Depression and Medical Illness Flashcards
What is the lifetime prevalence of any mental illness in Aus?
45%
What is the depression rate in general hospital admissions vs. community prevalence?
6-15% in general hospital admissions
2-5% in community
Is depression or anxiety more common in the GP setting? Which is more common in the community?
Depression (5-10%)
Anxiety more common in the community (14% vs 4% depression)
List 4 important diagnostic features of major depression
Lowering of mood is persistent
Interferes with function
And/or leads to substantial distress
At least 2 weeks lowered mood for most of the day on most days
3 main symptoms of major depression
Depressed mood
Anhedonia
Fatiguability
Describe the melancholic features of major depression
Anhedonia Worse in morning Early morning wakening (for 2 hours or more) Psychomotor retardation/agitation Significant weight loss/anorexia Excessive guilt Distinct quality to depressed mood
Important aspects when assessing for possible suicidal ideation
Presence/absence of suicidal ideation
Intention to pursue
Specific plans?
Any similar previous episodes
List 9 important questions to ask to elicit the symptoms of major depression. How do you assess the patient’s answers?
Energy Loss of interest Loss of confidence Hopelessness IF YES TO ANY GO ON TO: Concentration Loss of weight (and appetite) Early waking Feeling "slowed up" Feeling worse in the morning (1 point for each +ive answer; score >3 suggests MDD)
What aspect of the history is most predictive of a suicide attempt?
Sense of hopelessness (also worthlessness, helplessness, excessive guilt)
What are the 8 important features of MSE?
Appearance Behaviour and attitude to interview Speech and language Mood and affect Thought process and thought content Perception Cognition Insight
What is the relationship between MDD and CVD?
Independent risk factor equivalent to smoking, hyperlipidaemia or hypertension
How does major depression impact on CV health?
Alters the HPA axis, notably cortisol
Increases platelet aggregation
Increases HR variability
List 5 more reliable indicators of a clinical depressive state in medically ill pts
Cognitive symptoms including:
Depressed mood
Anhedonia
Feelings of worthlessness and guilt
Decreased concentration or ability to think clearly
Recurrent thoughts of death (not just fear of dying), suicidal ideas or plans
List 11 medical conditions associated with symptoms of depression
Stroke PD Hypothyroidism Hypomagnesaemia Cushing's syndrome Addison's disease Hypocalcaemia Viral infections Delirium in apathetic form Dementias Vitamin B deficiencies
List 4 cognitive symptoms of anxiety
Fear
Embarrassment
Doubt
Sense of impending doom
List 4 physical symptoms of anxiety
Tachycardia
Tachypnoea
Tremor
Sweating
What is the main behavioural symptom of anxiety?
Avoidance
What does the Yerkes-Dodson curve illustrate?
The relationship between arousal and performance (some anxiety enhances performance, too much impairs performance)
What are the 2 main diagnostic factors for an anxiety disorder?
Disproportionate intensity and/or duration of anxiety
Significant distress and/or functional impairment
List some somatic symptoms of pathological anxiety
Dizziness or light-headedness
Tachycardia
Sweating
Hyperreflexia
HTN
Palpitations
Pupillary mydriasis
Restlessness
Tingling the extremities
Tremors
Upset stomach ("butterflies")
Diarrhoea
Urinary frequency, hesitancy, urgencyWhat are the 9 key questions to ask in suspected GAD?
Felt keyed-up and on edge
Worrying a lot
Irritability
Difficulty relaxing
IF YES TO ANY 2, GO ON TO:
Poor sleep
Headaches, neckaches or tightness in the head
Dizziness, trembling, sweating, diarrhoea, etc
Worry about health
Difficulty falling asleep
1 point for each +ive answer, anxiety states usually score at least 5
What is the annual prevalence of mental illness?
1 in 5
Give examples of abnormal laboratory findings associated with MDD in the research setting
Dexamethasone non-suppression
Elevated cortisol
Alterations in sleep EEG profiles (tyramine challenge tests)
Asymmetry on dichotic listening tests
Outline the DSM-IV criteria for major depressive episode
At least 5 of the following symptoms (must include either 1 or 2), present on most days for most of the day over at least 2 weeks:
1. Depressed mood
2. Ahedonia
3. Significant weight/appetite loss or gain
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feeling worthless or excessively guilty
8. Diminished concentration or ability to think clearly
9. Recurrent thoughts of death (not just fear of dying), suicidal ideas or plans
Symptoms associated with distress or impaired function
