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Psychiatry > Depression > Flashcards

Depression Flashcards

1
Q

How many women and how many men will develop depression severe enough to require treatment at some point in their lives?

A

1 in 4 women and 1 in 10 men

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2
Q

How many primary care consultations does it account for?

A

5-10%

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3
Q

What are the biological factors for the aetiology of depression?

A

o Estimate of heritability for major depression is 37%
o Monoamine theory of depression decreases monoamine function may cause depression
o Structural brain changes ventricular enlargement and raised sucal prominence

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4
Q

What are the psychological factors for the aetiology of depression?

A

o Personality traits – neuroticism suggests mood lability, autonomic hyper arousal and negative biases in attention and processing
o Low self-esteem

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5
Q

What are the social factors for the aetiology of depression?

A

o Disruption due to life events e.g. births, job less, divorce, illness in 60% of cases
o Stress associated with poor social environment and social isolation can precipitate and perpetuate depression
o Social drift to lower social class

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6
Q

What are risk factors of depression?

A
  • Female sex – women have higher prevalence, incidence and morbidity
  • Past history of depression
  • Significant physical illness causing disability or pain
  • Other mental heath problems e.g. dementia
  • Depression is much more common in people from Afro-Caribbean, Asian, refugee and asylum seeker communities.
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7
Q

What are the CORE SYMPTOMS of depression?

A

low mood, loss of energy and anhedonia

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8
Q

Definition of anhedonia

A

Loss of pleasure (in particular with things they previously enjoyed)

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9
Q

What are the typical symptoms of depression?

A
  • Poor appetite +/- marked weight loss without dieting (Rarely increased appetite and weight gain)
  • Disrupted sleep – initial insomnia or early waking (3+ hours earlier than usual)
  • Psychomotor retardation - limited spontaneous movement and sluggish thought processes
  • Agitation
  • Decreased libido
  • Loss of concentration
  • Loss of confidence and self-esteem
  • Feelings of worthlessness, hopelessness, inappropriate guilt (may be delusional), or self reproach (not just about current illness but also about past decisions or events)
  • Recurrent thoughts of death, suicidal ideation or suicide attempts – may be PASSIVE (I wish I could disappear) or ACTIVE (my plan to overdose is…)
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10
Q

What is the classification of depression?

A
  1. Sub threshold depressive symptoms - <5 depressive symptoms
  2. Mild depression – core symptoms + 2-3 others, mild functioning impairment
  3. Moderate depression – Core + 4 others and function is impaired on the spectrum from mild to severe
  4. Severe Depression without psychotic symptoms – most symptoms present and the symptoms markedly interfere with normal functioning, suicidal.
  5. Severe Depression with psychotic symptoms – as above plus mood congruent  nihilistic, guilty delusions, derogatory auditory hallucinations.
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11
Q

What tools can you use for assessment of depression?

A
  • PHQ-9

* HAD scale

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12
Q

What are the DDx of depression?

A 
•	Psychiatric disorders:
o	Bipolar disorder
o	Schizophrenia 
o	Anorexia nervosa
o	Anxiety 
•	Dysthymia
•	Substance misuse
•	Dementia
•	Sleep disorders
•	Neurological disorders
•	Physical illness
•	Medication side effects e.g. beta-blockers
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13
Q

What is the monoamine hypothesis of depression?

A
  • Serotonin is a vasoconstrictor and important in digestion
  • Larger volumes of serotonin is linked to confidence and high self-esteem
  • Serotonin and noradrenaline are thought to be reduced in depression, this is supported by reduced serotonin levels found in CSF of suicide victims
  • Mode of most antidepressants are to increase serotonin and noradrenaline
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14
Q

What Ix would you do?

A
  • Blood tests – FBC, U&Es, LFTs, TFTs, calcium levels, blood glucose and inflammatory markers.
  • Drug testing
  • Imaging may be needed if atypical presentation
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15
Q

What are the types of antidepressants?

A

SSRIs, SNRIs, tricyclic antidepressants, Monoamine Oxidase Inhbitors

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16
Q

2 examples of SSRIs

A

fluoxetine, sertraline, citalopram

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17
Q

how do SSRIs work?

A

o Inhibits the reuptake pumps and serotonin transporters and increases free serotonin

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18
Q

What are red flag side effects to look out for in people taking SSRIs?

A

o RED FLAGS: serotonin syndrome, hyponatraemia (usually seen in older adults), GI bleeding

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19
Q

give an example of a Selective noradrenaline Reuptake inhibitors (SNRIs)?

A

Venlafaxine, Duloxetine

20
Q

How do SNRIs work?

A

o Inhibits reuptake pumps and inhibits noradrenaline transporters

21
Q

Side effects of SSRIs?

A

nausea, anxiety, weight loss, diarrhoea, insomnia, sexual dysfunction, agitation

22
Q

Side effects SNRIs?

A

nausea, sexual dysfunction, headache, insomnia, anxiety, sweating, and dose related hypertension.

23
Q

Example of tricyclic antidepressant?

A

Amitriptyline

24
Q

Which antidepressant can lead to cardio toxicity?

A

Tricyclic antidepressants

25
Q

Which antidepressants are good for management of neuropathic pain?

A

Tricyclic antidepressants

26
Q

side effects of tricyclic antidepressants?

A

postural hypotension, blurred vision, urinary retention, constipation, dry mouth, weight gain and drowsiness

27
Q

Give an example of a monoamine oxidase inhibitor (MAOIs)

A

Phenelzine, Isocarboxazid

28
Q

How do MAOIs work?

A

o MAOIs prevent the monoamine oxidase enzyme from removing serotonin, noradrenaline and dopamine from the brain. But also affects other neurotransmitters and that causes the side effects.

29
Q

which antidepressant has a lot of dietary restrictions?

A

MAOIs (and don’t forget a lot of drug interactions)

30
Q

side effects of MAOIS

A

Postural hypotension, dizziness, constipation, dry mouth, GI upset

31
Q

How long does it take on average for the antidepressants to start working?

A

3-6 weeks (but side effects can occur straight away)

32
Q

what is necessary to assess for when starting antidepressants initially?

A

suicidal ideation - can provide a ‘pick-me-up’, which means they have motivation to attempt suicide

33
Q

In order to prevent relapses, when is it recommended to stop antidepressants?

A

6 months after remission

34
Q

What are psychological treatments for depression?

A

Mindfulness, CBT, interpersonal therapy

35
Q

How would you treat mild depression?

A

Low intensity psychotherapy focused on sleep hygiene, anxiety management and problem-solving techniques. Antidepressants are not routinely used for mild depression unless it has an 8+ week history or previous diagnosis of depression.

36
Q

How would you treat moderate depression?

A

Combination of antidepressant and high-intensity psychological intervention (8-12 weeks CBT or interpersonal therapy), can use IAPT programme for this. For first episode of depression, SSRI is recommended.

37
Q

How would you treat severe depression?

A

(includes psychotic depression, high risk suicide and atypical depression)  need rapid mental health assessment and consideration of inpatient hospitalisation (may need MHA) or ECT.

38
Q

What lifestyle changes are recommended in order to help improve depression?

A
  • Exercise
  • Good routine
  • Healthy, balanced diet
  • Smoking cessation
  • Social interaction
  • Reading clubs
  • Meditation
39
Q

What does the SUICIDE acronym stand for with regards to severe depression?

A 
Suicide plan or ideas of self-harm 
Unexplained guilt or worthlessness
Inability to function (e.g. psycho-motor retardation or agitation)
Concentration impaired
Impaired appetite 
Decreased sleep/early waking 
Energy low/ unaccountable fatigue
40
Q

What are causes of secondary depression?

A 
•	Medical disorders
o	Hypothyroidism
o	Chronic disease
o	Mental illness e.g. schizophrenia
•	Drug induced
•	Life event  Bereavement, divorce, illness
41
Q

How may depression present in the elderly?

A
  • Somatic Concerns  hypochondriasis or could be exaggerated or over-valued ideas
  • Psychotic Symptoms  hypochondriacal delusions
  • Anxiety
  • Subjective memory Complaints
  • Suicidal ideation
  • Lack reactivity
  • Weight loss and self-neglect
42
Q

What may be causes of depression in the elderly?

A

• Loss  bereavement, role and occupation, independence, mobility
• Change in physical health + pain
• Attachments  change in ‘parental’ role (they are being looked after by children)
• New diagnosis of terminal/incurable disease e.g. dementia
• Previous life events leading to vulnerabilities
• Chronic depression
• Insomnia
• Anxiety
• Feeling a burden to family/friends
• Social isolation
People with a rigid personality may be unable to cope with adaptation after event e.g. bereavement

43
Q

What is DDx of depression in the elderly?

A

Hypoactive delirium

44
Q

What can deliberate self-harm be treated as in those aged over 65?

A

suicide attempt

45
Q

How many more time likely is it that older adults will die of suicide following deliberate self harm?

A

3x more likely than those under 65

Psychiatry (40 decks)

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