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Psychiatry Key Information > Depression > Flashcards

Depression Flashcards

1
Q

ICD-10 mood disorders

A
  1. mania
  2. bipolar disorder
  3. depressive disorder
  4. dysthymia
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2
Q

classification of depression

A

mild
moderate
severe with or without psychotic symptoms

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3
Q

criteria for depression

A

at least 2 weeks
no hypomanic or mania symptoms at any time during the patients life
Core features
additional features

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4
Q

Core features of depression

A

depressed mood
loss of enjoyment in everyday activities
decreased energy

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5
Q

additional features of depression

A 
loss of confidence
guilt
suicidal behaviour
diminished concentration
psychomotor retardation
sleep disturbance
weight change
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6
Q

moderate depression score

A

2 core + 4 additional = 6 total

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7
Q

severe depression score

A

3 core + 5 others = 8 total

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8
Q

sub-types of depression

A

somatic syndrome
atypical depression
psychotic depression
chronic depression

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9
Q

how long does depression last to be chronic?

A

beyond 2 years

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10
Q

what is somatic syndrome?

A 
loss of pleasure
lack of emotion
waking 2 hours earlier
depression worse in the morning
appetite and weight change
loss of libido
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11
Q

atypical depression

A

weight gain and increase in appetite
hypersomnia
leaden paralysis
interpersonal rejection

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12
Q

psychotic depression

A

paranoia

Cotard’s syndrome

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13
Q

pharmacological class options for depression treatment

A

monoamine oxidase inhibitors
monoamine reuptake inhibitors
atypical drugs

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14
Q

examples of monoamine oxidase inhibitors

A

phenelzine (irreversible)

moclobemide (reversible)

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15
Q

action of monoamine oxidase inhibitors

A

inhibit MAO-A and B

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16
Q

adverse of monoamine oxidase inhibitors

A 
cheese reaction/ hypertensive crisis
potentiates other drugs e.g. barbiturates
insomnia
postural hypotension
peripheral oedema
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17
Q

what causes the hypertensive crisis in MAO inhibitors?

A

inhibition of MAO-A in the gut and liver prevent breakdown of dietary tyramine (diet restriction needed- cheese)

18
Q

classes of monoamine reuptake inhibitors

A

tricyclics
selective serotonin reuptake inhibitors (SSRIs)
serotonin norepinephrine reuptake inhibitors (SNRIs)

19
Q

examples of tricyclics

A

imipramine
dosulepin
amitriptyline
lofepramine

20
Q

action of tricyclics

A

block reuptake of monoamines (mainly 5-HT and NA)

21
Q

side effects of tricyclics

A

anticholinergic
sedation
weight gain
cardiovascular

22
Q

anticholinergic side effects

A

blurred vision
dry mouth
constipation
urinary retention

23
Q

cardiovascular side effects in tricyclics

A

postural hypotension
tachycardia
arrhythmias
cardiotoxic in overdose

24
Q

examples of SSRIs

A 
fluoxetine
citalopram
escitalopram
sertraline
paroxetine
25
Q

action of SSRIs

A

block 5-HT (serotonin) reuptake

26
Q

side effects of SSRIs

A

nausea
headache
anxiety
transient increase in suicide ideation in <25s

27
Q

examples of SNRIs

A

venlafaxine

duloxetine

28
Q

action of SNRIs

A

block reuptake of 5-HT and NA

29
Q

where do atypical drugs work?

A

post-synaptically

30
Q

examples of atypical drugs

A

mirtazapine

bupropion

31
Q

action of mirtazapine

A

blocks alpha2, 5-HT2 and 5-HT3

32
Q

side effects of mirtazapine

A

weight gain
sedation
(good for insomnia and weight loss)

33
Q

action of bupropion

A

dopamine uptake inhibitor

34
Q

onset of action of antidepressants

A

delayed onset so need to wait several weeks before see improvement

35
Q

tools to monitor effectiveness of antidepressants

A

IDS-30-SR
QIDS
HADS
MADRS

36
Q

what is refractory depression?

A

failure to respond to 2 different drugs

37
Q

prescribing pathway in depression

A

SSRI > SNRI or mirtazapine > TCA > MAOI

38
Q

non-pharmacological management of depression

A

group IPT/ CBT

individual CBT

39
Q

relapse prevention for first epsiode

A

continue antidepressant for at least 6 months after full recovery

40
Q

relapse prevention for second episode

A

continue for at least a year, some need lifelong therapy

Psychiatry Key Information (34 decks)

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