40s
4 >50 y/o

A

2 - 40-60s

- onset can be in mid 20s

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13
Q

How long do the majority of untreated depressive episodes last?

1 - >1 month
2 - >3 months
3 - >6 months
4 - >12 months

A

3 - >6 months

- minority last years

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14
Q

The majority of untreated depressive episodes last >6 months, although a minority can last years. In comparison how long do treated depressive episodes last for?

1 - 2-3 months
2 - >3 months
3 - >6months
4 - >12 months

A

1 - 2-3 months

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15
Q

If a patient has an untreated (6 months) or treated (2-3 months) depressive episode, what % are likely to have a further episode?

1 - 20%
2 - 40%
3 - 60%
4 - 80%

A

4 - 80%

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16
Q

What % of patients with severe depression are at risk of suicide?

1 - 0.1%
2 - 1%
3 - 10%
4 - 25%

A

3 - 10%

  • this is 15 times more likely than in people without depression

- self neglect or harm to others is also a risk

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17
Q

When we think about the aetiology of depression, we need to think about biological, psychological and social aspects. We also need to think about Predisposing, Precipitating
(stressor), Perpetuating and Protective factors. Which of the following is a predisposing factor to developing depression?

1 - unemployment
2 - attachment style
3 - head injury
4 - all of the above

A

4 - all of the above

  • unemployment = social
  • attachment style = psychological
  • head injury = biological
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18
Q

When we think about the aetiology of depression, we need to think about biological, psychological and social aspects. We also need to think about Predisposing, Precipitating
(stressor), Perpetuating and Protective factors. Which of the following is a Precipitating factor to developing depression?

1 - stressors
2 - medical illness
3 - financial stress
4 - all of the above

A

4 - all of the above

  • stressors = psychological
  • medical illness = biological
  • financial stress = social
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19
Q

When we think about the aetiology of depression, we need to think about biological, psychological and social aspects. We also need to think about Predisposing, Precipitating
(stressor), Perpetuating and Protective factors. Which of the following is a Perpetuating factor to developing depression?

1 - alcohol misuse
2 - chronic negative thoughts
3 - ongoing social stress
4 - all of the above

A

4 - all of the above

  • alcohol misuse = biological
  • chronic negative thoughts = psychological
  • ongoing social stress = social
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20
Q

When we think about the aetiology of depression, we need to think about biological, psychological and social aspects. We also need to think about Predisposing, Precipitating
(stressor), Perpetuating and Protective factors. Which of the following is a Protective factor to developing depression?

1 - helpful coping strategies
2 - family support
3 - good physical health
4 - all of the above

A

4 - all of the above

  • helpful coping strategies = psychological
  • family support = social
  • good physical health = biological
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21
Q

Patients with depression often have depressive thinking. Which of the following is NOT an example of having thoughts of guilt and self blame from the PAST?

1 - stole something as a child
2 - not collecting mum from the shops
3 - assigning a new promotion to chance and not worth of it
4 - unhappy times, when they failed at something important

A

3 - assigning a new promotion to chance and not worth of it

  • this is a thought about the present
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22
Q

Patients with depression often have depressive thinking. Which of the following is NOT an example of having thoughts of guilt and self blame from the PRESENT?

1 - stole something as a child
2 - low self esteem with friends and partners
3 - assigning a new promotion to chance and not worth of it
4 - lack of confidence in speaking to new people

A

1 - stole something as a child

  • this is from the past
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23
Q

Patients with depression often have depressive thinking. Which of the following is NOT an example of having thoughts of guilt and self blame from the FUTURE?

1 - I will lose all my money
2 - my partner is going to leave me
3 - I am going to become sick and die
4 - lack of confidence in speaking to new people

A

4 - lack of confidence in speaking to new people

  • this is an example of negative thinking in the present
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24
Q

There is an extensive list of diagnostic features of a depressive episodes, but what are the main 3?

1 - high mood, low energy, loss of enjoyment
2 - low mood, high energy, loss of enjoyment
3 - low mood, low energy, loss of enjoyment
4 - normal mood, normal energy and loss of enjoyment

A

3 - low mood, low energy, loss of enjoyment

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25
Q

A clinical diagnosis depressive episode according to ICD-11 can be mild, moderate or severe based on what?

1 - duration of symptoms
2 - number of symptoms
3 - gender and the number of symptoms
4 - gender and duration of symptoms

A

2 - number of symptoms

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26
Q

A clinical diagnosis of a depressive episode according to ICD-11 must last how long?

1 - >1 week
2 - >2 weeks
3 - >4 weeks
4 - >12 weeks

A

2 - >2 weeks

  • must be persistent and impair day to day functioning accompanied by other symptoms such as low energy, lack of interest, poor sleep and poor concentration

- symptoms must be present all of or most of the time

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27
Q

A clinical diagnosis of a depressive episode according to ICD-11 must last 2 or more weeks with symptoms present all of or most of the time. What also must be present as a disability?

1 - lack of social support
2 - lack of insight
3 - social and functional impairments

A

3 - social and functional impairments

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28
Q

A clinical diagnosis of a depressive episode according to ICD-11 must last 2 or more weeks with symptoms present all of or most of the time, with impaired social and/or occupational function. What must the clinician exclude?

1 - other psychological disorders
2 - dementia
3 - major life events

A

3 - major life events

  • it could just be due to the death of a family member, which is different

- symptoms are not in context with a major life event, such as loss of relative

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29
Q

In depressive episodes patients have a low mood which can be diurnal. What does diurnal variation mean in this context?

1 - mood drops in the evening only
2 - mood is low in the mornings only
3 - mood can fluctuate throughout the day

A

3 - mood can fluctuate throughout the day

- diurnal = latin for daily variation

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30
Q

When we talk about depressive disorders, people often describe biological features. Which of the following is NOT one of the 4 most common?

1 - appetite changes
2 - reduced PA
3 - altered sleep pattern
4 - delusions
5 - reduced libido

A

4 - delusions

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31
Q

When we talk about depressive disorders, people often describe psychological features. Which of the following is NOT one of the 4 most common?

1 - manic episodes
2 - cognitive dysfunction (low concentration)
3 - low self-esteem
4 - negative thinking
5 - anxiety

A

1 - manic episodes

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32
Q

When we talk about depressive disorders, people can present with disassociation, what is this?

1 - physical and mental state separation
2 - patients feel separated from the world
3 - patients feel separated from from others
4 - patients want to be alone

A

3 - patients feel separated from from others

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33
Q

When we talk about depressive disorders, people can present with obsessions, what are these?

1 - thoughts of grander
2 - intrusive and repetitive thoughts of their own
3 - delusions
4 -hallucinations

A

2 - intrusive and repetitive thoughts of their own

  • this is the thought only
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34
Q

When we talk about depressive disorders, people can present with obsessions and compulsions. What are compulsions?

1 - thoughts of grander
2 - intrusive and repetitive thoughts of their own
3 - delusions
4 -behaviours relating to intrusive thoughts

A

4 -behaviours relating to intrusive thoughts

  • specifically related to behaviours
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35
Q

When we talk about depressive disorders, people can present with physical symptoms, which of the following is a common sign?

1 - headaches
2 - GIT discomfort
3 - pain
4 - all of the above

A

4 - all of the above

  • anything can change in patients with depressive disorders
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36
Q

We know that patients with severe depressive episodes can have features of psychosis, mainly delusions and hallucinations. What is the difference between delusions and hallucinations?

A
  • delusions = a false belief that persists in spite of evidence
  • in depression that can be negative and bad
  • hallucinations = sensations (voices, smells etc..) that feel real but are not
  • in depression these can be derogatory, ‘you are rubbish and bad’
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37
Q

Patients with severe depression can experience psychotic symptoms. What is the most common type of depressive hallucinations are most common?

1 - auditory
2 - visual
3 - smell
4 - touch

A

1 - auditory

  • generally in 2nd person, confirming negative thinking
  • you deserve to die
  • you are worthless
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38
Q

In patients who are having depressive symptoms, it can be common for them to have cognitive impairments and memory retention problems. It can be difficult to distinguish between depression and dementia, and is described as cognitive impairment due to depression. How is the clinician able to distinguish between dementia and depression?

1 - medical history and assessment
2 - in-depth cognitive testing
3 - relieving of signs/symptoms in response to treatment
4 - all of the above

A

4 - all of the above

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39
Q

Does depression increase the risk of dementia?

A
  • yes
  • number of depressive episode is associated with dementia
  • early symptoms of dementia may present as depression (prodrome)
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40
Q

A large number of patients with dementia will have depression. There are 4 main hypothesis that link depression with dementia. One of which is vascular damage. What happens here?

A
  • vascular damage leads to frontostriatal problems

- frontostriatal circuits are neural pathways that connect frontal lobe regions with the basal ganglia

41
Q

A large number of patients with dementia will have depression. There are 4 main hypothesis that link depression with dementia. One of which is hippocampus damage/atrophy. What happens here?

A
  • excessive cortisol releases Ca2+ into hippocampus

- becomes excitotoxic and damages hippocampus

42
Q

A large number of patients with dementia will have depression. There are 4 main hypothesis that link depression with dementia. One of which is Impaired amyloid clearance. What happens here?

A
  • protein involved in Alzheimer’s disease is not removed

- B amyloid builds up and blocks neuronal firing

43
Q

A large number of patients with dementia will have depression. There are 4 main hypothesis that link depression with dementia. One of which is chronic inflammation. What happens here?

A
  • may damage the brain and vascular system

- implicated in aetiology of both depression and Alzheimer’s

44
Q

There are a number of factors which can be linked with the aetiology of depression, which can be categorised into biological, psychological and social. Physical illness is a psychological stressor, but physical health, a biological factor can directly cause mood symptoms such as depression. Which of the following is NOT one of the common 3 physical illnesses that could lead to mood disorders?

1 - brain disease
2 - endocrine disorders
3 - gastrointestinal disorder
4 - infections including HIV

A

3 - gastrointestinal disorder

45
Q

There are a number of factors which can be linked with the aetiology of depression, which can be categories into biological, psychological and social. Physical illness is a psychological stressor, but physical health, a biological factor can directly cause mood symptoms such as depression. Do patients with or without physical illness have better clinical outcomes?

A
  • without physical illness

- depression worsens outcomes

46
Q

There is a genetic aetiology of depression with multiple genes being identified, but they are shared across psychological disorder. In first degree relatives what is the risk factor increase from a first degree relative with depression?

1 - x 0.5
2 - x 3
3 - x10
4 - x40

A

2 - x 3

47
Q

In depression there is the monoamine theory, what is this theory?

A
  • low levels of monoamines, serotonin, noradrenalin and dopamine can lead to depression
48
Q

In depression there is the monoamine theory. The theory suggests that depressive disorder are due to abnormalities in one or more monoamine neurotransmitter systems, namely serotonin, noradrenalin and dopamine. In the case of serotonin, how did this theory develop?

A
  • depletion of tryptophan (serotonin precursor) levels causes relapse of depression
  • decreases receptor binding for serotonin
  • decreases serotonin metabolites in CSF
  • anti-depressants increase serotonin levels
49
Q

In depression there is the monoamine theory. The theory suggests that depressive disorder are due to abnormalities in one or more monoamine neurotransmitter systems, namely serotonin, noradrenalin and dopamine. In the case of dopamine and noradrenaline, how did this theory develop?

A
  • if tyrosine hydroxylase is inhibited by 𝛂-methyl-para-tyrosine (AMPT) there will be no down stream effects from L-dopa metabolism
  • low levels of dopamine and noradrenaline are linked with depressive relapse occurs
50
Q

What is the hypothalamic–pituitary–adrenal axis pathway?

A
  • when stressed the hypothalamus stimulates the release of corticotropin-releasing hormone (CRH)
  • CRH stimulates the pituitary gland to release adrenocorticoptropic hormone (ACTH)
  • ACTH stimulates the adrenal glands to release cortisol (CORT)
  • Negative feedback from cortisol to control the axis via the hippocampus
51
Q

A consistent finding in depression is a dysfunctional HPA axis, which results in elevated levels of what?

1 - aldosterone
2 - renin
3 - noradrenaline
4 - cortisol

A

4 - cortisol

52
Q

A consistent finding in depression is a dysfunctional HPA axis, which results in elevated levels of cortisol. This has been shown to impair what?

1 - energy levels
2 - fatigue
3 - appetite
4 - cognition

A

4 - cognition

53
Q

In patients with depression there has been shown to be increased levels of inflammation. If we administer cytokines (synthetic inflammation) what can this then cause?

1 - reduced energy levels
2 - trigger depression
3 - appetite loss
4 - sleep impairment

A
  • trigger depression
54
Q

In patients with depression there has been shown to be increased levels of inflammation. If we administer cytokines (synthetic inflammation) this can then trigger depression. Post-mortem tissue suggests what in the brain is affected following the administration of cytokine?

A
  • neuroinflammation

- microglial cells

55
Q

Patients with depression often have depressive thinking. Which of the following is NOT an example of having thoughts of guilt and self blame from the PRESENT?

1 - stole something as a child
2 - low self esteem with friends and partners
3 - assigning a new promotion to chance and not worth of it
4 - lack of confidence in speaking to new people

A

1 - stole something as a child

  • this is from the past
56
Q

There are variants of depressive disorders. Which of the following matched the term agitated depression?

1 - patient is constantly agitated, and occurs more commonly in older patients
2 - prominent retardation
3 - reversed biological symptoms (more sleep, food, anxiety etc..)
4 - extreme retardation with extreme motionless

A

1 - patient is constantly agitated, and occurs more commonly in older patients

57
Q

There are variants of depressive disorders. Which of the following matched the term retarded depression?

1 - patient is constantly agitated, and occurs more commonly in older patients
2 - prominent retardation
3 - reversed biological symptoms (more sleep, food, anxiety etc..)
4 - extreme retardation with extreme motionless

A

2 - prominent retardation

  • psychomotor retardation is common
58
Q

There are variants of depressive disorders. Which of the following matches the term depressive stupor?

1 - patient is constantly agitated, and occurs more commonly in older patients
2 - prominent retardation
3 - reversed biological symptoms (more sleep, food, anxiety etc..)
4 - extreme retardation with extreme motionless

A

4 - extreme retardation with extreme motionless

  • stupor relates to lack of consciousness or functionality
  • when patient recovers they can recall events
59
Q

There are variants of depressive disorders. Which of the following matches the term atypical depression?

1 - patient is constantly agitated, and occurs more commonly in older patients
2 - prominent retardation
3 - reversed biological symptoms (more sleep, food, anxiety etc..)
4 - extreme retardation with extreme motionless

A

3 - reversed biological symptoms (more sleep, food, anxiety etc..)

60
Q

Which of the following are differentials for depression?

1 - bipolar disorder
2 - day to day sadness/grief
3 - psychosis
4 - anxiety disorder
5 - schizophrenia
6 - dementia
7 - substance abuse
8 - all of the above

A

8 - all of the above

61
Q

When deciding on the treatment that a patient requires we need to consider all of the following, EXCEPT:

1 - severity of the disorder
2 - previous treatment response
3 - gender
4 - patient preference
5 - access to treatment

A

3 - gender

62
Q

All of the following are general aspects of treating a patient with an acute phase of depression, EXCEPT?

1 - diet
2 - exercise/physical activity
3 - sleep
4 - outpatient hospital

A

4 - outpatient hospital

  • older patients are less likely to get be prescribed these
63
Q

Anti-depressant medication should not be prescribed to all patients with depression. Which severity should they NOT be prescribed to, at least initially?

1 - mild depression
2 - moderate depression
3 - severe depression
4 - all of the above

A

1 - mild depression

  • no real evidence for their effectiveness
  • older patients are less likely to get be prescribed these
64
Q

Is there one anti-depressants that is more effective than others?

A
  • no
  • depends on risks of drugs, previous response and specific to patient
65
Q

The 2 questions below are useful for what?

  • During the last month have you often been feeling down, depressed or hopeless?
  • During the last month have you often been bothered by having little interest or pleasure in doing things?

1 - cognitive assessment
2 - memory assessment
3 - depression screening
4 - physical illness screen

A

3 - depression screening

- needed as people wont tell you they are depressed

66
Q

In all patients with depression, what are the 3 things they should be offered straight away?

1 - advice about sleep hygiene, active monitoring of symptoms, medication
2 - psychoeducation, CBT, active monitoring of symptoms
3 - psychoeducation, advice about sleep hygiene, CBT
4 - psychoeducation, advice about sleep hygiene, active monitoring of symptoms

A

4 - psychoeducation, advice about sleep hygiene, active monitoring of symptoms

67
Q

In patients with mild to moderate depression, what would be the treatment strategy?

1 - low intensity psychosocial and high intensity psychological interventions
2 - CBT and low intensity psychosocial interventions
3 - low intensity psychosocial and psychological interventions
4 - low psychological interventions and CBT

A

3 - low intensity psychosocial and psychological interventions

  • if no improvement from 1 and 2 then need to consider medication
68
Q

In all patients with mild to moderate depression that do not respond to low intensity psychosocial and psychological interventions, what should these patients be offered?

1 - high intensity psychosocial and/or antidepressant medication
2 - CBT and antidepressant medication
3 - low intensity psychosocial and antidepressant medication
4 - low psychological interventions and CBT

A

1 - high intensity psychosocial and/or antidepressant medication

69
Q

In all patients with severe and complex depression, what should these patients be offered?

1 - high intensity psychosocial and/or antidepressant medication
2 - high intensity psychosocial intervention, antidepressants, specialist referral and crisis team
3 - low intensity psychosocial and antidepressant medication
4 - low psychological interventions and CBT

A

2 - high intensity psychosocial intervention, antidepressants, specialist referral and crisis team

  • specialist referral is MDTs
  • consider crisis team is admission to hospitals
70
Q

In patients with severe depression who are a high risk with threat to life (self neglect, suicidal) what are other treatment alternatives?

1 - urgent specialist referral
2 - hospital admission
3 - detained underMHA 2 (28 days of assessment
4 - electroconvulsive therapy (ECT)
5 - antipsychotic medication for psychotic symptoms
6 - all of the above

A

6 - all of the above

71
Q

What is psychoeducation?

A
  • evidence-based therapeutic intervention
  • patients with depression and their loved ones are provided with information and support to better understand and cope with depression
72
Q

Psychoeducation is an evidence-based therapeutic intervention where patients with depression and their loved ones are provided with information and support to better understand and cope with depression. What sort of things might be spoken about?

A

1 - Day to day things that can impact on mental health (+ and -)

  • Work
  • Family life
  • Sleep
  • Level of exercise
  • What we eat (i.e. diet)
  • Drugs and alcohol, smoking

2 - Sleep hygiene

73
Q

When a patient has been actively monitored, provided with psychosocial and given advice about their sleep hygiene, but none of this works, they could be offered a low intensity psychosocial intervention. Which of the following are examples this form can this low intensity psychosocial intervention take?

1 - regular exercise or group activity programmes
2 - befriending services
3 - local support groups and social groups
4 - social prescribing (identify and access groups and activities)
5 - all of the above

A

5 - all of the above

74
Q

When a patient has been actively monitored, provided with psychoeducation and given advice about their sleep hygiene, but none of this works, they could be offered a low intensity psychological intervention. What are low and high psychological interventions?

A

1 - low

 - computerised CBT
 - guided self help (e.g. book) based on CBT
 - group CBT

2 - high

 - individual CBT
 - other individual therapies
75
Q

Which of the following are focussed on in cognitive behavioural therapy?

1 - feelings
2 - thoughts
3 - behaviour
4 - all of the above

A

4 - all of the above

76
Q

The majority of anti-depressant medications act on monoamines neurotransmitters. What are the 3 key monoamines that anti-depressant medications act on?

1 - neuroadrenaline, serotonin, acetylcholine
2 - neuroadrenaline, acetylcholine, dopamine
3 - neuroadrenaline, serotonin, dopamine
4 - acetylcholine, serotonin, dopamine

A

3 - neuroadrenaline, serotonin, dopamine

77
Q

The majority of anti-depressant medications act on monoamines neurotransmitters. The 3 key monoamines that anti-depressant medications act on are neuroadrenaline, serotonin and dopamine. They are able to have a rapid effect within the synapse, but can then take time to have a therapeutic effect. How long can some anti-depressants take before the begin to have a therapeutic effect?

1 - 1 week
2 - 2 weeks
3 - 3-4 weeks
4 - >4 weeks

A

3 - 3-4 weeks

  • causes people to stop taking them as they feel its not helping
78
Q

Although not exactly known the reason there is a delayed response in anti-depressant medication is thought to be due to alterations in gene expression. One of the things altered gene expression may be involved in is down-regulation of receptors, what happens here?

A
  • medication will result in an increase in the levels of neurotransmitter
  • gene expression down regulates receptors, called desensitisation
  • cell is no longer as responsive to neurotransmitter
79
Q

Although not exactly known the reason there is a delayed response in anti-depressant medication is thought to be due to alterations in gene expression. One of the things altered gene expression may be involved in is neurogenesis/synaptic plasticity, what happens here?

A
  • create new synapses

- increase hippocampal and prefrontal cortex neurogenesis

80
Q

In clinical trials what % of patients with depression respond to active anti-depressant medication and placebo?

1 - 0.5%
2 - 5%
3 - 25%
4 - 50%

A

4 - 50%
- active anti-depressant medication = 50%

- placebo = 30%

81
Q

What are the first line choice in anti-depressant medication?

1 - benzodiazepines
2 - gabapentinoids
3 - selective serotonin reuptake inhibitors (SSRIs)
4 - ion channel blockers

A

3 - selective serotonin reuptake inhibitors (SSRIs)

- Citalopram is the core drug

82
Q

Selective serotonin reuptake inhibitors (SSRIs) are the first line choice in anti-depressant medication. If the patient is responding and there are no issues how long should these drugs be taken for and if stopped earlier what can happen?

1 - >1 month and relapse of depression
2 - >3 months and relapse of depression
3 - >6 months and relapse of depression
4 - >12 months and relapse of depression

A

3 - >6 months and relapse of depression

83
Q

Citalopram is a key drug that we need to be aware of. It is a selective serotonin reuptake inhibitors (SSRI) used commonly to treat depressant. Why is it important to warn patients about the side effects of SSRI, such as nausea and loss of appetite, diarrhoea, sexual dysfunction, insomnia, agitation, anxiety and headaches?

A
  • patients can initially feel worse and stop taking the medication
  • therapeutic effects may not begin for 3-4 weeks
84
Q

Citalopram is a key drug that we need to be aware of. It is a selective serotonin reuptake inhibitors (SSRI) used commonly to treat depressant. Although not commonly identified as common side effects, what are 2 side effects that can be dangerous in some patients?

A
  • hyponatraemia (low Na+)

- interaction with NSAIDs (GIT dysfunction)

85
Q

Which of the following is NOT a core SSRI drug we need to be aware of?

1 - Amitriptyline
2 - Citalopram
3 - Fluoxetine
4 - Sertraline

A

1 - Amitriptyline

  • this is a tricyclic drug that inhibits the re-uptake of serotonin and noradrenaline
  • used mainly in severe depression
86
Q

Tricyclic anti-depressants are drugs that inhibit the re-uptake of serotonin and noradrenaline. Which of the following is the core Tricyclic drug we need to be aware of?

1 - Amitriptyline
2 - Citalopram
3 - Fluoxetine
4 - Sertraline

A

1 - Amitriptyline

  • used mainly in severe depression
87
Q

Serotonin noradrenaline and reuptake inhibitors (SNRIs) are drugs that inhibit the re-uptake of serotonin and noradrenaline. Which 2 of the following are the core SNRIs drugs we need to be aware of?

1 - Amitriptyline
2 - Duloxetine
3 - Venlafaxine
4 - Sertraline

A

2 - Duloxetine
3 - Venlafaxine

  • inhibit re-uptake of serotonin and noradrenaline, BUT noradrenaline
88
Q

Tetracyclics are anti-depressant drugs that are able to antagonise the pre-synaptic a2 adrenoreceptors, resulting in less serotonin and noradrenaline being taken back up. Which of the following is the core Tetracyclic that we need to be aware of?

1 - Mirtazapine
2 - Duloxetine
3 - Venlafaxine
4 - Sertraline

A

1 - Mirtazapine

89
Q

Is combining more than one anti-depressant when a patient doesn’t respond the first option?

A
  • no
  • try an alternative anti-depressant 1st
90
Q

Combining more than one anti-depressant when a patient doesn’t respond is only tried once different anti-depressants alone have been tried 1st. Which of the following is NOT a current UK recommendation for prescribed anti-depressants together?

1 - SSRI, SNRI or tricyclic WITH mirtazapine
2 - SSRI WITH SNRI WITH mirtazapine
3 - any anti-depressant WITH lithium
4 - any anti-depressant WITH atypical antipsychotic

A

2 - SSRI WITH SNRI WITH mirtazapine

91
Q

To reduce the risk of relapse in patients with depression, what duration could they be prescribed anti-depressants for?

1 - 2 weeks
2 - 2 months
3 - 12 months
4 - 2 years

A

4 - 2 years

92
Q

Electroconvulsive therapy (ECT) involves sending electrical currents through the brain, similar to a seizure, with the hope it almost resets the brain. ECT is generally reserved for which patients with depression?

1 - severe depression
2 - non responder to several anti-depressants
3 - drugs tried for >6 weeks
4 - all of the above

A

4 - all of the above

  • lots of adverse effects compared to drugs
93
Q

lectroconvulsive therapy (ECT) involves sending electrical currents through the brain, similar to a seizure, with the hope it almost resets the brain. It is normally performed twice a week for 6 weeks. Which of the following are common side effects?

1 - Headache
2 - confusion
3 - muscular aches for period immediately after treatment
4 - cognitive symptoms
5 - all of the above

A

5 - all of the above

94
Q

Can cognitive behavioural therapy (CBT) be used for all patients with depression?

A
  • no
  • good in mild and moderate depression
95
Q

What % of patients with a depressive disorder do not respond to regular exercise, anti-depressant therapy and psychological therapy within 6 weeks?

1 - 0.3%
2 - 3%
3 - 30%
4 - 60%

A

3 - 30%

  • patients are re-assessed at 6 weeks
96
Q

When we think about the aetiology of depression, we need to think about biological, psychological and social aspects. We also need to think about Predisposing, Precipitating
(stressor), Perpetuating and Protective factors. Which of the following is a Precipitating factor to Perpetuating depression?

1 - alcohol misuse
2 - chronic negative throughts
3 - ongoing social stress
4 - all of the above

A
97
Q

When we think about the aetiology of depression, we need to think about biological, psychological and social aspects. We also need to think about Predisposing, Precipitating
(stressor), Perpetuating and Protective factors. Which of the following is a Precipitating factor to Perpetuating depression?

1 - alcohol misuse
2 - chronic negative throughts
3 - ongoing social stress
4 - all of the above

A
98
Q

When we think about the aetiology of depression, we need to think about biological, psychological and social aspects. We also need to think about Predisposing, Precipitating
(stressor), Perpetuating and Protective factors. Which of the following is a Protective factor to developing depression?

1 - alcohol misuse
2 - chronic negative thoughts
3 - ongoing social stress
4 - all of the above

A

C. Year 3 MLA Neurology/Behaviour Conditions/Diseases (28 decks)

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