Depression Flashcards
What were Amy’s symptoms?
- Fatigue
- Disturbed sleep
- Indecisiveness
- Increased appetite
What other symptoms may you ask Amy about?
- Persistent sadness or low mood
- Loss of interests or please
- Agitation or slowing of movements
- Feelings of worthlessness or inappropriate guilt
- Suicidal thoughts or acts
What is the biopsychosocial model?
suggests that biological, psychological and social factors are all interlinked - mind and body are interlinked
What functions are affectsed in depressed people?
- endocrine (hormone)
- immune
- neurotransmitter system functioning
What factors influence depression?
- characteristic negative patterns of thinking, deficits in coping skills
- judgment problems
- impaired emotional intelligence (the ability to perceive, understand, and express emotions) that depressed people tend to exhibit
What can psychological factors be influenced by?
- biology
- biologically-based personality characteristics
- social factors
What social factors can contribute to someone’s depression?
- experiencing traumatic situations
- early separation
- lack of social support
- harassment (bullying)
What does the NICE guidelines use?
DSM-IV (diagnostic and statistical manual of mental disorders)
What is the criteria for major depressive disorder?
- 1 or more key symptoms
2. 5 or more total symptoms
What are the key symptoms for major depressive disorder?
- Most days, most of the time for at least 2 weeks
1. Persistent sadness or low mood
2. Marked loss of interests or please
What are the associated symptoms?
- Disturbed sleep (decreased or increased compared to usual)
- Decreased or increased appetite and/or weight
- Fatigue or loss of energy
- Agitation or slowing of movements
- Poor concentration or indecisiveness
- Feelings of worthlessness or excessive or inappropriate guilt
- Suicidal thoughts or acts
What is important to know about when asking about risk to yourself?
- Asking about self harm and suicide does not increase the risk of these things happening
- It is our job to explore this sensitivity if anything in the history flags that the patients might be at risk - have a duty to assess risk of harm to self in order to establish how best to support and manage our patients
- Think about risk to others especially in psychosis
True or false: History of self harm is associated with an increased risk of suicide?
True
True or false: Self harm is most common in elderly males?
False
True or false: An overdose of medication should always be considered a suicide attempt rather than an episode of self harm?
False
True or false: Asking about self harm or suicidal thoughts increases the risk of the patient going away and doing these things?
False
True or false: Can involve cutting scratching burning hair pulling?
True
True or false: may take other forms such as punching a wall, banging ones head against a hard object or even getting into fights?
True
True or false: self harm is usually a way of coping with or expressing difficult feelings?
True
True or false: only healthcare professionals that know the patient should explore their risk of self-harm or suicide
false
True or false: parasuicide can only be used to refer to suicide attempt that has failed?
false
True or false: suicide is a fatal act of self harm initiated with the intention of ending one’s own life?
True
What are examples of social factors?
- Culture
- Financial security
- Work/school
- Social support
- Family circumstances
What are examples of psycho factors?
- Coping skills
- Self-esteem
- Attitude/beliefs
- Personality/temperament
What are examples of psycho and social factors?
- Traumatic life events
- Interpersonal relationship
What are biological factors?
- Physical health
- Metabolic disorder
- Genetic vulnerability
- Immune / stress response
- Neurochemistry
What is an example of psycho and biological factors?
- Emotions
- Cognitive factors/IQ
- Sleep
What are example of biological and social factors?
- Diet/lifestyle
- Drug effects
What does the P value do?
decide if we can reject null hypothesis (so no significant effect of ACE score on outcome)
What are the high risk behaviours and morbidity by ACE score categories?
- Binge drinking
- Heavy drinking
- Smoking status-current
- High risk HIV behaviour
- Depression
- Disability caused by poor health
- Use of special equipment because of diability
What is bias?
Systemic error is introduced into a sampling or testing by selecting or encouraging one outcome or answer over others - not deliberate
When is the P value statically significant?
less than 0.05 or including, so reject null hypothesis
What information is important for a patient taking 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 lead to side effects
- Antidepressants interact with many commonly prescribed drugs so it is important to tell doctors that you are taking them
What is Binge drinking?
8U/session
What is heavy drinking?
5x BINGE episodes per week
What is ECT?
used in severe depression in the initial period in conjunction with antidepressants
What is social prescribing?
A means of enabling healthcare professionals to refer people to a range of local non-clinical services
What does social prescribing recognise?
Health is determined by a range of social, economic and environmental factors and seeks to address needs in a holistic way
What is the aim of social prescribing?
Support individuals tot ake greater control of their own health
What is involved in social prescribing?
- Variety of activities which are typically provided by voluntary and community sector organisations
- Many different models for social prescribing, but most involve a link worker or navigator who works with people to access local sources of support
What is CBT?
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
What does CBT combine?
cognitive therapy (examining the things you think) and behaviour therapy (examining the things you do)
What is CBT used to treat?
nxiety, depression, bipolar, OCD or schizophrenia
What have studies shown for social prescribing?
mprovements in areas such as quality of life and emotional wellbeing, mental and general wellbeing, and levels of depression and anxiety
How does social prescribing help the NHS?
lead to a reduction in the use of NHS services - accident and emergency (A&E) attendance, outpatient appointments and inpatient admissions
How do MAOIs work?
- Inhibit monamine oxidase (metabolises serotonin) so not taken back to presynaptic terminal - A, NA, dopamine and serotonin
- Increase number of neurotransmitters to go into synapse
- Increase likelihood to dock onto post synaptic cell
What do TCAs do?
Blocks re-uptake of serotonin and NA, so stays longer in synapse increase chance dock onto post synaptic membrane and cause AP
What are side effects of TCAs?
histamine, (fatigue and sluggish) , toxic at high levels so maybe cardiac arrest if OD - side effect
Why would you use TCAs over SSRIs?
Bipolar with lithium, SSRIs can trigger manic episodes in bipolar
What are SSRIs?
Block reuptake, only block reuptake for serotonin, only specific receptors -effects one monoamine neurotransmitter
Why are SSRIs first choice?
fewer side effect - as most selective in what they act on.
Why are there side effects?
Act everywhere in body so side effects, sleeping problems, weight gain and sexual dysfunction - QoL
What is serotonin syndrome?
if combine SSRIs with the medicine withs serotonin
Why are MAOUs sub par?
MAOIs affect all monoamine neurotransmitters (epinephrine, norephinephrin, serotonin, dopamine), and increase neurotransmitters in body as well as brain, so inhibit process to metabolise medication, so lots of drugs interactions - if can’t metabolise build up and prevent breakdown of certain foods
What are NDRIs and NDRAs?
NDRIS - selective norepinephrine and dopamine reuptake inhibitors
NDRAS: selective norepinephrine and dopamine releasing agents
