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Mental Health > Depression and suicide > Flashcards

Depression and suicide Flashcards

1
Q

What is the DSM- IV critera for major depression?

A

At least five of the following symptoms for 2 weeks

  • pervasive depressed mood
  • marked loss of pleasure or interest
  • significant appetite or weight change
  • insomnia or hypersomnia
  • psychomotor agitation or retardation
  • fatigue/ loss of energy nearly every day
  • feelings of worthlessness or excessive guilt
  • impaired thinking or concentration; indecisiveness
  • suicidal thoughts/ thoughts of death or suicide
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2
Q

What is the DSM- IV critera for minor depression?

A

At least two to four of the following symptoms for 2 weeks (including one and two)

  • pervasive depressed mood
  • marked loss of pleasure or interest
  • significant appetite or weight change
  • insomnia or hypersomnia
  • psychomotor agitation or retardation
  • fatigue/ loss of energy nearly every day
  • feelings of worthlessness or excessive guilt
  • impaired thinking or concentration; indecisiveness
  • suicidal thoughts/ thoughts of death or suicide
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3
Q

What are some adverse effects of SSRIs eg fluoxetine?

A
  • Common: nausea, nervousness, fatigue agitation, diarrhoea, headaches, nervousness
  • Possible: sexual dysfunction (mainly ejaculatory), hypomania (in some people with bipolar)
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4
Q

What are some adverse effects of tricyclic antidepressants eg amitryptyline?

A
  • dry mouth, weight gain, constipation, sedation, glaucoma, urinary retention, tremor, confusion/ delirium in the elderly, sexual dysfunction, postural hypotension, cardiac conduction impairment, lowered seizure threshhold
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5
Q

What are some adverse effects of tetracyclic antidepressants eh mianserin?

A
  • sedation, lethargy, dizziness, polyathritis, dry mouth, headache
  • uncommonly reversible neutropaenia
  • fewer anticholinergic and cardiovascular side effects than tricyclics
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6
Q

What are some adverse effects of Monoamine Oxidase Inhibitors eg moclobemide?

A
  • significant hypotension when combined with various foods

- nausea, headache, agitation, dizziness, insomnia

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7
Q

What are some adverse effects of SNRIs eg venlafaxine?

A
  • nausea, dizziness, headache, sweating, insomnia and sexual dysfunction
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8
Q

What are some adverse effects of serotonin modulating antidepressants eg mirtazapine?

A
  • somnolence, increased appetite, weight gain
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9
Q

What are some adverse effects of noradrenaline reuptake inhibitors eg reboxetine?

A
  • dry mouth, sweating, headache, impotence, insomnia, urinary retention, constipation
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10
Q

What agents should be used first line in depression?

A

SSRIs

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11
Q

Are combinations of antidepressants more effective than monotherapy?

A

no

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12
Q

How long should antidepressant treatment continue in a first episode of depression?

A

6-9 months

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13
Q

How long should antidepressant treatment continue in a second episode of depression?

A

3 to 5 years

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14
Q

What are the symptoms of serotonin syndrome?

A

At least 3 of the following:

  • mental status/ behaviour changes (eg agitation, confusion)
  • altered muscle tone (eg tremor, shivering, myoclonus, hyperreflexia)
  • autonomic instability (eg hyper/hypotension, tachycardia, fever, diarrhoea)
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15
Q

What are some risk factors for suicide?

A
  • Male
  • age 45
  • major depression
  • previous suicide attempts
  • ethanol or other drug use
  • loss of rationality (psychosis, severe depression)
  • single
  • organised suicide plan
  • socially isolated
  • chronic illness
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16
Q

What is the rule of 7 re suicide?

A
  • 1 in 7 people with depression suicide
  • 70% of suicides have depression
  • 70% of patients who suicide hve seen a GP in the last 7 weeks
  • suicide is the 7th leading cause of death
17
Q

If there is concern about risk of suicide then medication should be supervised and drugs that are less toxic in overdose should be prescribed. What are 2 examples of antidepressants that are less toxic in overdose?

A
  • fluoxetine

- mianserin

18
Q

When should depressed patients be referred?

A
  • uncertainty about diagnosis
  • inpatient care necessary
  • severe depression
  • inability to cope at home
  • psychotically depressed (with delusions or hallucinations)
  • substantial suicide risk
  • failure of response to routine antidepressant therapy
  • associated psychiatric or physical disorders
  • difficult problem in the elderly where diagnosis including dementia is doubtful
  • children with apparent major depression

Mental Health (10 decks)

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