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Year 4 - Psychiatry > Depression > Flashcards

Depression Flashcards

1
Q

What is depression?

A

Disorder causing persistent feelings of :
- Low mood
- Low energy
- Anhedonia

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2
Q

What is the pathophysiology of depression?

A

Disturbance in neurotransmitter activity in CNS

Particularly serotonin (5-HT)

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3
Q

What causes depression?

A

Life events
No apparent triggers
Genetic, psychological, biological and environmental factors
Family history
Physical health conditions

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4
Q

What are the core symptoms of depression?

A

Low mood
Anhedonia
Low energy

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5
Q

How are the different grades of depression diagnosed?

A

PHQ9

OR

Mild
2 core + 2 others (able to function!)
Moderate
2 core + 3 (or 4) others
Severe
3 core + at least 4 others
Severe
With psychotic symptoms

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6
Q

What is cyclothymia?

A

Mild periods of elation/depression
Early onset, chronic course
Common in relatives of BPD

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7
Q

What is dysthymia?

A

Chronic low mood not fulfilling depression criteria

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8
Q

What are the emotional symptoms of depression?

A

Anxiety
Irritability
Low self-esteem
Guilt
Hopelessness about the future

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9
Q

What are the cognitive symptoms of depression?

A

Poor concentration
Slow thoughts
Poor memory

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10
Q

What are the physical symptoms of depression?

A

Low energy
Abnormal sleep
Poor appetite or overeating
Slow movements

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11
Q

What environmental factors contribute to depression?

A
  • Potential triggers (stress, grief or relationship breakdown)
  • Home enviornment
  • Relationships with family, friends, partners
  • Work
  • Financial difficulties
  • Safeguarding issues
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12
Q

When taking a history what essential factors must be explored?

A

Caring responsibilities
Social support
Drug use
Alcohol use
Forensic history

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13
Q

What should a risk assessment look for?

A

Self-neglect
Self-harm
Harm to others
Suicide

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14
Q

What is used to assess severity of depression?

A

PHQ-9 questionnaire

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15
Q

What is used to assess depression and what do the different scores mean?

A

PHQ-9 questionnaire

5-9 - Mild

10-14 - Moderate

15-19 - Moderately severe

20-27 - Severe

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16
Q

What are the management options for depression?

A

Active monitoring and self-help
Address lifestyle factors
Therapy
Antidepressants (SSRIs are first line)

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17
Q

When should antidepressants be offered first line?

A

If the patient has a preference for them

Otherwise not a first-line treatment

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18
Q

How are patients with severe or psychotic depression managed?

A

Specialist input and management

Crisis resolution and home treatment team- offers intense support without patient being admitted

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19
Q

When is admission to hospital required for depression?

A

High risk of self-harm
Suicide risk
Self-neglect
Immediate safeguarding issues

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20
Q

What specialist treatments can be trialled for unresponsive or severe depression?

A

Antipsychotic medications (olanzapine and quetiapine)
Lithium
Ectroconvulsive therapy
rTMS
tDCS

21
Q

What is electroconvulsive therapy?

A

Very effective treatment

Under general anaesthesia electrodes placed on patient’s head

Short electrical current administered, triggering a short generalised seizure lasting 30 seconds

22
Q

What are the side effects of electroconvulsive therapy?

A

Headache
Muscle aches
Short-term memory loss

23
Q

What is rTMS?

A

Repetitive transcranial magnet stimulation

Placing electromagnetic coil against head, sends repetitive pulses of magnetic energy at fixed frequency

24
Q

What is tDCS?

A

Transcranial direct current stimulation

Small battery-operate stimulator to deliver constant current by 2 electrodes on head

25
Q

What does psychotic depression generally indicate?

A

Severe depression

26
Q

What is psychotic depression?

A

Involves symptoms of psychosis
- Delusions
- Hallucinations
- Thought disorder

27
Q

What conditions is ECT licensed for?

A

Severe life-threatening depression
Treatment resistant depression
Catatonia
Prolonged manic episodes

28
Q

What are the spectrum of postnatal depressive disorders?

A

Baby blues
Postnatal depression
Puerpal psychosis

29
Q

What is the baby blues?

A

Affects 50% of women in first week post birth

Particularly first-time mothers

  • Mood swings
  • Low mood
  • Anxiety
  • Irritability
  • Tearfulness
30
Q

What causes baby blues?

A

Significant hormonal changes
Recovery from birth
Sleep deprivation
Increased responsibility
Difficulty with feeding

Mild symptoms which usually resolve within 2 weeks

31
Q

What is postnatal depression?

A

Depression similar to that outside of pregnancy

Classic triad of :
- Low mood
- Anhedonia
- Low energy

Affects women 3 months after birth

Can develop up to 1 year after birth of baby

32
Q

How long should symptoms of postnatal depression last before diagnosis?

A

At least 2 weeks

Treat as you would normal depression

33
Q

What is puerperal psychosis?

A

Rare, severe illness 2-3 weeks post delivery

Women experience psychosis
- Delusions
- Hallucinations
- Depression
- Mania
- Confusion
- Thought disorder

34
Q

Where do mothers with puerperal psychosis get admitted to?

A

Mother and baby unit

Specialist unit for pregnant women and women who have given birth in past 12 months

Designed to allow mothers to continue to build bond with baby while being treated

35
Q

What happens in birth trauma/PTSD?

A

Flashbacks, nightmares or intense upsetting memories of birth
Anxiety, anger, depression, guilt in relation to birth
Not wanting to think about it or thinking about it obsessively

36
Q

What is tokophobia?

A

Pathological phobia of birth and pregnancy

1- Never experienced birth before
2- Following traumatic birth

37
Q

What are the consequences of tokophobia?

A

Can affect obstetric decisions
Affected bonding with baby
Mental wellbeing during pregnancy

38
Q

How is tokophobia managed?

A

CBT
Hypnobirthing
Elective CS

39
Q

What tool is used to assess postnatal depression?

A

Edinburgh postnatal depression scale

  • How mother has felt over past week
  • 10 questions
  • Score out of 30
  • 10 or more indicates postnatal depression
40
Q

What SSRI is preferred in postpartum depression?

A

Paroxetine

Low milk/plasma ratio

Avoid fluoxetine, long half-life

41
Q

What are some potential risks of SSRIs in pregnancy?

A

First trimester - small risk of congenital heart defects

Third trimester- can cause persistent pulmonary hypertension of the newborn

Setralline preferred

42
Q

What SSRI has the highest risk of malformations during pregnancy?

A

Paroxetine

Particularly first trimester

43
Q

What are the risks of lithium in pregnancy?

A

Low risk of ebstein’s anomaly

44
Q

What can benzodiazepine use lead to in pregnancy?

A

Possible risks of defects in 1st trimester
Risk of neonatal withdrawals in 3rd trimester (floppy baby syndrome)

45
Q

What can antipsychotic use lead to in pregnancy?

A

Prolactin increase can affect fertility
DM risk causing macrosomia

46
Q

What is Beck’s cognitive triad for depression?

A

Negative views about the world
Negative views about the future
Negative views about oneself

47
Q

What is the simplified maintenance cycle?

A

Feel low
Avoid activity
No reward

48
Q

What are the key ideas of CBT?

A
  • Socratic questioning
  • Formulation
  • CBT models of disorder
  • Problems and targets
  • Collaboration
  • Homework
  • Make the patient their own therapist
49
Q

What does appraisal mean in CBT?

A

People are upset not by the events but the personal meaning that these events have for them

Year 4 - Psychiatry (23 decks)

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