Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Diploma: Mental Health > Depression > Flashcards

Depression Flashcards

You may prefer our related Brainscape-certified flashcards:
WSET® Level 4 Wine flashcards
1
Q

How is less severe depression managed?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

As well as drug treatment, what else should patients with more severe depression be treated with?

A

Psychological therapy (CBT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Should antidepressants be used routinely for mild depression?

A

No, psychological treatment should be considered initially

(However, can consider a trial if patient preference, have a hx of moderate-severe depression, refractory to CBT or if associated with psychosocial or medical problems)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is severe depression managed?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the three major classes of antidepressants?

A
  1. TCAs
  2. SSRIs
  3. MAOIs

Little difference in efficacy, make choice based on patient requirements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How long can it take for antidepressant action to take place after starting drug treatment? What may be required in interim in severe depression?

A

2 weeks

Electroconvulsive treatment may be required in severe depression during this time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which class of antidepressants are better tolerated and safer in overdose than the others?

A

SSRIs

They should be considered as first line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

TCAs have similar efficacy to SSRIs so why are they more likely to be discontinued?

A
  1. Less tolerable side effects

2. Toxicity in overdose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which 3 effects do SSRIs have less of compared with TCAs?

A
  1. Less sedation
  2. Less antimuscarinic effects
  3. Less cardiotoxic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which class of antidepressants has dangerous interactions with foods and drugs, should be reserved for use by specialists?

A

MAOIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which popular natural remedy for depression should NOT be prescribed or recommended for depression?

A

St John’s Wort

Enzyme inducer and different preparations have different amounts of the active ingredient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What effect does St John’s Wort have on metabolising enzymes?

A

Enzyme INDUCER

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How often should patients be reviewed at the start of antidepressant treatment?

A

Every 1-2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How long should treatment be continued before considering whether to switch due to lack of efficacy?

What about in the elderly or partial response?

A

4 weeks

6 weeks in the elderly

Partial response - continue for a further 2-4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Following remission, how long should antidepressant treatment be continued for at least?

What about in elderly/generalised anxiety disorder?

A

6 months at the same dose

12 months in elderly and at least 12 months in people receiving treatment for GAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How long should patients with a history of recurrent depression, severe functional impairment, health/social problems or incomplete response receive maintenance treatment for?

A

At least 2 years

Also consider referral for psychological treatments to prevent relapse (group CBT or MBCT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Continuation of antidepressants or psychological therapies after full or partial remission may reduce patient’s risk of relapse.

True or False?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which electrolyte effect has been associated with all classes of antidepressant, especially SSRIs?

A

Hyponatreamia (usually in elderly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

If a patient on antidepressants (especially SSRIs) presents with drowsiness, confusion, or convulsions, what should be considered?

A

Hyponatreamia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is there a particular risk of at the beginning of treatment or if a dose is changed?

A

Suicidal thoughts and behaviour

Children and young adults (18-25) most at risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is serotonin syndrome?

A

A relatively uncommon adverse drug reaction caused by excessive serotonergic activity

Symptoms can be mild or life threatening and develop within hours or days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When is serotonin syndrome most likely to occur?

A
  1. Initiation of treatment
  2. Dose increase
  3. Overdose
  4. Addition of new serotonergic drug
  5. Replacement of one serotonergic drug without allowing a long enough wash-out period between drugs (esp. if irreversible MAOI)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Severe toxicity usually occurs when a combination of serotonergic drugs is used - involving which particular drug?

A

MAOI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the main areas which symptoms of serotonin syndrome fall under?

A

Usually a symptom triad

  1. Neuromuscular hyperactivity
    (tremor, rigidity, involuntary movement)
  2. Autonomic dysfunction
    (tachycardia, hyperthermia/sweating, shivering, blood pressure changes, diarrhoea)
  3. Altered mental state
    (Agitation, confusion, mania)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the neuromuscular hyperactivity symptoms of serotonin syndrome?

A
  1. Tremor
  2. Hyperreflexia (overresponsive reflexes)
  3. Clonus (involuntary and repetitive muscle contractions)
  4. Myoclonus (involuntary jerking)
  5. Rigidity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the autonomic dysfunction symptoms of serotonin syndrome?

A
  1. Blood pressure changes
  2. Hyperthermia
  3. Tachycardia
  4. Shivering
  5. Diarrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the altered mental state symptoms of serotonin syndrome?

A
  1. Confusion
  2. Mania
  3. Agitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the options if there is failure to respond to initial treatment with an SSRI?

A
  1. Increase the dose
  2. Different SSRI
  3. Mirtazapine (SNRI)

2nd line: Lofepramine, moclobemide, and reboxetine

Other TCAs and venlafaxine should be considered for more severe forms of depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which drugs can be considered for more severe forms of depression

A
  1. TCAs

2. Venlafaxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Who can prescribe irreversible MAOIs?

A

Specialists only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the options is there is failure to respond to treatment with two antidepressants (each trialled for at least 4 weeks)?

A

Consider seeking specialist advice

  1. Adding another of a different class
  2. Using an augmenting agent (lithium, aripiprazole [unlicensed], olanzapine [unlicensed], quetiapine, or risperidone [unlicensed])
  3. Use Vortioxetine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Give some examples of augmenting agents used when antidepressant treatment fails with 2 drugs

A

LAROQ

  1. Lithium
  2. Aripiprazole
  3. Risperidone
  4. Olanzapine
  5. Quetiapine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Which 2 drugs are generally used to treat acute anxiety?

A
  1. Benzodiazepines
  2. Buspirone (if on CYP3A4 inhib reduce dose to 2.5mg BD) - contraindicated in epilepsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How long does anxiety have to last for it to be considered chronic?

A

4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

If anxiety lasts longer than 4 weeks, it is considered chronic. Which drugs may it be appropriate to start treatment with?

A

Antidepressants

Combined treatment with a benzodiazepine may be required until the antidepressant takes effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Which drug class do duloxetine and venlafaxine fall under?

A

SNRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is first line for GAD?

A

SSRIs

Escitalopram, paroxetine, or sertraline [unlicensed]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

After SSRIs, what can be used to treat GAD?

A

SNRIs

Duloxetine and venlafaxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

If a patient cannot tolerate SSRIs and SNRIs, what is used to treat GAD?

A

Pregabalin - licensed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is first line for panic disorder, PTSD, social anxiety and OCD?

A

SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What MAOI is licensed for treatment of social anxiety disorder?

A

Moclobemide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Which two groups can TCAs be roughly divided into?

A
  1. Sedating
  2. Less-sedating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

TCAs which call into which group will benefit agitated and anxious patients?

A

Sedating

Examples:

  • Clomipramine
  • Trazodone
  • Amitriptyline and dosulepin - but dangerous in overdose so not recommended for depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

TCAs which call into which group will benefit apathetic patients?

A

Less-sedating

Examples:

  • Imipramine
  • Nortriptyline
  • Lofepramine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Give examples of sedating TCAs

A
  1. Amitriptyline (dangerous in overdose, not recommended for depression)
  2. Clomipramine
  3. Trazadone
  4. Trimipramine
  5. Dosulepin (dangerous in overdose, specialist use)
  6. Doxepin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

In most patients, long half life of TCAs allows for what?

A

Once daily administration

MR preparations unnecessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

At which time of day are TCAs usually administered?

A

At night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Apart from depression, TCAs can also be used in which conditions?

A
  1. Panic and anxiety disorders
  2. Nocturnal enuresis
  3. Neuralgia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Are TCAs recommended for treating depression in children?

A

No, studies have shown they are not effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are the dangers of MAOIs?

A

Interactions with drugs and food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Give 4 examples of MAOIs

A
  1. Tranylcypromine
  2. Phenelzine
  3. Isocarboxazid
  4. Moclobenide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Which crisis is associated with MAOIs?

A

Hypertensive crisis

Throbbing headache, chest pain, blurred vison, shortness of breath

53
Q

How long may response to treatment with MAOIs take to show?

A

3 weeks

54
Q

After the 3 weeks it takes to show a response in treatment for MAOI, how many additional weeks can it take for response to become maximal?

A

Additional 1-2weeks

55
Q

After stopping a MAOI, how long should we wait before starting another anti-depressent?

MAOI -> Different antidepressant

A

2 weeks

3 weeks if starting clomipramine or imipramine

56
Q

How long after stopping a MAOI should we wait if the patient is starting clomipramine or imipramine (TCAs)?

MAOI -> clomipramine or imipramine

A

3 weeks

57
Q

How long should we wait before starting a new MAOI after stopping an old MAOI?

MAOI -> MAOI

A

2 weeks (0 weeks for moclobemide as reversible)

Start new MAOI at a reduced dose

58
Q

How long should we wait before starting a MAOI after stopping a TCA?

TCA -> MAOI

A

1-2 weeks

3 weeks for clomipramine and imipramine

59
Q

How long should we wait before starting a MAOI after stopping an SSRI?

SSRI -> MAOI

A

1 week

5 weeks for fluoxetine

60
Q

How long should we wait before starting a MAOI after stopping fluoxetine?

Fluoxetine -> MAOI

A

5 weeks

61
Q

Which class of antidepressants carries a risk of postural hypotension as well hypertensive crisis?

What should be monitored?

A

MAOI

Monitor blood pressure

62
Q

Which side effects should patients be aware of when taking MAOIs as they can be sign of postural hypotension and hypertensive responses?

A
  1. Headaches
  2. Palpitations

Discontinue use if experience either

63
Q

Can MAOIs be stopped suddenly?

A

No

64
Q

What are the withdrawal symptoms of MAOIs?

A
  1. Agitation
  2. Irritability
  3. Movement disorder
  4. Ataxia
  5. Insomnia
  6. Drowsiness
  7. Vivid dreams
  8. Cognitive impairment
  9. Slowed speech

Can occur within 5 days of stopping treatment

Symptoms increased after treatment of 8 weeks or more.

65
Q

How long should the dose of MAOIs be withdrawn over? (what about if used long term?)

A

4 weeks (6 months if have used long term)

66
Q

How should antidepressants be weaned down?

A
  • Slowly reduce the dose to zero, at each step prescribing a proportion of the previous dose (for example, 50%)
  • Take into account the pharmacokinetic profile (antidepressants with a short half-life need to be tapered more slowly) and duration of treatment
  • Consider using smaller reductions (for example, 25%) as the dose becomes lower
  • If slow tapering cannot be achieved using tablets or capsules, consider using liquid preparation
67
Q

Regarding food, what should patients taking MAOIs be counselled on?

A
  1. Only eat fresh food, avoid food that is stale or gone off
  2. Avoid tyramine rich food (mature cheese, wine, pickled/fermented food, marmite/bovril, meat stock, broad bean pods, game)
  3. No alcohol or “de-acoholised/low alcohol” drinks

Interactions can persist for 2 weeks after discontinuing treatment (except Moclobemide as reversible)

68
Q

Which foods should patients taking MAOIs be particularly cautious of?

A
  1. Meat (esp. Game)
  2. Fish
  3. Poultry
  4. Offal
69
Q

Which are the irreversible MAOIs?

A
  1. Isocarboxazid
  2. Phenelzine
  3. Tranylcypromine
70
Q

Which is the only reversible MAOI?

A

Moclobomide

Does not need a washout period

71
Q

What is a sign of a nhypersensitivity reaction with SSRIs?

A

Rash

72
Q

What are the signs of SSRI overdose?

A
  1. Nausea
  2. Vomiting
  3. Drowsiness
  4. Sinus tachycardia
  5. Convulsions
73
Q

What are the signs of SSRI abrupt withdrawal? (9)

A
  1. GI disturbance
  2. Headache
  3. Anxiety
  4. Electric shock sensation in the head
  5. Tinnitus
  6. Sleep disturbance
  7. Fatigue
  8. Flu-like symptoms
  9. Sweating
74
Q

How long should the SSRI dose be tapered over?

A

4 weeks, (6 months if long term)

75
Q

What can citalopram prolong?

A

QT interval

76
Q

What is the dose equivalence of citalopram oral drops compared with tablets?

A

8 drops = 16mg drops = 20mg tablets

77
Q

What class of drug is Venlafaxine?

A

SNRI

78
Q

What are the symptoms of TCA overdose (can also occur as side effects at normal doses)?

A
  1. Dry mouth
  2. Coma
  3. Hypotension
  4. Hypothermia
  5. Convulsions
  6. Cardiac conduction defects
  7. Arrhythmias
  8. Dilated pupils
  9. Urinary retention
79
Q

If a patient with bipolar is being treated with a TCA, when should it be stopped?

A

If they enter a manic phase

80
Q

What is the mechanism of action of Mirtazapine?

A

Presynaptic alpha-adrenoceptor antagonist which increases noradrenergic and serotonergic nuerotransmission

81
Q

Which drug is used to treat inappropriate sexual behaviour?

A

Benperidol

82
Q

Which antidepressant is preferred in people with unstable angina or have had a recent MI?

A

Sertraline

83
Q

List some of the side effects that may occur within the first few weeks of treatment in those taking antidepressants

A

Increased potential for agitation, anxiety, and suicidal ideation

84
Q

Give 4 examples of SSRIs

A

Citalopram/Escitalopram, Fluoxetine, Sertraline, Paroxetine

85
Q

Give 4 examples of TCAs

A

Amitriptyline, clomipramine, imipramine, lofepramine

86
Q

Why are antipsychotics or anxiolytics not generally used in depression?

A

Anxiety is often present in depressive illness, these drugs might mask the true diagnosis

However, may be necessary if have psychotic symptoms (specialist)

87
Q

How is serotonin syndrome treated?

A

Withdrawal of the serotonergic medication and supportive care

Seek specialist advice

88
Q

How is generalised anxiety disorder treated?

A

GAD is a form of chronic anxiety

Treated with:

  1. Psychological therapy
  2. SSRI (Escitalopram, Paroxetine, sertraline [unlicensed])
  3. SNRIs (Duloxetine, Venlafaxine)
  4. Pregabalin
89
Q

Which SNRI is licensed for panic disorder?

A

Venlafaxine

90
Q

What is used second line for panic disorder?

A

clomipramine [unlicensed] or imipramine [unlicensed] (TCAs)

91
Q

Give examples of Less-sedating TCAs

A
  1. Imipramine
  2. Nortriptyline
  3. Lofepramine
92
Q

TCAs have varying degrees of antimuscarinic side-effects and cardiotoxicity in overdose.

Which one has the lower incidence of side-effects and is less dangerous in overdose?

A

Lofepramine

Has a lower incidence of side-effects and is less dangerous in overdose but is infrequently associated with hepatic toxicity

93
Q

Which TCA has the most antimuscarinic side effects?

A

Imipramine

94
Q

Which TCAs are particularly dangerous in overdose?

A

Amitriptyline and Dosulepin

Not recommended for treatment of depression

95
Q

Which TCAs are not recommended for the treatment of depression?

A

Amitriptyline and Dosulepin

96
Q

Mechanism of action of TCAs?

A

TCAs block the re-uptake of both serotonin and noradrenaline

Different TCAs are selective for each one to different extents

  • Clomipramine more selective for serotonin (sedative)
  • Imipramine more selective for noradrenaline (less-sedative)
97
Q

TCA doses should be sufficiently high enough for effective treatment.

But who would normally be prescribed lower doses of TCAs initially?

A

Elderly patients

98
Q

What is the STOPP criteria for TCAs in elderly patients?

A
  1. If prescribed in those with:
    - Dementia
    - Narrow angle glaucoma
    - Cardiac conduction abnormalities
    - Prostatism
    - History of urinary retention

Due to risk of worsening these conditions

  1. If initiated as first-line (higher risk of ADRs than with SSRIs or SNRIs)
99
Q

Which MAOI is most likely to cause a hypertensive crisis?

A

Tranylcypromine (greater stimulant action)

Discontinue if experience throbbing headache

100
Q

Which MAOIs are most likely to hepatotoxicity?

A

Isocarboxazid and phenelzine

101
Q

Which MAOI should be reserved for second line treatment?

A

Moclobemide

102
Q

What is Flupentixol (Fluanxol ®) indicated for?

A

Has antidepressant properties when given by mouth in low doses

Also used for treatment of psychoses

103
Q

Which antidepressant can be used for patients whose condition has responded inadequately to 2 antidepressants within the current episode?

A

Vortioxetine

104
Q

Which antidepressants are used for neuropathic pain?

A

Amitriptyline

Nortriptyline

105
Q

Which antidepressant is licensed in children (8 - 18 years)?

A

Fluoxetine

106
Q

Which antidepressants can cause QT prolongation?

A

Citalopram, Escitalopram

107
Q

Which antidepressants have the greatest risk of withdrawal?

A

Paroxetine (SSRI) and Venlafaxine (SNRI) due to their shorter half lives

108
Q

Which antidepressant is also used in diabetic retinopathy?

A

Duloxetine

avoid in patients with uncontrolled hypertension

109
Q

Which MAOI does not need a wash out period? Why?

A

Moclobemide

110
Q

What are the irreversible and reversible MAOI?

A

Phenelzine, Isocarboxazid, Tranylcypromine (irreversible inhibition)

Moclobemide (reversible inhibition)

111
Q

SSRI side effects? (GASH)

A

G - GI disturbances (nausea, vomiting, diarrhoea)
A - Appetite or weight loss/gain
S - Serotonin syndrome
H - Hypersensitivity reactions (stop if rash occurs)

Also:

  • Hyponatraemia
  • Lowers seizure threshold
  • Bleeding risk
  • Sexual dysfunction
  • QT prolongation (citalopram and escitalopram)
  • Insomnia (take in the morning)
  • Movement disorders and dyskinesia
112
Q

When should SSRIs be taken? What about TCAs? What about Mirtazepine?

A

SSRIs - take in the morning as can cause insomnia

TCAs - take at night as can cause drowsiness

Mirtazapine (tetracyclic)- take at night as can cause drowsiness

113
Q

Key interactions for SSRIs

A

CYP450 enzyme inhibitors (SICKFACES.COM)
- Grapefruit juice (inhibitor)

Drugs which increase BLEEDING RISK
- NSAIDs/Aspirin/Anticoagulants

Drugs which increase risk of QT PROLONGATION (for citalopram and escitalopram)

  • Macrolides, Anti-arrhythmics, Lithium, TCAs, Chloroquine and Mefloquine, antipsychotics
  • Drugs which cause hypokalaemia e.g. theophylline, steroids, B2 agonists, loop/thiazide diuretics (increased risk of QT prolongation)

Drugs which increase risk of HYPONATRAEMIA
- Loop/thiazide diuretics, carbamazepine, NSAIDs, trimethoprim, desmopressin

Drugs which increase risk of SEROTONIN SYNDROME
- Sumatriptan, Tramadol, Lithium, Ondansetron, TCAs/MAOIs, St John’s Wort, Amphetamines

114
Q

What are SSRIs cautioned in?

A

Cardiac disease
Bleeding- especially GI
Epilepsy as they can lower seizure threshold

115
Q

What are the symptoms of TCA overdose?

A 
Hypotension
Hypothermia
Convulsions
Respiratory failure
Dilated pupils
Urinary retention
116
Q

Side effects of TCAs? (TCAS)

A

T - Toxic in overdose (more so than SSRIs)
C - Cardiac side effects (QT prolongation, arrhythmias, hypotension, heart block)
A - Antimuscarinic side effects (dry mouth, constipation, urinary retention, raised intraocular pressure, blurred vision)
S - Seizures

Can also cause:

  • Hallucinations and mania
  • Sexual dysfunction
117
Q

Key interactions for TCAs

A

CYP450 enzyme inhibitors and inducers

  • Cimetidine (inhibitor)
  • Carbamazepine (inducer)
  • Grapefruit juice (inhibitor)

Drugs which increase risk of QT PROLONGATION (for Clomipramine)

  • Citalopram, escitalopram
  • Macrolides, Anti-arrhythmics, Lithium, TCAs, Chloroquine and Mefloquine, antipsychotics
  • Drugs which cause hypokalaemia e.g. theophylline, steroids, B2 agonists, loop/thiazide diuretics (increased risk of QT prolongation)

Drugs which increase risk of HYPONATRAEMIA
- Loop/thiazide diuretics, carbamazepine, NSAIDs, trimethoprim, desmopressin

Drugs which increase risk of HYPOTENSION
- antihypertensives, SGLT2 inhibitors, diuretics, Sildenafil, antipsychotics

Drugs which increase risk of ANTIMUSCARINIC side effects
- antimuscarinic drugs, antihistamines, atropine, antipsychotics

Drugs which increase risk of SEROTONIN SYNDROME
- Sumatriptan, Tramadol, Ondansetron, TCAs/MAOIs, St John’s Wort, Selegiline, Amphetamines

118
Q

Mechanism of action of MAOIs?

A

Block monoamine oxidase enzymes which leads to accumulation of monoamines (dopamine, serotonin, noradrenaline)

119
Q

Combination of MAOIs with which other drugs could cause a hypertensive crises?

A
  • Phenylepherine/Pseudoephedrine (DO NOT GIVE SUDOFED)
  • Sumatriptan
  • TCAs
  • Adrenaline/noradrenaline
  • Levodopa
  • MAO-B inhibitors (resegiline, selegiline)

Interaction between TCAs and MAOIs could be potentially fatal
- AVOID TRANYLCYPROMINE AND CLOMIPRAMINE - FATAL

120
Q

What is post-natal depression?

A

Similar to other forms of depression, patients may experience a persistent low mood, lack of interest and enjoyment in usual activities, low self-esteem or lack of energy

They may feel as though they are a bad parent, are unable to cope with their baby or may feel indifferent to their baby

Symptoms of PND can persist for months or years without treatment

Mothers should be routinely assessed for signs of PND when interacting with healthcare professionals and should be referred to their GP or mental health team if they demonstrate any red flags

121
Q

Many women will be emotional or experience mild mood changes in the first week after having a baby (referred to as the ‘baby blues’), but these feelings should be self-limiting. True or False?

A

True

122
Q

What are risk factors for post natal depression?

A
  • Previous history of depression or PND (greatest risk factor)
  • Poor social support
  • Having more than one child
  • Financial instability
  • Having a poor relationship with their partner
  • Recent stressful life events (e.g. break up of a relationship, job loss, family bereavement)
  • History of abuse (e.g. physical, sexual or emotional abuse, neglect)
123
Q

When are women at the greatest risk of PND?

A

In the first four to six weeks after birth

Increased risk of developing depression by as much as 3x. In addition, the risk of a first presentation of psychosis is higher in the first four weeks after birth than at any other point in a woman’s life

124
Q

In men, PND in their partner is a significant risk factor for them also developing PND. True or False?

A

True

As is feeling excluded from the bond between the mother and baby, and a lack of a good male role model in a male parent’s life

125
Q

What are red flag symptoms for post natal depression?

A
  • Recent significant change in mental state or emergence of new psychiatric symptoms
  • New thoughts or acts of violent self-harm
  • New and persistent expressions of incompetency as a mother, such as estrangement from the infant, being overly self-critical and feelings of incompetence.

Patients with suicidal thoughts must be referred immediately to specialist perinatal mental health services.

126
Q

What is postpartum psychosis?

A

Severe illness that shows similarities to bipolar disorder (e.g. an elated or depressed mood that can cycle rapidly, irritability, hallucinations or delusions)

It usually presents in the days or weeks after childbirth.

Prompt treatment is essential; if left untreated it can put both the mother and baby at risk

127
Q

Hyperthyroidism and hypothyroidism can present alongside mood disorders, with episodes of thyrotoxicosis (excess thyroid hormone) presenting similarly to postpartum psychosis.

True or False?

A

True

128
Q

How is PND screened for?

A

** Whooley questions or Patient Health Questionnaire-2**
Recommended by NICE and can be used by any healthcare professional
- During the past month, have you often been bothered by feeling down, depressed or hopeless?
- During the past month, have you often been bothered by having little interest or pleasure in doing things

If the questions below identify possible depressive symptoms, it is useful to ask if the patient would like any help with this and make a referral where possible:

**Generalised Anxiety Disorder scale **
Two questions about anxiety symptoms:
- Over the past two weeks, how often have you been bothered by feeling nervous, anxious or on edge?
- Over the past two weeks, how often have you been bothered by not being able to stop or control worrying
This should be followed by asking:
- Do you find yourself avoiding places or activities and does this cause you problems?

If the patient says they have experienced these feelings, they should be referred for further clinical assessment.

Patient Health Questionnaire
A follow on from the Patient Health Questionnaire-2 that is more commonly used to monitor severity of established depression, rather than diagnose it
- Nine questions based DSM-5 criteria for depression
- Patient rates how frequently they have experienced symptoms over the past two weeks

Edinburgh Postnatal Depression Scale
- Ten-question scale
- Asks the patient to rate how they feel about the questions asked, based on how frequently they have felt like that over the past week, scoring 0–3 for each question
- The maximum score is 30 and a score of 11 or more is indicative of PND. The scale has also been validated for use in men

The Bromley Postnatal Depression Scale
- A specific questionnaire for PND that looks at diagnosing previous episodes of PND, as well as the current one
- It asks the patient to write down when the previous episodes started, when episodes were worse and how long they lasted. The scale also contains a ten-item questionnaire.

Diploma: Mental Health (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions