Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

psychiatry > Depression > Flashcards

Depression Flashcards

1
Q

what is depression

A

Depression is a condition composing of a number of clinical symptoms

The sufferer usually displays

  • > Depressed Mood
  • > Loss of Interest and enjoyment
  • > Reduced energy leading to increased fatigue and lack of activity

-> A duration of two weeks is required.

There are some other common symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is recurrent depressive disorder

A
  • Repeated episodes of depression
  • With complete recovery in-between
    (“several months”)
  • No evidence of severe elation of mood or hyperactivity
    (because that would make the diagnosis Bipolar Affective Disorder)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

first line med for depression

A

SSRI

At least Moderate Severity (comment about drug effectiveness based on severity)

NNT - 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

which pts should have ECT

A
  • CATATONIA
  • LIFE THREATENING DEPRESSION/DEPRESSIVE STUPOR
  • TREATMENT RESISTANCE
  • PREGNANCY
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is cotard

ass w

A

believes that they (or in some cases just a part of their body) is either dead or non-existent. This delusion is often difficult to treat and can result in significant problems due to patients stopping eating or drinking as they deem it not necessary.

severe depression and psychotic disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

physical disorders that can cause secondary mood disorders

A 
anaemia
hypothyroidism
malignancy
cushing's syndrome
addison's disease
MS
parkinsonism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

psychiatric disorder that cause secondary mood disorders

A

schIzophrenia
alcoholism
dementia
personality disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

drugs that can cause secondary mood disorder

A 
beta-blockers
interferon-alpha
corticosteroids
digoxin
antiepileptic drugs
anitdepressants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

RFs of depression

A 
female 
Family history
Alcohol
Adverse events
Past depression
Physical co-morbidities
LOW
Social support
Socioeconomic status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

core Sx

cognitive Sx

Biological Sx

Psychotic Sx

DEPRESSION

A

CORE

  1. anhedonia - lack of interest
  2. low mood - present for at least two weeks
  3. lack of energy - anergia

COGNITIVE Sx

  1. lack of concentration/attention
  2. negative thoughts
  3. excessive guilt
  4. suicidal ideation
  5. low self-esteem

BIOLOGICAL Sx

  1. Changes in sleep pattern - diurnal variation in the mood
  2. early morning wakening
  3. loss of libido - reduced sexual drive
  4. psychomotor retardation
  5. weight loss and loss of appetitie

PSYCHOTIC Sx

  1. hallucinations auditory > visual (
  2. delusions nihilistic - where they think part of them is not working, persecutory)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ICD-10 classification of depression

A

mild depression = 2 core Sx + 2 other Sx

moderate depression = 2 core Sx + 3-4 other Sx - pt is distressed and cant continue

Severe depression = 3 core Sx +>= >4 other Sx - sig deficits in self-esteem and feelings of worthlessness and/or suicide. CANT FUNCTION

Severe depression w psychosis = 3 core Sx + >= other Sx + psychosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Ix for depression

Diagnostic questionnaires

Imaging

A

Diagnostic questionnaires - PHQ-9, HADS and Beck’s depression inventory

MRI/CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Blood tests for depression

A
  1. FBC - exclude anaemia
  2. TFTs exclude hypothyroidism
  3. U&Es
    - GLUCOSE
    - VIT B12
    FOLATE
  4. calcium levels (biochemical abnormalities may cause physical Sx which can mimic some depressive inventory
  5. glucose (diabetes - anergia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Mx of mild to moderate depression

A

1) watchful waiting - reassess in 2 weeks
2) low intensity psychosocial interventions - sleep hygiene, regular exercise, befriending services

low intensity psychological intervention -> IAPT

-> antidepressants - ONLY FOR 1. long time 2. PMH of moderate-severe depression 3. failure of other interventions

or

  • > High intensity psychological intervention
  • CBT
  • IPT
  • behavioural activation
  • behavioural couples therapy for ppl who have a regular partner
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Mx of moderate sever depression

A

suicide risk assessment - high risk AVOID citalopram, TCAs

1) 1st line SSRIs

OR

  • anxiety may worsen initially
    Tx for a t least 6 months following remission
  • consider toxicity in overdosex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

define bipolar affective disorder

A

chronic episodic mood disorder

- last one episode of mania (or hypomania) and a further episode of mania or depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

genetic
neurochemical
endocrine
environmental

causes of bipolar

A

monozygotic twin studies
strong FH

neurochemical - increased dopamine, increased serotonin

endocrine - increased cortisol, aldestrone, thyroid

environmental - adverse life events, exams, post-partum period, loss of loved one

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

clinical features of depressive bipolar disorder

A 
Depressive Sx
Depressed mood
Energy loss (anergia)
Anhedonia
Death thoughts
Sleep disturbance
Worthlessness or guilt
Appetite
Mentation (concentration) reduced
Psychomotor retardation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ICD-10 criteria for bipolar disorder

A

requires at least two episodes - one of which MUST BE MANIA OR HYPOMANIA

REQUIRES 3/9 Sx to be present

(1) Grandiosity/inflated self esteem
2. decreased sleep
3. pressure of speech
4. flight of ideas
5. distractibility
6. psychomotor agitation
7. reckless behaviour
8. loss of social inhibitions
9. marked sexual energy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Ix for bipolar disorder

A 
blood tests
- FBC 
TFTs - hypo/hyperthyroidism
U&Es - baseline renal function with view to starting lithium
LFTs - baseline hepatic function
glucose
calcium - biochemical distrubances

CT head to rule out SOLs, tumour, infarction, haemorrhage, MS

may show hyperintense subcortical structures (esp. temporal lobes), ventricular enlargement, and sulcal prominence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

general Mx of bipolar disorder

A

full risk assessment - suicidal ideation and risk to self

DVLA

medical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

DVLA rules if they have stable hypomania or mania

A

DO NOT DRIVE
NOTIFY DVLA

  • may be considered if well fro at least 3 MONTHS
  • adheres to Mx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

DVLA rules if they have Unstable hypomania or mania

A

DO NOT DRIVE
NOTIFY DVLA

  • may be considered if well fro at least g MONTHS
  • adheres to Mx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Mx of bipolar depression

A

psychological intervention

  • CBT
  • INTERPERSONAL THERAPY
  • BEHAVIOURAL COUPLES THERAPY
pharm
fluoxetine + olanzapine
OR
Quetiapine
OR
lamotrigine

if already on Li

  • ^ dose
  • fluoxetine and olanzapine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

medical mx for acute manic epsiode

A

FIRST LINE - offer an antipsychotic - olanzapine, risperiodne, quetiapine, haloperidol

SECOND LINE - mood stabilisers - lithium
sodium valporate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

MSE of a bipolar patient

A

Appearance and behaviour – Perhaps flamboyant or revealing clothing, irritability,
psychomotor agitation, over-familiar behaviour.

Speech – pressured speech which is difficult to interrupt, loud speech, copious/excessive
speech.

Mood – May be excessively happy or excitable, or may be irritable and easily angered.

Thoughts – Thought disorder in the form of flight of ideas. May describe racing thoughts,
grandiose thoughts, persecutory beliefs most often related to their own perceived special
status/abilities (e.g. others jealous of them or after their ideas). Thoughts of harm to self or
others may occur secondary to delusional beliefs. Delusional beliefs are usually mood
congruent.

Perceptions – Perceptual abnormalities are less common than in schizophrenic type illnesses
(if psychosis is a predominant feature, the diagnosis of schizoaffective disorder may be
considered).

Insight likely to be diminished

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

caution for prescribing sodium valporate

A

avoided in women of child-bearing age

-> teratogenic
-> birth defects
- spina bifida
- cleft lip/palate,
abnormalities of the limbs/heart/urinary tract and developmental delays
- Higher incidence of Polycystic Ovarian Syndrome (PCOS) which can
affect future fertility

28
Q

what monitoring is required when initiating lithium and continuing lithium

A
  1. U&Es to check eGFR – monitored 3-6 monthly.
    Can lead to reduced
    -> eGFR
    -> CKD
    ass w nephrogenic diabetes insipidus which can lead to thirst and polydipsia.
  2. TFTs – risk of hypothyroidism - monitored 6 monthly.
  3. Weight
  4. ECG – particularly important in those with risk factors for, or pre-existing cardiovascular
    disease – to monitor for ECG changes or arrhythmias.
  5. Lithium levels - When initially started monitoring should be done weekly until concentrations are stable. 12 hours after first dose then weekly therapeutic level (0.8-1.0mmol/L) has been stable for 4 weeks. Once stable every 3 months for a year.

thyroid, renal, CA, weight/BMI - 6 monthly

29
Q

common side effects of Lithium

A 
Lethargy.
Insipidus (diabetes)
Tremor. fine
Hypothyroidism.
Insides (GI upset)
Urine (increased)
Metallic taste.
long term
nephrotoxic - nephrogenic DI
hyper/hypothyroid
hyperpara
renal tumor
rhabdomyolysis
30
Q

minimum effective serum Li level for maintenance

ideal range

A
  1. 4mmol/L
  2. 6-0.8mmol/L

narrow therapeutic range

31
Q

Li toxicity level and the Sx seen

A 
> 1.5mmol/L
EARLY
tremor
anorexia
nausea/vomiting/diarrhoea, dehydration
lethargy.

sever > 2 seizures, syncope, hyperreflexia, dehydration death

Further CNS effects
include drowsiness, muscle weakness/twitching and ataxia. These can progress to marked
disorientation, seizures, coma and death.

32
Q

Apart from pharm Mx other Mx that should be considered in bipolar

A

Psychoeducation programmes – to discuss medication, lifestyle, relapse warning signs. Group
psychoeducation may be considered.

Psychological management such as CBT or family therapy can be recommended if
appropriate.

Ongoing CPN support.

Support with benefits or occupational support if relevant.

33
Q

common SEs of sertraline

A
  • syncope
  • lightheadedness
  • diarrhoea
  • nausea
  • sweating
  • dizziness
  • xerostomia
  • confusion
  • hallucinations
  • tremor
  • somnolence
  • impotence
34
Q

if a pt refuses Mx and wants to commit suicide in a GP setting what do u do

A

Arrange a Mental Health Act assessment as she is refusing treatment. Crisis to work the pt needs to consent to engage in order to make the referral

35
Q

class of venlafaxine

A

SNRI - selective noradrenaline reuptake inhibitor

36
Q

Which section/form would the consultant complete to initiate emergency ECT?

A

Section 62 of the MHA – FORM IS C6. Allows two sessions of emergency ECT. A second opinion approved doctor (SOAD) should be applied for at this time in order to provde the required legal framework for ongoing ECT

37
Q

Possible SEs of ECT

A
  • short memory loss – memory tests should be performed throughout treatment to monitor for significant memory loss
  • headache – analgesia
  • confusion
  • sore muscles – due to seizures, although muscle relaxants are given during the procedure
  • Feeling sick
  • increased heart rate and blood pressure
38
Q

other components of Mx in depression apart from medication

A

Referral for a CPN.
Referral to the outpatient psychiatry clinic.
Referral to the Crisis Team for initial support on discharge – especially whilst awaiting
allocation of a CPN. The crisis team can provide initial more intensive support for the first
week or two after discharge.
Psychological therapies – this may differ from patient to patient. CBT is often recommended
for mood disorder.
Recommend support groups or psychoeducation courses.
Benefits and occupational advice.
Advice on lifestyle measures e.g. the importance of sleep and routine and the risks of
substance use, e.g. alcohol.
Mindfulness.

39
Q

which SSRI is recommended in reduced doses in the elderly

A

citalopram as it is thought to prolong QT interval in which will lead to cardiac arrhythmias

40
Q

what monitoring is done w pts on sodium valoprate

A

LFTs are recommended before and during the firs t 6 months of Mx DUE TO RISKS OF HEPATOTOXICITY

41
Q

Which drugs should not be prescribed with lithium

A

NSAIDs

42
Q

which Mx is NOT an option for treatment resistant depression

A

sodium valporate

43
Q

DDx of depression

A

organic causes - hypothyroidism, delirium

grief reaction

  • bipolar disorder
  • adjustment
  • seasonal affective disorder
  • dementia
  • schizophrenia
44
Q

stopping antidepressants

A

reduce dose frequnecy gradually over 4 weeks

discontinuation Sx
restless, altered feelong, physical Sx

onset few days from treatment cessation

mild, self-limiting

increase risk: increase dose/Tx duration
shorter 1/2 life antidep ie paroxetine

45
Q

serotonin syndrome

A

triggers
SSRI
MAOI
Drugs - stimualnts ie cocaine, ectasy, amphetamines

features
cognitive - headache, agitation, hypomania, confusion, hallucinations, coma
confusion
agitation
muscle twitching
sweating
shivering
diarrhoea

autonomic - increase temp, HR, BP

neurological - hyperreflex, dialted pupils, rigidity
sweating, tremor, myoclonus

Mx
stop offending agent
benzodiazepines (Agitation)
supportive Mx IV fluids

sever cases serotonin antagoni crytpohepatidine

46
Q

Tx for refractory cases

A

augmentation strategies - Li
ECT
light therapy

47
Q

manic episode criteria

A

elevated at least 3 manic Sx, at least 1 week
major impairment functioning
psychotic features

hypomanic - at least 4 days

mixed
1 week hypomania + 3 depression Sx
- 2 weeks depression + 3 (hypo)mania Sx during current/recent episode

48
Q

DDx for bipolar

A
  • thyroid disorders
  • substance misuse
  • ADHD
  • depression
  • cyclothymia
  • iatrogenic causes
  • personality disorders
    anxiety disorders, OCD,
    schizophrenia
49
Q

primary care referral

A

hypomania -> routine referral CMHT
Mania - urgent referral

long term
lithium
sodium
olanzapine

50
Q

adverse effects of Na valporate

A 
GI irritation
weight gain
hair loss
blood disorders (thrombocytopeni, leucopenia)
hepatotoxicity, pancreatitis

NB
P450 inhibitor

51
Q

difference between hypomania and mania

A

presence of psychotic symptoms

hypomania being less than 7-10 days

52
Q

what is dysthymia

A

chronic mildly low mood which lasts at least several years but does not meet criteria for a recurrent depressive disorder

53
Q

what is cyclothymia

A

chronic instability of mood with periods of mild depressive and elation, none of which are sever enough to meet criteria for bipolar/depression

54
Q

what is the classification of mood disorders ICD-10

A 
hypomania
manic episode
bipolar
depressive - mild/moderate/sever
recurrent depressive disorder
recurrent depressive disorder
persisted mood (affective states) - cyclothymia/dysthymia
55
Q

physical Sx of depression

other Sx which may occur as part of the depressive syndrome

A

headaches

  • abdominal pain
  • GI symptoms - constipation, nausea
  • pain
  • chest pains
  • > depersonalisation
  • > obsessions
  • > phobias
  • > conversion syndrome
56
Q

types of typical depressive delusions

A 
delusion of guilt
delusion of hypochondriasis
delusion of poverty
nilhilistic delusion - no future
delusion of persecution
57
Q

what are the variants of depressive disorder

A

agitated depression - common in elderly

retarded depression - psychomotor retardation

depressive stupor - pt is motionless, mute, refuses to eat/drink

atypical depression - characterised by reversed biological Sx iw increased sleep, increased appetite

58
Q

types of SSRI

common SEs

A

fluoxetine, paroxetine, sertraline

nausea
agitation
insomona
sexual dysfunction

59
Q

components of CBT

A

behavioural activation - pts are encouraged to plan and engage in more activites that are enjoyable and satisfying

cognitive retraining - challenge negative thoughts

60
Q

types of psychological Mx

A

CBT

supportive adn problem-solving treatments

interpersonal psychotherapy - improving pts interpersonal functioning

dynamic psychotherapy

61
Q

clinical features of a mania/manic episode

A

-> Elevated mood increased energy
• Over-activity.
• Reduced need for sleep.

-> Formal thought disorder
• Pressured speech.
• Flight of ideas.
• Racing thoughts.

-> increased self-esteem, evident as:
• Over-optimistic ideation.
• Grandiosity.
• Reduced social inhibitions.
• Over-familiarity (which may be overly amorous)
- facetiousness

-> Tendency to engage in behaviour that may have serious
consequences:
• Preoccupation with extravagant, impracticable schemes. • Spending recklessly.
• Inappropriate sexual encounters.

  • > Other behavioural manifestations, including excitement, irritability, aggressiveness, and suspiciousness.
  • > Marked disruption of work, usual social activities, and family life.

mutism
suicidal ideation

62
Q

psychotic Sx of mania

A

• Grandiose ideas may be delusional

• Suspiciousness -> persecutory
delusions.

• Pressured speech

• Flight of ideas, prolixity, and pressured thoughts can result in the
loss of clear associations.

• Irritability and aggression may lead to violent behaviour.

• Preoccupation with thoughts and schemes may lead to self-
neglect, to the point of not eating or drinking, and poor living
conditions.

  • Catatonic features—also termed manic stupor.
  • Total or partial loss of insight.
63
Q

DDx for mania

A
  • Schizophrenia, schizoaffective disorder, delusional disorder, other psychotic disorders.
  • Anxiety disorders/PTSD.
  • Circadian rhythm sleep–wake disorders
  • ADHD/conduct disorder.
  • Alcohol or drug misuse, e.g. stimulants, hallucinogens, opiates.
  • Physical illness, e.g. hyper-/hypothyroidism, Cushing’s syndrome, SLE, MS, head injury, brain tumour, epilepsy, HIV, other encephalopathies, neurosyphilis, Fahr’s disease, WD, and pseudobulbar palsy.
  • Other antidepressant treatment or drug-related causes
64
Q

clinical features of hypomania/hypomanic episode

A
  • > Mildly elevated, expansive, or irritable mood
  • > increased energy and activity.
  • > Marked feelings of well-being, physical, and mental efficiency
  • > self-esteem.
  • > Sociability.
  • > Talkativeness.
  • > Over-familiarity.
  • > increased sex drive.
  • > Reduced need for sleep.
  • > difficulty in focusing on one task alone
65
Q

stopping lithium treatment how are u supposed to do it

A

reduce the dose gradually over at least 4 weeks, and preferably up to 3 months

66
Q

what needs to be measured when starting Na valporate, monitoring and stopping

A

weight
BMI
FBC
LFTs

monitoring -> weight/BMI, LFTs, FBC again after 6 months of Mx and then annually

stopping reduce dose over at least 4 weeks

67
Q

What are the advantages and disadvantages of SSRIs as compared to tricyclic antidepressants (TCAs)?

A

reduced the risk of toxicity in overdose
fewer side effects better tolerated
more effective in treatment of depression with anxiety

disadvantages
in severe illness TCAs are supposed to be better
thoughts of suicide and self harm has increased

psychiatry (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions