Depression

Question 1

Factors which suggest depression > dementia?

Answer 1

Short history/rapid onset,
Biological symptoms,
Patient worried about poor memory,
Reluctant to take tests.
MMTS - variable,
Global memory loss whereas dementia causes recent memory loss.

Question 2

Presentation of depression?

Answer 2

Core symptoms = Low mood and anhedonia (lack of pleasure/interest in activities)
Emotional symptoms = Anxiety, irritibility, low self esteem, guilt
Cognitive symptoms = Poor concentration, slow thoughts, poor memory.
Physical symptoms = Low energy, abnormal sleep, poor appetite, slow movements

Question 3

Important questions to ask when taking a history?

Answer 3

Caring responsibilities,
Social support,
Drug use,
Alcohol use,
Forensic history (violence or abuse)

Question 4

How to do brief risk assessment for pt with depression?

Answer 4

Self neglect - are you eating
Self harm,
Harm to others,
Suicidal thoughts.

Question 5

Classification of depression?

Answer 5

Less severe - PHQ-9 score < 16.
More severe - PHQ-9 score > 16

Question 6

Management of less severe depression?

Answer 6

First line = Guided self help,
CBT,
SSRIs are not offered unless patient has preference to take SSRI.

Question 7

Management of more severe depression?

Answer 7

First line - combination of CBT and an antidepressant.

Question 8

DSM-5 criteria for major depressive episode?

Answer 8

1. Depressed mood most of the day, nearly every day.
2. Diminished interest/pleasure in activities.
3. Weight loss/gain or decrease/increase in appitite.
4. Insomnia/hypersomnia
5. Psychomotor agitation
6. Fatigue.
7. Feelings of worthlessness.
8. Diminished ability to think or concentrate.
9. Thoughts of death/suicidal ideation

Question 9

How to switch from citalopram, escitalopram, sertraline or paroxetine to another SSRI/venlofaxine?

Answer 9

Direct switch possible.

NOT possible with fluoxetine

Question 10

How to switch from fluoxetine to different SSRI/venlafaxine?

Answer 10

Withdraw then leave gap of 4-7 days before starting a low dose of an alternative SSRI.

Question 11

How to switch from SSRI to TCA?

Answer 11

Cross tapering is recommended unless fluoxetine.

Question 12

Indications for ECT, its contraindication and its side effects

Answer 12

ECT is an option for patients with severe depression refractor to medication or patients with psychotic symptoms.

Contraindication - raised ICP.

Short term side effects - Short term memory loss, cardiac arrhythmia, headache, nausea, memory loss of events prior to ECT.

Long term side effects - Impaired memory.

Question 13

Features of seasonal affective disorder?

Answer 13

Depression which occurs predominately in winter months.
Treat the same was as normal depression

Question 14

What are the risk factors for suicide?

Answer 14

Male sex,
History of deliberate self harm,
Alcohol/drug misuse,
History of mental illness,
History of chronic disease,
Advancing age,
Unemployement,
being unmarried/divorces/widowed.

Question 15

If person is unsuccessful in attempting suicide, what factors suggest increase future risk?

Answer 15

Efforts to avoid discovery,
Planning,
Leaving written note,
Final acts eg, sorting out finances,
Violent method.

Question 16

Protective factors which reduce risk of patient committing suicide?

Answer 16

Family support,
Children at home,
Religious belief.

Question 17

What is a schizoeffective disorder?

Answer 17

Patient experiences schizophrenia and mood disorder

Question 18

What is dysthymic disorder?

Answer 18

Chronic low-level depression which is not as severe but may be longer lasting than major depressive disorder.

Question 19

Mood vs affect?

Answer 19

Mood - what patient describes
Affect - what observer sees