Depression Flashcards
frequency of the short course of CBT offered
6-8 sessions over 10-12 weeks, 1-1 with a counsellor trained in CBT
Aim of CBT
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
5 types of non medical treatments for depression
- CBT
- online CBT
- IPT (interpersonal therapy)
- psychodynamic psychotherapy
- counselling
purpose of risk assessment?
helps the doctor how to decide to proceed in managing a patient with thoughts of suicide/following an act of self harm
4 presentations in which require ASAP referral to psychiatric services
- Significant perceived risk of suicide, harm to others or severe self-neglect
- Presence of psychotic symptoms
- If there is a history or clinical suspicion of bipolar disorder
- In all cases where a child or adolescent is presenting with major depression
risk factors associated with a higher risk of suicide
- age > 45 y/o
- unemployed
- male
- divorced/widowed/single
- substance misuse
- fh of depression/suicide
- psychiatric illness
- physical illness
minimum period over which antidepressants should be tapered down over when stopping antidepressants?
purpose of this?
- 4 weeks
- risk of withdrawal syndrome
common symptoms of withdrawal syndrome?
- dizziness
- headache
- nausea
- lethargy
2 depression questionairres
- PHQ-9
- HADS
recommended threshold for PHQ-9 score for considering intervention
12
questionairre to assess severity of depression and response to treatment, mainly in primary care
PHQ-19
medical conditions that may cause depressive symptoms
- chronic health conditions
- hypothyroidism
- addisons disease
- diabetes mellitus
- alcohol/substance abuse
medications that may cause depressive symptoms
- corticosteroids
- beta blockers
- statins
- OCP
- isotretinoin
formula to calculate units of alcohol
mls x %ABV
/
1000
investigations in a patient presenting with depressive symotoms
- BP, pulse
- Bloods
- ECG
- BMI
medications that increase QT interval + risk of ventricular arrhythmias
- Citalopram
- Escitalopram
- Amitrypytline
risk factors for relapse of depressive episode (3)
- severity of previous episode
- number of relapses
- presence of residual symptoms
continue antidepressant treatment for how long following a major depressive episode for:
Low risk of relapse
low risk = 1 only episode previously without other risk factors
6-9 months after full remission
what defines a patient at high risk of relapse of a depressive episode
> 5 lifetime episodes
OR
2 episodes in last few years
length of antidepressant treatment following a depressive episode in a patient at high risk of relapse
2 years at least, longer term treatment should be considered
team that assesses patients following attempted suicide
Mental health crisis team
+ urgent assessment under mental health act
CRHTT
Crisis Resolution Home Treatment Team
2 screening questions for depression?
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
cognitive features of depression (3)
- poor concentration
- poor self esteem
- ideas of guilt + unworthiness
physiological + behavioural features of depression (4)
- EMW
- loss of appetite
- fatigue
- low energy levels
- ideas of self harm or suicide
4 groups of antidepressants
- SSRI
- TCA
- MAOI
- SNRI
common symptoms of antidepressant withdrawal (4)
- dizziness
- nausea
- lethargy
- headache
minimum period for tapering down antidepressants
4 weeks
antidepressant to switch to when tapering antidepressants and patient is experiencing withdrawal symptoms
+ why
Fluoxetine
has a longer half life
management of antidepressant withdrawal syndrome
- switch to fluoxetine
- explanation + reassurance
- more severe reactions: antidepressant restarted
length of term for adequate trial of antidepressants
2 months
chance of relapsing if antidepressants are discontinued
50%
when do antidepressants start to work?
3-6 weeks after therapeutic dose is achieved
what is Serotonin syndrome
excessive levels of serotonin
autonomic dysfunction features in serotonin syndrome
- tachycardia
- hypertension
- hyperthermia
- tremor
- agitation
- diarrhoea
- sweating
management of serotonin syndrome (4)
- active cooling
- discontinue medications
- benzodiazepine for agitation
- serotonin antagonist
cognitive features of serotonin syndrome
- confusion
- agitation
- hypomania
- hyperactivity
- restlessness
name a serotonin antagonist
Cyproheptadine
7 markers of severe depression
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
how is ECT thought to work?
MRI evidence that ECT interrupts the hyper-connectivity between various areas of the brain thought to maintain depression
indication of ECT (3)
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
typical course length of ECT
2 sessions per week for 3-6 weeks
= 6-12 sessions
cautions for ECT
- recent cerebral bleed (subarachnoid/subdural)
- stroke
- MI
side effects of ECT
- confusion
- headaches
- short term retrograde amnesia (usually completely resolves)
core symptoms of depression (ICD-10) (3)
- depressed mood
- loss of interest/anhedonia
- fatigue/low energy
biological symptoms of depression (7)
- loss of emotional reactivity
- diurnal mood variation
- anhedonia
- EMW
- psychomotor retardation/agitation
- apetite/weight loss
- libido loss
psychotic symptoms of depression
- delusions
- hallucinations
- catatonic symptoms
outline examples of delusions in depression (5)
- personal inadequacy
- guilt
- responsibility of world events
- deserving of punishment
- nihilistic delusions
when can ECT be given without consent
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
contraindications for administering ECT in a patient without consent that lacks capacity despite agreement with independent SOAD
- patient has valid advance decision refusing ECT
oR - lasting power of attorney refuses
how is the relapse rate of ECT reduced
prophylaxis of antidepressants
maintenance of weekly ECT
