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Psychiatry > Depression > Flashcards

Depression Flashcards

1
Q

frequency of the short course of CBT offered

A

6-8 sessions over 10-12 weeks, 1-1 with a counsellor trained in CBT

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2
Q

Aim of CBT

A

concentrates on how to change the way you think, feel and behave in the present

teaches you how to overcome negative thoughts, and challenge hopeless feelings

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3
Q

5 types of non medical treatments for depression

A
  • CBT
  • online CBT
  • IPT (interpersonal therapy)
  • psychodynamic psychotherapy
  • counselling
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4
Q

purpose of risk assessment?

A

helps the doctor how to decide to proceed in managing a patient with thoughts of suicide/following an act of self harm

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5
Q

4 presentations in which require ASAP referral to psychiatric services

A
  1. Significant perceived risk of suicide, harm to others or severe self-neglect
  2. Presence of psychotic symptoms
  3. If there is a history or clinical suspicion of bipolar disorder
  4. In all cases where a child or adolescent is presenting with major depression
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6
Q

risk factors associated with a higher risk of suicide

A
  • age > 45 y/o
  • unemployed
  • male
  • divorced/widowed/single
  • substance misuse
  • fh of depression/suicide
  • psychiatric illness
  • physical illness
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7
Q

minimum period over which antidepressants should be tapered down over when stopping antidepressants?

purpose of this?

A
  • 4 weeks

- risk of withdrawal syndrome

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8
Q

common symptoms of withdrawal syndrome?

A
  • dizziness
  • headache
  • nausea
  • lethargy
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9
Q

2 depression questionairres

A
  • PHQ-9

- HADS

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10
Q

recommended threshold for PHQ-9 score for considering intervention

A

12

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11
Q

questionairre to assess severity of depression and response to treatment, mainly in primary care

A

PHQ-19

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12
Q

medical conditions that may cause depressive symptoms

A
  • chronic health conditions
  • hypothyroidism
  • addisons disease
  • diabetes mellitus
  • alcohol/substance abuse
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13
Q

medications that may cause depressive symptoms

A
  • corticosteroids
  • beta blockers
  • statins
  • OCP
  • isotretinoin
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14
Q

formula to calculate units of alcohol

A

mls x %ABV
/
1000

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15
Q

investigations in a patient presenting with depressive symotoms

A
  • BP, pulse
  • Bloods
  • ECG
  • BMI
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16
Q

medications that increase QT interval + risk of ventricular arrhythmias

A
  • Citalopram
  • Escitalopram
  • Amitrypytline
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17
Q

risk factors for relapse of depressive episode (3)

A
  • severity of previous episode
  • number of relapses
  • presence of residual symptoms
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18
Q

continue antidepressant treatment for how long following a major depressive episode for:
Low risk of relapse

A

low risk = 1 only episode previously without other risk factors

6-9 months after full remission

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19
Q

what defines a patient at high risk of relapse of a depressive episode

A

> 5 lifetime episodes
OR
2 episodes in last few years

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20
Q

length of antidepressant treatment following a depressive episode in a patient at high risk of relapse

A

2 years at least, longer term treatment should be considered

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21
Q

team that assesses patients following attempted suicide

A

Mental health crisis team

+ urgent assessment under mental health act

22
Q

CRHTT

A

Crisis Resolution Home Treatment Team

23
Q

2 screening questions for depression?

A

During the last month have you ever felt down or hopeless

During the last month have you often become bothered by having little interest or pleasure in doing things

24
Q

cognitive features of depression (3)

A
  • poor concentration
  • poor self esteem
  • ideas of guilt + unworthiness
25
Q

physiological + behavioural features of depression (4)

A
  • EMW
  • loss of appetite
  • fatigue
  • low energy levels
  • ideas of self harm or suicide
26
Q

4 groups of antidepressants

A
  • SSRI
  • TCA
  • MAOI
  • SNRI
27
Q

common symptoms of antidepressant withdrawal (4)

A
  • dizziness
  • nausea
  • lethargy
  • headache
28
Q

minimum period for tapering down antidepressants

A

4 weeks

29
Q

antidepressant to switch to when tapering antidepressants and patient is experiencing withdrawal symptoms
+ why

A

Fluoxetine

has a longer half life

30
Q

management of antidepressant withdrawal syndrome

A
  • switch to fluoxetine
  • explanation + reassurance
  • more severe reactions: antidepressant restarted
31
Q

length of term for adequate trial of antidepressants

A

2 months

32
Q

chance of relapsing if antidepressants are discontinued

A

50%

33
Q

when do antidepressants start to work?

A

3-6 weeks after therapeutic dose is achieved

34
Q

what is Serotonin syndrome

A

excessive levels of serotonin

35
Q

autonomic dysfunction features in serotonin syndrome

A
  • tachycardia
  • hypertension
  • hyperthermia
  • tremor
  • agitation
  • diarrhoea
  • sweating
36
Q

management of serotonin syndrome (4)

A
  • active cooling
  • discontinue medications
  • benzodiazepine for agitation
  • serotonin antagonist
37
Q

cognitive features of serotonin syndrome

A
  • confusion
  • agitation
  • hypomania
  • hyperactivity
  • restlessness
38
Q

name a serotonin antagonist

A

Cyproheptadine

39
Q

7 markers of severe depression

A

S - suicide plans or plans of self harm
U - unexplained guilt or self worthlessness
I - Inability to function (psycho-motor retardation/agitation
C - Concentration impaired
I - Impaired apetitis
D - Decreased sleep/early waking
E - Energy low/unaccountable fatigue

40
Q

how is ECT thought to work?

A

MRI evidence that ECT interrupts the hyper-connectivity between various areas of the brain thought to maintain depression

41
Q

indication of ECT (3)

A

to gain rapid improvement of severe symptoms after an adequate trial of other treatments has proven ineffective and/or condition is considered to be life threatening with

  • prolonged or severe manic episode
  • severe depression
  • catatonia
42
Q

typical course length of ECT

A

2 sessions per week for 3-6 weeks

= 6-12 sessions

43
Q

cautions for ECT

A
  • recent cerebral bleed (subarachnoid/subdural)
  • stroke
  • MI
44
Q

side effects of ECT

A
  • confusion
  • headaches
  • short term retrograde amnesia (usually completely resolves)
45
Q

core symptoms of depression (ICD-10) (3)

A
  • depressed mood
  • loss of interest/anhedonia
  • fatigue/low energy
46
Q

biological symptoms of depression (7)

A
  • loss of emotional reactivity
  • diurnal mood variation
  • anhedonia
  • EMW
  • psychomotor retardation/agitation
  • apetite/weight loss
  • libido loss
47
Q

psychotic symptoms of depression

A
  • delusions
  • hallucinations
  • catatonic symptoms
48
Q

outline examples of delusions in depression (5)

A
  • personal inadequacy
  • guilt
  • responsibility of world events
  • deserving of punishment
  • nihilistic delusions
49
Q

when can ECT be given without consent

A

1) emergency if: patient at real risk to their own or other lives, stop them becoming seriously unwell
2) Lacks capacity and requires agreement with an independent second opinion approved doctor

50
Q

contraindications for administering ECT in a patient without consent that lacks capacity despite agreement with independent SOAD

A
  • patient has valid advance decision refusing ECT
    oR
  • lasting power of attorney refuses
51
Q

how is the relapse rate of ECT reduced

A

prophylaxis of antidepressants

maintenance of weekly ECT

Psychiatry (9 decks)

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