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Year 2 CSI > Depression > Flashcards

Depression Flashcards

1
Q

What had happened since Amy’s last GP visit?

A

Injunction against ex
Still feels rubbish
Has being seeing her mum a bit and they are getting on
She texts her friends
Not bothered to get out much - feels like too much effort
Works part-time at the salon
Not taken much time off work which is an improvement

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2
Q

What more medical things does Amy discuss with the GP?

A

Sleep isn’t great, still wakes up early but is still tired
Eats when she feels low - junk food
Has had thoughts about harming herself (but hasn’t)
On medication
Has had some psychotherapy in the past

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3
Q

What is depression?

A

Feeling persistently sad for weeks or months

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4
Q

What are some symptoms of depression?

A 
Unhappiness
Hopelessness
Losing interest in things you used to enjoy 
Feeling very tearful
Constantly tires
Sleeping badly
No appetite or sex drive
Various ached and pains
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5
Q

What can severe depression lead to?

A

Suicidal thoughts

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6
Q

What causes depression?

A

Life-changing events e.g. bereavement, losing job, giving birth

Family history

Sometimes there is no obvious reason

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7
Q

How is depression treated?

A

Lifestyle
Talking therapies e.g. CBT
Medicine

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8
Q

What lifestyle changes can improve depression?

A

Exercise
Less alcohol
Giving up smoking
Eating healthily

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9
Q

Give more detailed psychological symptoms of depression

A

continuous low mood or sadness
feeling hopeless and helpless
having low self-esteem
feeling tearful
feeling guilt-ridden
feeling irritable and intolerant of others
having no motivation or interest in things
finding it difficult to make decisions
not getting any enjoyment out of life
feeling anxious or worried
having suicidal thoughts or thoughts of harming yourself

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10
Q

Give more detailed physical symptoms of depression

A

moving or speaking more slowly than usual
changes in appetite or weight (usually decreased, but sometimes increased)
constipation
unexplained aches and pains
lack of energy
low sex drive (loss of libido)
changes to your menstrual cycle
disturbed sleep – for example, finding it difficult to fall asleep at night or waking up very early in the morning

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11
Q

Give more detailed social symptoms of depression

A

avoiding contact with friends and taking part in fewer social activities
neglecting your hobbies and interests
having difficulties in your home, work or family life

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12
Q

What are the different severities of depression?

A

mild depression – has some impact on your daily life
moderate depression – has a significant impact on your daily life
severe depression – makes it almost impossible to get through daily life; a few people with severe depression may have psychotic symptoms

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13
Q

What is the difference between grief and depression?

A

Grief is an entirely natural response to a loss, while depression is an illness.

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14
Q

What are the different types of depression?

A

Postnatal

Bipolar

SAD

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15
Q

What is postnatal depression?

A

sometimes new mothers, fathers or partners develop depression after they have a baby

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16
Q

What is bipolar disorder?

A

“manic depression”, in bipolar disorder there are spells of both depression and excessively high mood (mania); the depression symptoms are similar to clinical depression, but the bouts of mania can include harmful behaviour, such as gambling, going on spending sprees and having unsafe sex

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17
Q

Summarise the causes of depression

A 
Personality
Family history
Giving birth
Loneliness
Alcohol and drugs
Illness
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18
Q

What illnesses can cause depression?

A

Coronary heart disease
Cancer
Both long term

Severe head injury can trigger mood swings and emotional problems

Minor head injury can damage pituitary gland

Hypothyroidism

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19
Q

What is the aim of CBT?

A

aims to help you understand your thoughts and behaviour, and how they affect you

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20
Q

How does CBT work?

A

ecognises that events in your past may have shaped you, but it concentrates mostly on how you can change the way you think, feel and behave in the present

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21
Q

What is IPT?

A

interpersonal therapy

focuses on your relationships with others and problems you may be having in your relationships, such as difficulties with communication or coping with bereavement

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22
Q

What is psychodynamic psychotherapy?

A

Encouraged to say whatever is going through your mind

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23
Q

What is counselling?

A

form of therapy that helps you think about the problems you’re experiencing in your life so you can find new ways of dealing with them

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24
Q

What are SSRIs?

A

Selective serotonin reuptake inhibitors

antidepressant

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25
Q

Give examples of SSRIs?

A

paroxetine (Seroxat), fluoxetine (Prozac)

citalopram (Cipramil).

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26
Q

What are withdrawal symptoms (antidepressants)?

A 
an upset stomach
flu-like symptoms
anxiety
dizziness
vivid dreams at night
sensations in the body that feel like electric shocks
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27
Q

What are other treatments for depression?

A

Mindfulness

St John’s wort (herbal treatment)

Brain stimulation

Transcranial direct current stimulation (tCDS)

Repetitive transcranial magnetic stimulations

Electroconvulsive therapy

Lithium

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28
Q

How does cannabis affect your mental health?

A

make your depression symptoms worse
feel more tired and uninterested in things
are more likely to have depression that relapses earlier and more frequently
will not have as good a response to antidepressant medicines
are more likely to stop using antidepressant medicines
are less likely to fully recover

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29
Q

What are symptoms of psychosis?

A

delusions – thoughts or beliefs that are unlikely to be true

hallucinations – hearing and, in some cases, feeling, smelling, seeing or tasting things that are not there; hearing voices is a common hallucination

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30
Q

What signs of depression does Amy show?

A 
Slow speaking
Disturbed sleep 
Social withdrawal 
Eating more junk food when low (stress eating)
Low mood
Apathy
Nervous fiddle (agitation)
No longer takes pleasure in things she used to enjoy (anhadonia?)
Feelings of worthlessness
Not going out much
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31
Q

What questions could we ask Amy?

A 
Persistens sadness
Slowing of movements
Weightloss
Relationships?
Suicidal thoughts?
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32
Q

How can we diagnose depression?

A

DSM

ICD

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33
Q

What is the DSM?

A

Linked to NICE guidelines

Diagnostically and statistical measures of medicine?

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34
Q

What does the DSM say are key symptoms?

A

Persistent sadness or low mood

Marked loss of interests of pleasure

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35
Q

What is the timeframe for diagnosis?

A

most days, most of the time for at least two week

36
Q

What is the criteria for DSM diagnosis?

A

1 or more key symptoms

5 or more associated symptoms

37
Q

What are the three risk factors that can manifest as thoughts or actions?

A

Self harm
Suicide
Harm to others

38
Q

In what group is self-harm most common in?

A

Females 17-19

39
Q

In what group is suicide most common in?

A

Males 50-59

40
Q

What factors can influence someones likelihood to self-harm/commit suicide?

A

Demographic (cultural, sex, etc.)
Where in the world
Occupation

41
Q

Define suicide

A

Suicide is a fatal act of self-harm initiated with the intention of ending one’s life

42
Q

What is a history of self harm associated with?

A

Higher risk of suicide

43
Q

What is parasuicide?

A

Apparent attempted suicide without the actual intention of killing oneself

44
Q

What forms of injury can be classified as self harm?

A 
Punching wall
Banging head 
Cutting 
Scratching 
Hair pulling
45
Q

Why do people often self harm?

A

Self-harm is usually a way of coping or expressing difficult feelings

46
Q

What are the biological factors to consider with depression?

A

Genetic variability
Physical health
Sleep
Diet and Lifestyle

47
Q

What are the psychological factors to consider with depression?

A

Sleep
Self-esteem
Trauma
Attitude/beliefs

48
Q

What are the social factors to consider with depression?

A

Family circumstance
Financial security
Diet and Lifestyle
Trauma

49
Q

What are ACEs?

A

Adverse childhood experiences

50
Q

What are Adverse childhood experiences ?

A

Potentially traumatic events that can have long-lasting affects

51
Q

What behaviours in adult life can ACEs influence?

A 
Binge drinking
Heavy drinking
Smoking
Disability caused by poor health
Depression
High risk HIV behaviour
Use of special equipment because of disability
52
Q

What is BRFSS?

A

Questionnaire that asks about traumatic events in childhood

Comprised of 11 questions

53
Q

What is bias?

A

A form of error

54
Q

What must you bear in mind when looking at research?

A

This is just one piece of research
The fact that there is/is not statistical significance in this study does not mean that it is consistently true

Also something may not be statistically significant but clinically significant

you can make associations without establishing causality

55
Q

What is the difference between heavy and binge drinking?

A

In the UK, binge drinking is drinking more than:

8 units of alcohol in a single session for men
6 units of alcohol in a single session for women

56
Q

What is the difference between statistical and clinical signifcance?

A

Something may be statistically significant without being clinically

e.g. a combo of drugs is seen to statistically improve survival

Clinically this is not as important as it only extends life by a few days

57
Q

What drugs can have an anti-depressant affect?

A

SSRIs
Serotonin auto-receptor antagonist
Post-synaptic Serotonin receptor agonist

58
Q

How does a SSRI work?

A

Prevents reuptake of Serotonin so it remains in the bloodstream

= anti-depressant affect

most commonly used medications in depression

59
Q

How do MAO inhibitors work?

A

Serotonin builds up in presynaptic terminal

Conc. gradient impacted and serotonin leaves synapse at far lower rate

60
Q

What does the Serotonin auto-receptor do?

A

Receptor decreases serotonin release

so the antagonist drug works as an anti-depressant

61
Q

What is the monoamine hypothesis?

A

Drug for TB was discovered to anti-depressant properties

Block monoamine oxidase

Which began the theory that serotonin is involved in depression

Over time we have realised that monamines are involved but is not the whole story

62
Q

Give points that patients should be told before given medication

A

Drugs tell several weeks to work
May get worse initially
Need to continue for 6 months after remission
Need to wean the drugs gradually
Interact with many commonly prescribed drugs

63
Q

What are some potential side effects of anti-depressants?

A 
Suicidal thoughts 
Serotonin syndrome (high levels)
- Tremors 
Nausea
Drowsiness
Sexual dysfunction
Insomnia
64
Q

What might Amy’s GP suggest in terms of social prescribing?

A

Support group

Local art group (re-start a previous interest)

Exercise group

Community cooking class

Online educational engagement

Volunteering

Building strong networks

65
Q

What is social prescribing?

A

Enabling health care professionals to refer people to a range of local, non-clinical services

Recognised that many factors determine health

Aims to support individuals to take better control of their health

66
Q

Give examples of Monoamine neurotransmitters

A

Serotonin
Adrenaline
Noradrenalin
Dopamine

67
Q

What are the three classes of anti-depressants?

A

MAOIs
TCAs
SSRIs

68
Q

What are MAOIs?

A

Monoamine oxidase inhibitors

69
Q

What are TCAs?

A

Tricyclics

70
Q

What are SSRIs?

A

Selective Serotonin Reuptake Inhibitors

71
Q

How do MAOIs work?

A

Monoamine oxidase breaks down Its not stored in vessicles

Increases amount of NT that can be released in to synapse

72
Q

How do TCAs work?

A

3 ring structure

Increase the levels of noradrenaline and serotonin

Work by interfering with reuptake

Block reuptake channels

NT stays in synapse longer

Increases likelihood NT will dock onto receptor on the postsynaptic membrane and trigger an action potential

73
Q

How do SSRIs work?

A

Block reuptake channels for serotonin

But for selective (specific) serotonin receptors

74
Q

How do doctors know which anti-depressant to prescribe?

A

Depends on side effects

MAOIs and TCAs are first gen so have many side effects

75
Q

What are examples of side effects from MAOIs?

A

Stops medication metabolism in the liver

Can lead to build up of drugs in body

Long list of foods people on MAOIs cannot eat

76
Q

What are the side effects of TCAs?

A

Can effect histamines leading to fatigue and sluggishness

Overdose of TCAs can lead to cardio problems due to toxicity

77
Q

Why are TCAs often given to those with bipolar disorder?

A

Often prescribed for those with bipolar disorder as other medication can trigger manic episodes

78
Q

What are side effects of SSRIs?

A

Sleeping problems
Weight gain
Sexual dysfunction
Can have negative affect on QoL

Serotonin Syndrome which can be life-threatening

79
Q

What are new treatments now on offer?

A

SSRI and SNRI
Selective serotonin and noradrenaline reuptake inhibitors

NDRIs
Selective noradrenaline and dopamine reuptake inhibitors

NDRAs
Selective noradrenaline and dopamine releasing agents

80
Q

What is CBT?

A

Cognitive behavioural therapy (CBT) is a type of talking treatment which focuses on how your thoughts, beliefs and attitudes affect your feelings and behaviour, and teaches you coping skills for dealing with different problems

81
Q

What is CBT based on?

A

CBT is based on the idea that the way we think about situations can affect the way we feel and behave

82
Q

What happens if your negative interpretation of situations goes unchallenged?

A

These patterns in your thoughts, feelings and behaviour can become part of a continuous cycle

83
Q

How does CBT work?

A

Teaches you coping skills

Identify and challenge any negative thinking patterns and behaviour which may be causing you difficulties

84
Q

Who is involved with social prescribing?

A

GP

Link worker or navigator who works with people to access local sources of support

85
Q

What is limited with regards to social prescribing schemes?

A

robust and systematic evidence on the effectiveness of social prescribing is very limited

studies are small scale, do not have control groups, focus on progress rather than outcomes

86
Q

What must be considered re social prescribing?

A

cost-effectiveness

Bristol study found that positive health and wellbeing outcomes came at a higher cost than routine GP care over the period of a year

Year 2 CSI (8 decks)

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