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Psych AM > Depression > Flashcards

Depression Flashcards

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1
Q

What are the general diagnostic features of depression?

A

Depressed mood
Energy decreased
Anhedonia

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2
Q

What are the additional diagnostic features of depression?

A 
Death (suicidal) thoughts
Sleep disturbance- early wakening, insomnia, hypersomnia
Worthlessness or guilt
Appetite change 
Mentation decreased 
Psychomotor retardation
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3
Q

What are the possible signs of psychomotor retardation in depression?

A

Slowing of motor responses including speech
Catatonia
Stupor- state of extreme retardation in which consciousness is intact but patient stops moving, speaking, eating, drinking

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4
Q

What are some “other” features of depression

A 
Loss of libido
Constipation
Physical pain
irritability, agitation
PSychosis
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5
Q

What are the features of psychosis?

A

Hallucinations- mainly auditory, olfactory strongly associated
Delusions

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6
Q

What are the features of hallucinations?

A

Have full force and clarity of true perception
Not willed or controlled
Located in external space

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7
Q

What is a delusion?

A

Unshakable idea or belief which is out of keeping with the person’s social or cultural background, it is held with extraordinary conviction

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8
Q

What are the types of delusions?

A

Paranoid
Grandiose
Self referential
Hypochondrial

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9
Q

What are the criteria for diagnosis of depression?

A

At least 2 weeks
No manic or hypomanic episodes in life
Not attributable to organic disorder or psychoactive substance use
Features

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10
Q

What is the criteria for mild depression?

A

At least 2 general featues

Additional to give at least 4

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11
Q

What are the features of moderate depression?

A

At least 2 general features

Additional to give 6

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12
Q

What are the features of severe depression?

A

All 3 general and additional to give at least 8

OR psychotic symptoms

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13
Q

What are the management options for subtheshild to mild depression?

A

Active monitoring
Sleep hygiene
Low intensity psych and psychosocial interventions
Antidepressant therapy in certain circumstances

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14
Q

What are the indications for antidepressant therapy in sub threshold to mild depression?

A

PMH moderate to severe depression
>2 years sub threshold symptoms
Not responding to other interventions

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15
Q

What is the management of moderate to severe depression?

A

Antidepressant therapy
High intensity psychological intervention- CBT, IPT, behavioural actovation
Couples/family therapy

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16
Q

What is the anti depressant therapy pathway?

A
  1. SSRI
  2. Increase dose/try another SSRI
  3. SNRI, MAOI or TCA- usually SNRI
  4. Augmentation and combination in consultation with psychiatry
17
Q

What are some psychological interventions?

A 
CBT
IPT
Family therapy
Couples therapy
Individual psychodynamic therapy
18
Q

What are some physical treatments of depression?

A

ECT
Psychosurgery
Deep brain stimulation
Vagus nerve stimulation

19
Q

What are some SSRIs?

A

Sertraline
Fluoxetine
Citalopram
Paroxetine

20
Q

What are the most common side effects of SSRIs?

A

GI upset= most common
Sexual dysfunction
Discontinuation syndrome

21
Q

What is the presentation of discontinuation syndrome?

A

Agitation
Nausea
Dysequilibrium

22
Q

What are some SNRIs?

A

Venlafaxine

Duloxetine

23
Q

What are some side effects of SNRIs?

A 
Sedation, insomnia
Hypomania
Dry mouth, sweats
Sexual dysfunction- not as much as SSRIs
Loss of appetite 
Discontinuation syndrome
24
Q

What are the types of TCAs?

A

tertiary- amitriptyline, imipramine

Secondary- nortitriptyline, clomipramine

25
Q

Why are TCAs nt widely used for depression?

A

Side effect profile

Toxicity in overdose

26
Q

In what TCAs are side effects less common?

A

Secondary TCAs- e.g. noritriptyline

27
Q

What are some side effects of TCAs?

A 
Sedation
Dry mouth
Blurred vision
Weight gain
Constipation
Sexual dysfunction
28
Q

Why are MAOIs generally avoided?

A

Side effects common and severe

29
Q

What are the side effects of MAOIs?

A 
Orthostatic hypotension
Weight gain
Dry mouth
Sedation
Sexual dysfunction 
Serotonin syndrome
30
Q

What is done to avoid serotonin syndrome with MAOIs?

A

Wait 2 weeks before switching from SSRI/SNRI to MAOI

31
Q

What type of delusions are seen in depression?

A

Generally mood congruent, catastrophic, nihilistic

32
Q

What is th management of catatonic stupor?

A

ECT

BZDs

Psych AM (14 decks)

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