Depression and GAD Flashcards
Symptoms of depression
triggered by life events but can happen without any apparent triggers
Low mood Anhedonia, a lack of pleasure in activities Low energy Anxiety and worry Clinginess Irritability Avoiding social situations (e.g. school) Hopelessness about the future Poor sleep, particularly early morning waking Poor appetite or over eating Poor concentration Physical symptoms such as abdominal pain
potential triggers for depression
Potential triggers (e.g. loss of a family member) Home environment Family relationships Relationship with friends Sexual relationships School situations and pressures Bullying Drugs and alcohol History of self harm Thoughts of self harm or suicide Family history Parental depression Parental drug and alcohol use History of abuse or neglect
mild depression management
low associated with a single negative event watchful waiting and advice about healthy habits and healthy diet
follow up in 2 weeks
avoid alcohol and cannabis
NICE CAMHS referral for moderate-severe depression
Full assessment to establish a diagnosis
- Psychological therapy as the first line treatment with cognitive behavioural therapy, non-directive supportive therapy, interpersonal therapy and family therapy
- Fluoxetine is the first line antidepressant in children, starting at 10mg and increasing to a maximum of 20mg
- Sertraline and citalopram are second line antidepressants
When the child responds to medical treatment, it should continue 6 months after remission is achieved - When they do not respond to medical treatment they may require intensive psychological therapy
GAD- Generalised Anxiety Disorder
mental health condition caused by excessive disproportional anxiety and worry that negatively impacts persons everyday activity.
GAD assessment
The GAD-7 anxiety questionnaire can help establish the severity of the diagnosis
Assess for co-morbid mental health problems, such as depression and obsessive compulsive disorder
Assess for environmental triggers and contributors, such as family relationships, friendships, bullies, school pressures, alcohol and drug use
Management GAD
watchful waiting, self help strategies (meditation, diet)
avoid alcohol, caffeine drugs
moderate- severe
- counselling
- CBT
- SSRI/bisoprolol?
physiological reactions to anxiety
Decreased blood flow to gut Smooth muscle contraction in the gut Increased blood flow to skeletal muscle Increased muscle tension Pupil dilatation Nausea Increased HR Increased BP
GAD six key features
diagnosis (at least 3)
Restlessness Fatigue Irritability Poor concentration Sleep disturbance Muscle tension
impact on daily functioning
treatment of GAD
pscyhoeducation avoid exacerbating lifestyle factors (caffeine, nicotine) regular exercise stress reduction techniques CBT pharmacological
pharmacological therapy for anxiety
anxiolytics
SSRI
- Propanolol (useful for situational anxiety to control physiological symptoms) (public speaking)
- benzodiazepines (increases the amount of GABA released) diazepam, lorazepam. short term use.
