Depression Flashcards

Question

What is the common presentation of depression in absence of somatic symptoms?

Answer 1

Hostile depression which is more common in younger people with anxiety that have a history of hostile behaviours in response to stress like yelling, physical damage to objects and impulsivity. They have a poor response to antidepressants. AND Anxious depression: typically an early onset depression, where they are shy and withdrawn. There is a higher likelihood of substance dependency and self-harm and suicide, but a better response to antidepressants

Answer 2

Tiredness Low mood Headache Backache Indigestion Chest pain Sleep disturbances Stress Dizziness

Answer 3

Psychotic depression is a severe depressive episode accompanied by psychotic symptoms such as Delusions, typically nihilistic in nature such as guilt, responsibility for world events and deserving of punishment Hallucinations that may be auditory like accusatory voices, olfactory sense of rotting or visual images of torment like demons or torture. This typically occurs within the context of schizophrenia or bipolar disorder, and presents with typical symptoms of depression. Psychotic depression typically features psychomotor changes and suicide ideation.

Answer 4

PHQ-2 tool used in primary care and general hospital where patients are screened, based on the first two questions from the PHQ-9 that detects a majority of cases of depression: “Do you struggle with feelings of depression and hopelessness?” “Do you struggle with a loss of interest of hopelessness or loss of interest?”

Answer 5

Cluster of depressive symtpoms with preoccupation with the deceased where it: ->Intense enough to be diagnosed by clinical depression ->Delayed to avoid grief ->Last longer than 6 months

Answer 6

Grief is the emotional response to a loss where a person may experience shock, numbness, sadness, helplessness and depression.

Answer 7

Appearance Behaviour Speech Thoughts Perception Mood Cognition Insight

Answer 8

Acute onset, earlier age of onset, endogenous depression

Answer 9

3 P’s Predisposing factors: features of patient history which puts them at risk based on the aetiology of depression Precipitating factors: Important recent events that occurred in the patient’s life Perpetuating factors: Which aspects of the patient’s social or biomedical history is making the depression worse

Answer 10

Insidious/slow onset Elderly Neuroticism Co-morbidity Lack of social support Neuroticism Low self confidence

Answer 11

3 P’s Predisposing factors: features of patient history which puts them at risk based on the aetiology of depression Precipitating factors: Important recent events that occurred in the patient’s life Perpetuating factors: Which aspects of the patient’s social or biomedical history is making the depression worse OR Physical Psychological factors such as stress Social factors such as job or relationship

Answer 12

History of moderate or severe depression Sub threshold depressive symptoms that have not warranted treatment but have been. Present for at least 2 years Antidepressant choice is based on tolerability, safety and history of prior treatments. There will be initially frequent follow up 1-4 weeks to monitor treatment response and any unwanted side effects

Answer 13

Depression occurs due to the monoamine theory, where there is a depletion of serotonin and noradrenaline, therefore treatment using MAO inhibitors act to increase its availability. Depression is an independent risk factor for osteoporosis and coronary heart disease, and many patients report medically unexplained physical symptoms.

Answer 14

For mild to moderate: Psychotherapies such as CBT and counselling Antidepressant drugs exclusively for severe cases, which are shown to be effective for majority of patients. Ideally, a combination of pharmacological and psychological approaches.

Answer 15

Guilt and nihilism, with delusions of worthlessness and self-harm.

Answer 16

Tricyclic antidepressants due to correcting previous psychomotor retardation with greater noradrenaline and serotonin.

Answer 17

Avoid alcohol and illicit drugs CBT has evidence of high effectivity Treatments include anti-psychotics, anti-depressants, lithium and electro convulsive therapy.

Answer 18

Failure of antidepressants is Alternative antidepressant from a different class or side effect profile Addition of lithium Electroconvulsive therapy for severe biological features like significant weight loss and psychomotor retardation

Answer 19

Low intensity psychosocial interventions for guided self-help CBT, and avoid drug treatment when possible. Techniques such as watchful waiting, sleep hygiene and managing anxiety.

Answer 20

Compliance for effective treatment for 6 months to 1 year after remission, and discontinuation should be gradual Patients with severe or frequent episodes should continue treatment for at least 5 years -> There is a high risk of relapse with 70-90% when stopping medication within 5 years

Answer 21

Antidepressant drugs, but always offer high intensity CBT sessions with 16-20 sessions over 3-4 months.

Answer 22

Antipsychotics are the first line treatment and highly effective and should be commenced for at least a few days before beginning secondary treatment such as antidepressants. Antidepressants and antipsychotics are more effective as a combination therapy than independently, however they may worsen side effects. As a second line treatment, Electroconvulsive therapy is highly effective for psychotic depression, and can be used in combination with antipsychotics

Answer 23

Inpatient admission Home treatment team and Crisis treatment team Electroconvulsive therapy

Answer 24

Subtype of depressive disorder with clinical features of: Depressed mood Hypersomnia for at least 3 days a week for 3 months Hyperplasia with weight gain Leaden paralysis Oversensitivity to perceived rejection Reversed diurnal mood: Better mood in morning, worse throughout day

Answer 25

Individual CBT and mindfulness-based CBT

Answer 26

1) SSRIs 2) Tricyclic antidepressant, MAO inhibitor, venlafaxine 3) Antipsychotic drug 4) Electroconvulsive therapy

Answer 27

Therapeutic conversation Therapeutic alliance between t he patient and therapist A therapist rationale A therapeutic base for regular meeting

Answer 28

Only use for rapid short term improvement in severe or life-threatening depression when all other treatments have failed, such as: Psychosis including schizophrenia and mania Catatonia Severe depressive illness It involves the use of general anaesthetic and neuromuscular blocker to sedate the patient during the procedure. An electrical current is passed through the brain to induce a brief grand mal seizure, following this, patients will typically experience mild to moderate amnesia. The benefits of ECT reduce after a few weeks, so a maintenance plan should be in place and ECT should not be the maintenance treatment.

Answer 29

Increases metabolic requirements Cerebral blood flow Greater vagal tone causing bradycardia and atrial fibrillation Adrenaline release during seizure peas and causes tachycardia and hypertension Increases cortisol and may worsen insulin resistance

Answer 30

Cerebral aneurysm Recent MI or cardiac arrhythmia Phaemochromocytoma

Answer 31

The therapeutic dose window is important to achieve high effectivity. Side effects are more likely to occur in women or the elderly and immediate side effects include: Aches and Headaches commonly induced by suxamethonium Stiffness and tension in the jaw Confusion and nausea Damage to teeth Longer term side effects will include memory loss of gaps of time.

Answer 32

A machine is used to deliver electrical currents on the electrodes placed on the patient’s head on the right temple unilaterally or bitemporally, with one electrode superior to the left eye. ->Anti-convulsant hypothesis ->Neurogenesis hypothesis

Answer 33

The post-ictal phase of the grand mal seizure is mediated by the pre-frontal cortex, which enhances the actions of GABA, and also increases the threshold of seizures following this therapy. ECT causes an increase in seizure threshold, delta activity and levels of other inhibitory neurotransmitters like opioids.

Answer 34

ECT stimulates the proliferation of brain derived growth factor cells that is important for neuroplasticity which also occurs in humans with pathological epileptic seizures, however there is no clear link to drop in depression symptoms.

Answer 35

Minimise memory issues or cognitive impairment and there was a previous good response.

Answer 36

‘All or nothing’ thinking, where they evaluate situations as black or white.

Answer 37

Where the patient’s reality and their perception of a situation is disproportionate.

Answer 38

Patient tends to focus on the small negative that overshadows their experience rather than the whole picture.

Answer 39

Individuals will attribute the entire blame of a situation on themselves, including external factors.

Answer 40

The individual’s personal feelings about a situation will determine the conclusions they come to rather than reason, eg “I feel anxious so it is not going to go well.”

Answer 41

Disqualifying positive attributes you have or experiences and magnifying others.

Answer 42

Making broad conclusions based on a few instances from the past.

Answer 43

There has been a review of the previous use of ECT Alternative options have been considered Risks and benefits have been discussed with patient and/or carer

Answer 44

Valid and informed consent should be made with no coercison jointly with the patient, taking into account the Mental Health act especially for at risk groups such as pregnant women, elderly and children/young people. The patient should be reminded that they have the right to withdraw consent at any point, and providers should have strict adherence to guidelines about consent. Where informed consent is not possible, ECT should only be given if it does not interfere with advance directives and a patient’s carer has been consulted.

Answer 45

Electrode placement, where bilaterally has greater effectivity but a higher risk for cognitive impairment compared to unilateral ECT.

Answer 46

Clinical outcome and cognitive function following ECT should be measured before and after at least 3-4 treatments of ECG based on: —> Orientation and time to reorientate —> **Measuring new learning, retrograde amnesia and subjective memory impairment at least 24 hours after treatment. **

Answer 47

Proven effectivity with severe mental illness, where other treatments don’t work.

Answer 48

Requires the use of multiple brief anaesthetics Induces an acute confusional state following administration of the anaesthetic Causes both anterograde and retrograde memory impairment

Answer 49

Minimum amount of electrical energy required to induce cerebral paroxysmal neuronal discharge. There is a greater seizure threshold in older people, women and those receiving bilateral ECT treatment

Answer 50

Patients with severe/treatment resistant depression such as catatonia must first establish that ECT is effective, prior to beginning a course of anti-depressants. ECT as a stand alone treatment has a high risk of relapse following treatment, therefore it is important that supplemental treatment is also used, such as CBT.

Answer 51

Anti-psychotics are effective when used alongside ECT as they improve the acute positive manic symptoms of psychosis, however it is not useful for the residual symptoms or negative schizophrenia

Answer 52

Unless the medications are part of a patient’s long term history, these should be avoided: Anticonvulsant will raise the seizure threshold Lithium will raise the seizure threshold, prolong seizures and increase post-ictal confusion Benzodiazepines unless they are are a repeat medication, because they reduce the antidepressant efficacy of ECT

Answer 53

Headache and muscle ache Confusion Short term memory loss Damage to teeth, tongue and lips from administration of the general anaesthetic

Answer 54

Long term Memory impairment and cognitive function on tasks

Answer 55

ACUTE: Increases the levels of plasma catecholamines, especially noradrenaline. It increases cerebral nnoradrenaline and plasma tyrosine hydroxylase activity for the formation of dopamine. CHRONIC: Decreases density of beta-adrenoreceptors

Answer 56

ACUTE: Increases cerebral serotonin CHRONIC: Increases post-synaptic 5-HT2 receptors

Answer 57

ACUTE: Increases cerebral concentration of dopamine and dopamine metabolites and responsiveness to dopamine agonists CHRONIC: Increases D1 receptor density and potential ion of secondary messengers of D1

Answer 58

ACUTE: Increases the release of GABA and GABA-b binding, and may contribute to the hypo metabolic state following ECT administration