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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
Give examples of SSRIs?
paroxetine (Seroxat), fluoxetine (Prozac) | citalopram (Cipramil).
26
What are withdrawal symptoms (antidepressants)?
``` an upset stomach flu-like symptoms anxiety dizziness vivid dreams at night sensations in the body that feel like electric shocks ```
27
What are other treatments for depression?
Mindfulness St John's wort (herbal treatment) Brain stimulation Transcranial direct current stimulation (tCDS) Repetitive transcranial magnetic stimulations Electroconvulsive therapy Lithium
28
How does cannabis affect your mental health?
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
29
What are symptoms of psychosis?
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
30
What signs of depression does Amy show?
``` 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 ```
31
What questions could we ask Amy?
``` Persistens sadness Slowing of movements Weightloss Relationships? Suicidal thoughts? ```
32
How can we diagnose depression?
DSM | ICD
33
What is the DSM?
Linked to NICE guidelines Diagnostically and statistical measures of medicine?
34
What does the DSM say are key symptoms?
Persistent sadness or low mood | Marked loss of interests of pleasure
35
What is the timeframe for diagnosis?
most days, most of the time for at least two week
36
What is the criteria for DSM diagnosis?
1 or more key symptoms | 5 or more associated symptoms
37
What are the three risk factors that can manifest as thoughts or actions?
Self harm Suicide Harm to others
38
In what group is self-harm most common in?
Females 17-19
39
In what group is suicide most common in?
Males 50-59
40
What factors can influence someones likelihood to self-harm/commit suicide?
Demographic (cultural, sex, etc.) Where in the world Occupation
41
Define suicide
Suicide is a fatal act of self-harm initiated with the intention of ending one's life
42
What is a history of self harm associated with?
Higher risk of suicide
43
What is parasuicide?
Apparent attempted suicide without the actual intention of killing oneself
44
What forms of injury can be classified as self harm?
``` Punching wall Banging head Cutting Scratching Hair pulling ```
45
Why do people often self harm?
Self-harm is usually a way of coping or expressing difficult feelings
46
What are the biological factors to consider with depression?
Genetic variability Physical health Sleep Diet and Lifestyle
47
What are the psychological factors to consider with depression?
Sleep Self-esteem Trauma Attitude/beliefs
48
What are the social factors to consider with depression?
Family circumstance Financial security Diet and Lifestyle Trauma
49
What are ACEs?
Adverse childhood experiences
50
What are Adverse childhood experiences ?
Potentially traumatic events that can have long-lasting affects
51
What behaviours in adult life can ACEs influence?
``` Binge drinking Heavy drinking Smoking Disability caused by poor health Depression High risk HIV behaviour Use of special equipment because of disability ```
52
What is BRFSS?
Questionnaire that asks about traumatic events in childhood | Comprised of 11 questions
53
What is bias?
A form of error
54
What must you bear in mind when looking at research?
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
What is the difference between heavy and binge drinking?
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
What is the difference between statistical and clinical signifcance?
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
What drugs can have an anti-depressant affect?
SSRIs Serotonin auto-receptor antagonist Post-synaptic Serotonin receptor agonist
58
How does a SSRI work?
Prevents reuptake of Serotonin so it remains in the bloodstream = anti-depressant affect most commonly used medications in depression
59
How do MAO inhibitors work?
Serotonin builds up in presynaptic terminal Conc. gradient impacted and serotonin leaves synapse at far lower rate
60
What does the Serotonin auto-receptor do?
Receptor decreases serotonin release so the antagonist drug works as an anti-depressant
61
What is the monoamine hypothesis?
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
Give points that patients should be told before given medication
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
What are some potential side effects of anti-depressants?
``` Suicidal thoughts Serotonin syndrome (high levels) - Tremors Nausea Drowsiness Sexual dysfunction Insomnia ```
64
What might Amy's GP suggest in terms of social prescribing?
Support group Local art group (re-start a previous interest) Exercise group Community cooking class Online educational engagement Volunteering Building strong networks
65
What is social prescribing?
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
Give examples of Monoamine neurotransmitters
Serotonin Adrenaline Noradrenalin Dopamine
67
What are the three classes of anti-depressants?
MAOIs TCAs SSRIs
68
What are MAOIs?
Monoamine oxidase inhibitors
69
What are TCAs?
Tricyclics
70
What are SSRIs?
Selective Serotonin Reuptake Inhibitors
71
How do MAOIs work?
Monoamine oxidase breaks down Its not stored in vessicles Increases amount of NT that can be released in to synapse
72
How do TCAs work?
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
How do SSRIs work?
Block reuptake channels for serotonin But for selective (specific) serotonin receptors
74
How do doctors know which anti-depressant to prescribe?
Depends on side effects MAOIs and TCAs are first gen so have many side effects
75
What are examples of side effects from MAOIs?
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
What are the side effects of TCAs?
Can effect histamines leading to fatigue and sluggishness Overdose of TCAs can lead to cardio problems due to toxicity
77
Why are TCAs often given to those with bipolar disorder?
Often prescribed for those with bipolar disorder as other medication can trigger manic episodes
78
What are side effects of SSRIs?
Sleeping problems Weight gain Sexual dysfunction Can have negative affect on QoL Serotonin Syndrome which can be life-threatening
79
What are new treatments now on offer?
SSRI and SNRI Selective serotonin and noradrenaline reuptake inhibitors NDRIs Selective noradrenaline and dopamine reuptake inhibitors NDRAs Selective noradrenaline and dopamine releasing agents
80
What is CBT?
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
What is CBT based on?
CBT is based on the idea that the way we think about situations can affect the way we feel and behave
82
What happens if your negative interpretation of situations goes unchallenged?
These patterns in your thoughts, feelings and behaviour can become part of a continuous cycle
83
How does CBT work?
Teaches you coping skills Identify and challenge any negative thinking patterns and behaviour which may be causing you difficulties
84
Who is involved with social prescribing?
GP Link worker or navigator who works with people to access local sources of support
85
What is limited with regards to social prescribing schemes?
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
What must be considered re social prescribing?
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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