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PA40256 > Depression and insomnia > Flashcards

Depression and insomnia Flashcards

1
Q

What is mild depression?

A

Four symptoms

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2
Q

What is moderate depression?

A

Five to six symptoms

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3
Q

What is severe depression?

A

Seven or more symptoms with or without psychotic symptoms

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4
Q

How long should symptoms be present for in order to diagnose depression?

A

A month or more and every symptom should be present for most of every day

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5
Q

What are the two questions you should ask someone if you think they could be depressed?

A

During the last month, have you often been bothered by feeling down, depressed or hopeless?
During the last month, have you often been bothered by having little interest or pleasure in doing things?

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6
Q

Diagnosis of depression is performed using what?

A

ICD-10

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7
Q

What are the key symptoms of depression (ICD-10(?

A

Persistent sadness or low mood
Loss of interest and pleasure
Fatigue or low energy

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8
Q

What are the associated symptoms with depression?

A 
Disturbed sleep
Poor concentration and indecisiveness
Low self confidence
Poor or increased appetite
Suicidal thoughts or acts
Agitation or slowing of movement
Guilt or self blame
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9
Q

What are the symptoms reported by at least 90% of people with depression?

A 
Less enjoyment from usual activities
Hopelessness
Disappointment with self
Irritability
Difficulty sleeping
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10
Q

How many hours of sleep should a 15 year old have?

A

8 hours

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11
Q

How many hours of sleep should a 20 year old have?

A

7.5 hours

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12
Q

How many hours of sleep should a 40 year old have?

A

6.8 hours

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13
Q

How many hours of sleep should a 60 year old have?

A

6.3 hours

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14
Q

How many hours of sleep should a 80 year old have?

A

5.8 hours

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15
Q

How many weeks is short term insomnia?

A

Less than 4 weeks

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16
Q

How many weeks is long term insomnia?

A

More than 4 weeks

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17
Q

How long should you avoid caffeine, nicotine, and alcohol before going to bed? (to help with sleep)

A

6 hours

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18
Q

How long before bed should you avoid exercise for?

A

4 hours

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19
Q

What is the maximum length of time to treat short term insomnia pharmacologically?

A

3 weeks

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20
Q

What is preferred for insomnia treatment, short acting benzodiazepines or zopiclone?

A

There is no firm evidence of differences between the two

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21
Q

What is recommended for the long-term management of insomnia?

A

Pharmacological therapy is generally not recommended.

Referral to a specialist would be needed.

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22
Q

When should pharmacological treatment be used to treat depression?

A

For moderate or severe depression or mild with previous moderate/severe episode

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23
Q

What drug class is used first line to treat depression?

A

SSRIs

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24
Q

Which SSRIs should be considered first line to treat depression?

A

Sertraline and escitalopram

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25
Q

Which SSRI has a QT prolongation warning?

A

Escitalopram

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26
Q

What drug class is sertraline?

A

SSRI

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27
Q

What drug class is escitalopram?

A

SSRI

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28
Q

What drug class is Citalopram?

A

SSRI

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29
Q

What drug class is Fluoxetine?

A

SSRI

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30
Q

What drug class is Paroxetine?

A

SSRI

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31
Q

What antidepressant may be an option if sedation is desired or where hyponatraemia or an increased bleeding risk is a concern?

A

Mirtazepine

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32
Q

When should patients receiving pharmacological treatment for short term insomnia be reviewed?

A

after 2 weeks of treatment

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33
Q

When should people on mirtazapine be assessed for response?

A

4 weeks for adults or 6 weeks for over 65 year olds

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34
Q

For people who are not considered to be at increased risk of suicide, when should they normally be reviewed for their depression treatment?

A

2 weeks

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35
Q

For people who are younger than 30 years, when should you normally review them for their depression treatment?

A

1 week

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36
Q

What adverse effects should you monitor for when SSRIs are prescribed?

A

GI upset
Bleeding
Hyponatraemia

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37
Q

What period of time should an antidepressant be stopped over?

A

4 weeks

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38
Q

Does paroxetine have a long or short half life?

A

Short

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39
Q

Does fluoxetine have a long or short half life?

A

Long

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40
Q

How long should antidepressants be continued if it is the patients first episode?

A

6 months

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41
Q

How long should antidepressants be continued if it is the patient’s second episode?

A

2-3 years

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42
Q

How long should antidepressants be continued if it is the patient’s 3rd episode?

A

5 years

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43
Q

How long should antidepressants be continued if is it the person’s 4th or more episode?

A

Lifelong

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44
Q

What is transient insomnia?

A

Lasts a few days and is usually a result of a stressful situation

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45
Q

What is short term insomnia?

A

Lasts 1-4 weeks. Typically due to emotional trauma or physical illness

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46
Q

What is chronic insomnia?

A

Lasts more than one month

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47
Q

Benzodiazepine withdrawal syndrome can occur up to how long after discontinuation?

A

3 weeks

48
Q

What are the predominant signs and symptoms of benzodiazepine withdrawal symptom?

A 
Insomnia
Anxiety
Loss of appetite and body weight
Tremor
Perspiration
Tinnitus
Perceptual disturnaces
49
Q

What are the common side effects of benzodiazepines?

A

Drowsiness, light headedness, confusion, ataxia and amnesia

50
Q

What may be useful for people who fall asleep easily but then wake up in the early hours and find it difficult to fall back asleep?

A

Zaleplon

51
Q

Are TCAs licensed for use as hypnotics?

A

No

52
Q

Are sedative anthistamines licensed for short term use as hypnotics?

A

Yes

53
Q

What are the three ‘Z’ drugs?

A

Zaleplon
Zolpidem
Zopiclone

54
Q

If a person does not respond to one hypnotic drug, should another be prescribed?

A

No they should not be prescribed any of the others

55
Q

The prevalance of insomnia is higher in who?

A

Women

Older people

56
Q

What are the 6 hypnotics the BNF lists?

A 
Nitrazepam
Flunitrazepam
Flurazepam
Loprazolam
Lormetazepam
Temazepam
57
Q

Which two hypnotics are blacklisted and cannot be prescribed on the NHS?

A

Flunitrazepam

Flurazepam

58
Q

What two benzodiazepines are licensed for insomnia and anxiety?

A

diazepam

lorazepam

59
Q

Which 4 benzodiazepines have a shorter duration of action?

A

Loprazolam
Lorazepam
Lormetazepam
Temazepam

60
Q

Which benzodiazepines have a longer elimination half life?

A

Diazepam

Nitrazepam

61
Q

Which benzodiazepine is associated with a greater risk of withdrawal symptoms?

A

Lorazepam

62
Q

What is the elimination half life of zaleplon?

A

1 hour

63
Q

What is the elimination half life of zolpidem?

A

2.5 hours

64
Q

What is the elimination half life of zopiclone?

A

3.5-6.5 hours

65
Q

What are the recommended pharmacological treatments of insomnia?

A

Short acting benzos: temazepam, loprazolam, lormetazepam

Non-benzos: Zopiclone, Zolpidem and Zaleplon

66
Q

When is diazepam useful?

A

If insomnia is associated with daytime anxiety

67
Q

Why are diazepam, nitrazepam and flurazepam generally not recommended for insomnia?

A

Their long half lives commonly gives rise to next day residual effects

68
Q

NICE guidelines on depression use which criteria for diagnosis of depression?

A

DSM-4

69
Q

According to DSM-4, which are the core features that should be present for depression to be considered?

A

A low or depressed mood

Loss of interest or pleasure in activities that the person would otherwise enjoy (anhedonia)

70
Q

For a diagnosis of depression to be made against DSM-4 criteria, how many symptoms must have been present during the same two week period?

A

Five or more

71
Q

According to DSM-4, how many symptoms are present for mild depression?

A

Few (if any) in excess of the five required to make the diagnosis

72
Q

According to DSM-4, how many symptoms are present for severe depression?

A

Most symptoms should feature

73
Q

When can antidepressants be used in people with mild depression?

A

When there is a previous history of moderate or severe depression.
Subthreshold symptoms have been present for 2 years.
Other interventions have been tried and have not been successful.

74
Q

Why are SSRIs the mainstay of antidepressant treatment?

A

Because of their relatively tolerable side effect profile and safety in overdose compared with other antidepressant classes

75
Q

What age range are most likely to be at risk of suicide in the first few weeks of antidepressant treatment?

A

adolescents- 25 years

76
Q

How long should antidepressants be taken for before considering their full efficacy?

A

at least 4 weeks

77
Q

Discontinuation symptoms usually occur within how many days of stopping antidepressants?

A

5 days

78
Q

Which SSRI has an association with QT-interval prolongation?

A

Citalopram

79
Q

Which is considered an antidepressant of choice in those with diabetes?

A

Fluoxetine

80
Q

What are the side effects of fluoxetine?

A

Tremor, nausea, sweating and anxiety

81
Q

Why might SSRIs increase bleeding times?

A

They cause decreased platelet activation

82
Q

What antidepressant should be considered in people at risk of GI bleeding?

A

Mirtazapine

83
Q

Which SSRIs are considered to have the lowest propensity for interaction via CYP450?

A

Citalopram

Sertraline

84
Q

What medicines commonly cause or exacerbate depression?

A

Methyldopa, corticosteroids, benzodiazepines. levodopa, some anticonvulsants. isotretinoin, CCBs-nifedpine, lipophilic beta blockers- propranolol

85
Q

Which antidepressant class are less dangerous if taken in overdose?

A

SSRIs

86
Q

What should be avoided if taking MAOIs?

A

Tyramine containing foods

87
Q

What are common SEs of TCAs?

A

antimuscarinic
histaminergic
cardiovascular

88
Q

After how many weeks could a change to another antidepressant be warranted?

A

6 weeks

89
Q

How many symptoms must be present for mild depression according to ICD-10?

A

4 and 2 must be key symptoms

90
Q

How many symptoms must be present for moderate depression according to ICD-10?

A

6 but 2 must be key

91
Q

How many symptoms must be present for severe depression according to ICD-10?

A

8 but at least 3 must be key

92
Q

What are they key symptoms of depression according to ICD-10?

A

depressed mood
anhedonia
lack of energy

93
Q

What was the SAD Personas scale developed for?

A

Identify people at risk of suicide

94
Q

What does SAD PERSONAS stand for?

A 
Sex
Age
Depression
Previous attempt
Ethanol abuse
Rational thought loss
Social supports lacking
Organised plan
No spouse
Access to lethal means
Sickness
95
Q

What drug class is amitriptyline?

A

TCA

96
Q

What drug class is dosulepin?

A

TCA

97
Q

What drug class is lofepramine?

A

TCA

98
Q

What are TCAs contra-indicated in?

A

Recent MI, arrhythmias, manic phase of bipolar disorder

99
Q

When should TCAs be taken and why?

A

Bedtime because they have sedative properties

100
Q

Which two TCAs have the least sedative profile?

A

Lofepramine

Nortriptyline

101
Q

When should SSRIs be taken?

A

With or after food

102
Q

Which are considered safer in overdose, TCAs or SSRIs?

A

SSRIs

103
Q

What drug class is Moclobemide under?

A

Reversible inhibitor of monoamine oxidase type a

104
Q

What drug class are venlafaxine and duloxetine?

A

serotonin and norepinephrine reuptake inhibitors

105
Q

At low doses (75mg) what does venlafaxine mainly act on?

A

5-HT receptor

106
Q

At medium doses (150mg) what does venlafaxine mainly act on?

A

NE reuptake

107
Q

What are SNRIs contra-indicated in?

A

Patients with conditions associated with high risk of cardiac arrhythmia and uncontrolled hypertension

108
Q

What drug class is mirtazepine?

A

Norepinephrine and specific serotonin antidepressant (NASSA)

109
Q

What drug class is mirtazapine?

A

Norepinephrine reuptake inhibitor

110
Q

How is SSRI treated?

A

Discontinuation of the SSRI, IV fluids, cyproheptadine, activiated charcoal, benzodiazepines

111
Q

SSRIs should not be taken with NSAIDs, true or false?

A

True

112
Q

What are the 3 depression questionnaires used in primary care?

A

PHQ-9
HADS
BDI-II

113
Q

Section 2 of the mental health act allows compulsory admission for how long?

A

28 days

114
Q

Section 3 of the mental health act allows compulsory admission for how long?

A

6 months

115
Q

Section 4 of the mental health act allows compulsory admission for how long?

A

72 hours

116
Q

Are SSRIs sedating or do they have more of a stimulant effect?

A

Stimulant

PA40256 (10 decks)

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