depression Flashcards
what are the symptoms of depression that are exhibited?
indecisiveness
disturbed sleep
fatigue
increased appetite
what further questions should Amy be asked initially?
persistent sadness/ low mood
loss of interests or pleasure
agitation or slowing of movements
feelings of worthlessness or inappropriate guilt
suicidal thoughts or acts
what are the criteria for major depressive disorder/depression?
can be mild, moderate, severe
NICE guidelines use DSM-IV criteria
at least 1 of the key symptoms most days, most of the time for at least 2 weeks:
- persistent sadness or low mood
- marked loss of interests or pleasure
4 or more associated symptoms as well as one key:
- disturbed sleep
- changes in appetite or weight gain
- fatigue/loss of energy
what other questions should be asked to determine risk?
thoughts and/or actions related to:
- self-harm (most commonly happens in young females 17-19 yrs)
- suicide (most commonly happens in middle aged males 40-59 yrs)
- harm to others (particularly important in psychosis)
asking about self-harm, suicide etc. does not increase risk of these things happening
what 5 things can be considered true when referring to self-harm?
history of self-harm is associated with increased suicide risk
can involve cutting, scratching, burning, hair-pulling - may also take other forms such as punching a wall, banging one’s head against a hard object, getting into fights
self-harm is usually a way of coping with/expressing difficult feelings
suicide is a fatal act of self-harm initiated with the intention of ending one’s own life
what is parasuicide?
apparent attempted suicide without the actual intention of killing oneself
what are some of the biological factors that contribute to risk of depression?
physical health
metabolic disorders
immune/stress response
neurochemistry
genetic vulnerability
what are some of the bio-psycho factors that contribute to risk of depression?
emotions
cognitive factors/IQ
sleep
what are some of the psychological factors that contribute to risk of depression?
coping skills
self esteem
attitudes/beliefs
personality/temperament
what are some of the bio-social factors that contribute to risk of depression?
diet/lifestyle
drug effects
what are some of the social factors that contribute to risk of depression?
culture
financial security
work/school
social support
family circumstances
what are some of the psycho-social factors that contribute to risk of depression?
interpersonal relationships
traumatic life events
what is ACE?
adverse childhood experiences
experiencing/seeing certain things during childhood can increase risk of certain behaviours/illnesses
what high risk behaviours have a strong association with ACE scores?
binge drinking
heavy drinking
smoking
high risk HIV behaviour
depression
disability caused by poor health
use of special equipment because of disability
what is bias?
occurs when systematic error is introduced into sampling or testing by selecting or encouraging one outcome or answer over others
can occur at any phase of research
e.g. confirmation bias, selection bias, recall bias
what is the difference between clinical and statistical significance?
statistical significance indicates reliability of the study results
clinical significance reflects its impact on clinical practice
“P” value, frequently used to measure statistical significance, is the probability that the study results are due to chance rather than to a real treatment effect
what is the monoamine hypothesis?
underlying pathophysiologic basis of depression is depletion in the levels of serotonin, norepinephrine, and/or dopamine (i.e. monoamines) in CNS
what are some of the drugs that can result in an anti-depressant effect?
SSRI
post-synaptic serotonin receptor agonist
monoamine oxidase inhibitor
serotonin auto-receptor antagonist
what information should be given to people before they start a course of antidepressants?
drugs take several weeks to work
symptoms may worsen initially
need to continue for around 6 months after remission of symptoms
need to wean drugs gradually - if stopped suddenly, may cause side-effects
may interact with several commonly prescribed drugs (tell doctors what medications you are taking?
what are the aims of social prescribing?
enable healthcare professionals to refer people to local, non-clinical services - variety of activities typically provided by voluntary or community sector organisations
recognises that health is determined by a range of social, economic and environmental factors - seeks to address needs in a holistic way
aims to support individuals to take greater control of their own health
many different models for social prescribing - most involve link worker/navigator who works with people to access local sources of support
how do monoamine oxidase inhibitors work?
monoamine oxidase - breaks down neurotransmitter
inhibition increases amount of neurotransmitter that can be released into the synapse
increases likelihood of neurotransmitter binding to post-synaptic receptor and triggering an action potential
how do tricyclic antidepressants work?
increase norepinephrine and serotonin
block re-uptake channels
neurotransmitter stays in synapse for a longer period of time
increases likelihood of neurotransmitter binding to post-synaptic receptor and triggering an action potential
how do SSRIs (e.g. Prozac) work?
block very specific serotonin re-uptake channels
neurotransmitter stays in synapse for a longer period of time
increases likelihood of neurotransmitter binding to post-synaptic receptor and triggering an action potential
why do monoamine oxidase inhibitors have many side effects?
affect ALL monoamine neurotransmitters (not just in brain, all around the body)
e. g. affects medication metabolism process in liver, need to be careful about drug interactions
e. g. affects digestion of certain foods - fruits, alcohol, dairy etc.
what are the side effects of TCAs?
can affect histamines - can lead to fatigue and sluggishness
toxic at higher levels - could cause cardiac arrest if a patient overdoses (intentionally or accidentally)
but usually given for bipolar disorders as other drugs like SSRIs can trigger manic episodes
what are the side effects of SSRIs?
sleeping problems
weight gain
sexual dysfunction
(if taken in conjunction with other serotonin inducing medication, can cause serotonin syndrome)
what are some newer antidepressants?
selective serotonin and norepinephrine reuptake inhibitor (SSRIs, SNRIs) - work like TCAs
selective norepinephrine and dopamine reuptake inhibitor (NDRIs)
selective norepinephrine and dopamine releasing agents (NDRAs) - inhibit reuptake and stimulate release
what is cognitive behavioural therapy (CBT)?
type of talking treatment focussing on how thoughts, beliefs and attitudes affect feelings and behaviour
used for many mental health problems including anxiety, depression, bipolar disorder, OCD, schizophrenia
teaches you coping skills for dealing with different problems.
combines cognitive therapy (examining the things you think) and behaviour therapy (examining the things you do)
what is the theory behind CBT?
based on the idea that the way we think about situations can affect the way we feel and behave
interpreting a situation negatively might result in experiencing negative emotions - those might then lead you to behave in a certain way
these patterns might become part of a continuous cycle
CBT works to identify and challenge any negative thinking patterns and behaviour which may be causing you difficulties - in turn this can change the way you feel about situations, and enable you to change your behaviour in future
how does negative thinking start?
can start from childhood onwards
e.g. not getting enough attention or praise from your parents or teachers at school - thoughts about worthlessness, uselessness
over time you might come to believe these assumptions, until as an adult these negative thoughts become automatic
this way of thinking might affect how you feel at work, in your general life
does social prescribing work?
studies have pointed to improvements in areas such as:
- quality of life
- emotional wellbeing
- mental and general wellbeing
- levels of depression and anxiety
what is a practical benefit of social prescribing for the NHS?
reduction in use of NHS services
one study showed reductions in use of A&E attendance, outpatient appointments, inpatient admissions
another showed reduced GP attendance rates
what are the isssues with assessing the benefits of social prescribing?
robust and systematic evidence very limited
many studies:
- small scale
- no control group
- focus on progress, not outcomes
- relate to individual interventions rather than social prescribing model
evidence is qualitative and self-reported
difficulty of measuring outcome of complex intervention, making meaningful comparisons between different schemes
hard to determine cost, cost effectiveness and resource implications - contrast between short term and long term
how does social prescribing fit in with wider health and care policy?
interest in the model has expanded in the past decade or so although it has been used for longer - more than 100 schemes currently running in the UK (quarter in London)
was highlighted in a 2006 paper as a mechanism for promoting health, independence and access to local services
objectives of social prescribing support the principles set out in NHS policy documents (including the 2014 NHS five year forward view - encourages focus on prevention and wellbeing, patient-centred care, and better integration of services, highlighting role of third sector in delivering services that promote wellbeing)
a 2016 paper emphasised role of voluntary sector organisations (including through social prescribing specifically) in reducing pressure on GP services
social prescribing also contributes to a range of broader government objectives, for example in relation to employment, volunteering and learning.
NICE does not provide guidance on social prescribing specifically, but some of its guidelines relating to mental health include initiatives that could be described as social prescribing activities.
increasing amount of guidance on social prescribing available for commissioners and others in the NHS and local government
new Social Prescribing Network set up to provide support and share practice on social prescribing at a local and national level.
2016 - NHS England appointed a national clinical champion for social prescribing to advocate for schemes and share lessons from successful social prescribing projects
