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CP2 Psychiatry > Depression > Flashcards

Depression Flashcards

1
Q

M:F depression

A

1:2

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2
Q

What is the lifetime prevalence of depression symptoms?

A

10-20%

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3
Q

What % of those w/ depression will recover within a year?

A

50-60%

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4
Q

What % of those w/ depression will it become chronic?

A

10-25%

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5
Q

What % of those with depression will die by suicide?

A

5-15%

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6
Q

Within 10 years, what % of those once diagnosed with depression will have a relapse?

A

75%

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7
Q

What are the 3 core symptoms of depression?

A

Low mood
Anhedonia
Anergia

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8
Q

Biological symptoms of depression (2)

A

Disturbed sleep

Changes in appetite

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9
Q

Cognitive symptoms of depression (6)

A 
Reduced concentration or memory 
Poor self esteem 
Ideas of guilt + unworthiness 
Hopelessness 
Pessimism about the future 
Ideas/acts of self-harm/suicide
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10
Q

Neurotic/reactive depression

A

Patient is to some degree ‘understandably’ depressed, reacting to adverse psychosocial circumstances

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11
Q

Features of ‘Somatic Syndrome’ (8)

A 
Markedly reduced appetite 
W loss - >5%W 1 month 
Early morning wakening 
Diurnal variation in mood 
Psychomotor retardation/agitation 
Loss libido 
Marked anhedonia
Lack emotional reactivity
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12
Q

Depressive stupor

A

Causes someone to remain speechless + motionless for an extended period

Depression w/ psychosis

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13
Q

Definition of a mild depressive episode

A

At least 2/3 core symptoms
+ additional Sx –> 4
w/ or w/o somatic syndrome

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14
Q

Definition of moderate depressive episode

A

At least 2/3 core Sx
+ additional Sx –> 6
W/ or w/o somatic syndrome

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15
Q

Definition of severe depressive episode

A

All 3 core Sx

+ additional Sx –> 8

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16
Q

Definition of severe depressive episode w/ psychotic Sx

A

All 3 core Sx
+ additional Sx –> at least 8
+ delusions, hallucinations or depressive stupor

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17
Q

Organic DDx depression (5)

A

Neuro - MS/PD/HD/CVA
Endocrine - thyroid/parathyroid, Cushings/Addisons
Infections
Iatrogenic - opiates. L-dopa, steroids
Others - malignancies, SLE, RA, renal failure, porphyria, chronic pain, IHD

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18
Q

phsyical Ix - depressive pt

A

FBC - anaemia/infection/MCV (alcohol)
U+E
LFT - GGT
TFT +Ca

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19
Q

What is the most common co-morbidity - depression

A

Substance abuse

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20
Q

How is depression managed?

A

Via NICE’s Stepped care approach

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21
Q

Step 1 NICE stepped care for depression

A 
For all known/suspected PS of depression: 
Assess 
Active monitoring 
Psychoeducation 
Computer CBT
Sleep hygiene 
Guided self-help
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22
Q

Step 2 NICE stepped care for depression

A

Mild/mod depression - 1’ care:
Low intensity psychological interventions
Meds - 1st line = norm SSRIs

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23
Q

Step 3 NICE stepped care for depression

A

Mod/severe depression. Failure to respond to Tx. 1’ care:
Meds
High-intensity psychological intervention
Consider 2’ care referral

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24
Q

Step 4 NICE stepped care for depression

A 
Sever complex depression. Life threatening/severe self-neglect: 
Meds - venlafaxine/mitrazapine/tca/MAOIs
High intensity psycho interventions 
MDT
Inpt care
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25
If 1 episode of depression, how long should meds be continued for after pt is feeling better?
6 months
26
If recurrent depression, how long should meds be continued for after pt is feeling better?
2 years
27
Indications - antidepressants (10)
``` Depressive illness Anxiety Neuropathic pain Insomnia Bulimia Impulsivity Migraines Chronic fatigue Syndrome IBS Nacrolepsy ```
28
SSRIs - e.g.s (6)
``` Fluoxetine Paroxetine Sertraline Escitalopram Citalopram Fluvoxamine ```
29
Time taken between initiation and response - SSRIs
1-6 w
30
SE of SSRIs (9)
``` Nausea Exacerbation of anxiety Insomnia Apathy/fatigue Diarrhoea Dizziness Sweating Restlessness Sexual dysfunction ```
31
E..g.s of SNRI (2)
Venlafaxine | Duloxetine
32
SE SNRIS
Similar to SSRIs More sedation Greater discontinuation Sx
33
TCAs e.g.s (5)
``` Amitriptyline Imipramine Clomipramine Dosulepin Lofepramine ```
34
Which antidepressant is 1st line in pregancny
TCAs
35
SE TCAs (9)
``` Dry mouth Blurred vision Constipation Urinary retention Sedation W gain Dizziness HoTN Delirium ```
36
E.g.s of MOAIs (4)
Phenelzine Tranylcypromine Isocarboxazid Moclobemide
37
When are MOAIs depresibed (5)
``` Resistant/atypical depression Anxiety ED Parksinsons Migraine ```
38
SE MOAIs (7)
``` Dry mouth Nausea Diarrhoea Constipation Headache Sleep disturbance Postural HOTN ```
39
e.g. NaSSA
Mirtazapine
40
C/I NaSSA
Mania
41
SE NaSSA (5)
``` W gain Increased appetite Drowsiness Dizziness Headache ```
42
Why should antidepressants be cautioned in people with epilepsy
B/c they tend to lower the seizure threshold
43
What % of pt w/ depression respond to their 1st antiD
70%
44
Discontinuation Sx antidepressants
Generally mild /transient | Tapering dose gradually over p of 4 weeks can help to reduce Sx
45
Which 2 antiD tend to have discontinuation Sx the most
Paroxetine | Venlafaxine
46
Def Self harm
A deliberate, non-fatal act of injuring oneself, done with the knowledge that its potentially harmful
47
Def suicide
The act of intentionally killing oneself with the primary aim of dying
48
Ways in which people self harm (13)
``` Over/undereating XS exercise Pulling hair out Ligaturing Swallowing non-food items Inserting objects into body OD Burning skin Scratching/picking skin Poisoning themselves Cutting themselves Vomiting Headbutting/hitting themselves ```
49
M:F self harm
1:2
50
What are the most common methods of self harm
OD | Cutting
51
Biological predisposing factors to SH (3)
Genetics Substance misuse Age (teens/ young adults)
52
Psychological predisposing factors to SH (6)
``` Abuse Bullying Bereavement Relationship breakdown Difficult feelings Endings/change ```
53
Social predisposing factors to SH (3)
Having friends who SH Housing concerns Money worries
54
Spiritual predisposing factors to SH
Crisis of faith
55
Biological precipitating factors SH
Substance misuse
56
Psychological precipitating factors SH (6)
``` Abuse Bullying Bereavement Relationship breakdown Difficult feelings Endings/change ```
57
Social precipitating factors SH (5)
``` Having friends who self harm Money concerns Housing concerns Work/school P Endings /change ```
58
Spiritual precipitating factors SH
Crisis of faith
59
Biological perpetuating factors SH
Substance misuse
60
Psychological perpetuating factors SH (6)
``` Abuse Bullying Bereavement Relationship breakdown Difficult feelings Endings/change ```
61
SOcial perpetuating factors SH (5)
``` Having friends who self harm Money concerns Housing concerns Work/school P Isolation, loneliness ```
62
Mx Self harm
1 - assessment 2 - approp enviro to reduce risk of further self harm 3 - care + foreward planning inncl physical Tx for injuries, Rx for psychosocial assessment
63
How much more likely are those who SH to die by suicide than the general population
66x
64
Factors predicting reptition of self harm (5)
``` No' previous eps Diagnosis PD Hx violence Alcohol misuse/dependence Being unmarried ```
65
Factors indicating suicidal intent (6)
``` Precautions to avoid intervention Planning Leaving a nodte Anticipatory acts e.g. Will Use of violent methods Percieved lethality by pt ```
66
Most common method of suicide
Hanging
67
M:F suicide
3:1
68
Who are particularly vulnerable groups from suicide? (7)
``` Prisoners Asylum seeks LGBTQ+ Veterens Living alone/social isolation Cert occu - vet/Dr/nuse/farmer Unemployed ```
69
WHat % of those who common suicide had a mental health disorder
90%
70
Indications - ECT (4)
Tx resistant severe depression Life-threatening severe depression Tx resisttant mania Catatonia
71
ECT schedule
4-12 sessions | Usually twice weekly
72
What % of those who have ECT recover from their clinical depression
80%
73
Absolute C/I ECT
Cochlear implant
74
Relative C/I ECT (9)
``` Raised ICP Intracranial aneurysm Hx cerebral haemorrhage Recent MI (<3months) Aortic aneurysm Uncontrolled cardiac arrhythmias Decompensated cardiac failure Acute resp infection DVT ```
75
Common SE ECT (4)
Headache Confusion Impaired cognitive fct Temp retrograde/anterograde amnesia
76
Which electrode placement in ECT is more commonly used
Biateral
77
Risk of mortality ECT
1 in 100,000
78
Psychodynamic therapy - timing
ONce weekly 50mins | From 4m --> several years
79
What is the aim of psychodynamic therapy?
Facilitate conscious recognition of Sx causing unconscious processes Therapist ID'd and interprets these
80
What is interpersonal therapy?
Enables pt to evaluate their social interactions, + improve their interpersonal skills in all social roles

CP2 Psychiatry (15 decks)

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