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Year 3 Exam 2 > Depression + Anxiety clinical > Flashcards

Depression + Anxiety clinical Flashcards

1
Q

Is depression higher in men or women?

A

Women

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2
Q

What are the risk factors of depression?

A
  • Genetics
  • Anxiety
  • Gender
  • Lack of parental care or childhood sexual abuse
  • Social adversity, stress and the persons reaction to it
  • Physical illness (kidney disease and diabetes give a 5 times higher risk)
  • Poor sleep and chronic insomnia
  • Vitamin D deficiency
  • Quitting smoking
  • Drugs
  • Mother having postnatal depression
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3
Q

What are the risks to the individual for untreated depression?

A
  • Increase in risky behaviour such as drug or alcohol abuse
  • Cognitive impairment, including poor interactions with friends, family, colleagues etc…
  • Poor work
  • Poor sleep and it’s consequences
  • Suicidal ideation or suicidal acts
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4
Q

What are the risk factors for recurrent depression?

A
  • History of frequent and/or multiple episodes
  • Onset after the age of 60
  • Long duration of individual episodes
  • Family history of affective disorder
  • Poor symptom control during continuation therapy
  • Co-morbid anxiety disorder or substance abuse
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5
Q

What drugs/substances can induce depression?

A
  • Alcohol
  • Steroids (e.g. dexamethasone)
  • Benzodiazepines (e.g. diazepam, lorazepam)
  • Antipsychotics
  • Anticonvulsants (e.g. carbamazepine, pregabalin)
  • NSAIDs
  • Cardiovascular drugs (e.g. beta-blockers, CCBs)
  • Caffeine/caffeine withdrawal
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6
Q

What are the emotional symptoms of depression?

A
  • Sadness
  • Anxiety
  • Irritability
  • Lack of enjoyment
  • Suicidal ideation
  • Hopelessness
  • Inappropriate guilt
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7
Q

What are the physical symptoms of depression?

A
  • Fatigue
  • Eating/weight changes
  • Joint, abdominal and other pains
  • Insomnia/hypersomnia
  • Sexual dysfunction
  • Headaches
  • Psychomotor agitation
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8
Q

What are the cognitive symptoms of depression?

A

Difficulties with:
- Attention and concentration
- Short and long term memory
- Decision making
- Planning and organisation
- Mental sharpness
- Word-finding
- Thinking speed
- Judgement

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9
Q

What is sub-threshold depression?

A

Where the person has a few symptoms and feels low, but can still function.

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10
Q

What is mild depression?

A

Where the person has enough symptoms for a diagnosis but can function reasonably well.

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11
Q

What is moderate depression?

A

Where the person has a range of symptoms and is not coping well.

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12
Q

What is severe depression?

A

Where the person has a full set of symptoms, can’t function and may even suffer psychotic symptoms too.

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13
Q

What is complex depression?

A

Where symptoms have failed to improve with treatment and may have psychosis and/or other symptoms and problems.

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14
Q

What are possible differential diagnosis for depression?

A
  • Bipolar depression
  • GAD
  • Drug- induced depression
  • Schizophrenia
  • ADHD
  • Substance misuse
  • Personality disorders
  • Normal bereavement
  • Physical illness
  • Dementia
  • Panic disorder
  • Seasonal affective disorder
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15
Q

What are the 7 more common depression co-morbidities?

A
  • GAD
  • Psychosis
  • Insomnia
  • OCD
  • PTSD
  • Panic disorder
  • Dementia
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16
Q

What are the low intensity non-pharmacological treatments for depression?

A
  • Guided self-help
  • Being active
  • Computer based CBT
17
Q

What are the high intensity non-pharmacological treatments for mild, moderate and severe depression?

A
  • Psychological therapies e.g. CBT, interpersonal therapies etc…
  • General support and advice e.g. on financial matters to reduce stress
18
Q

What are the high intensity non-pharmacological treatments for severe and complex depression?

A
  • ECT (electroconvulsive therapy)
  • TMS (transcranial magnetic stimulation)
19
Q

What are the three standard first line anti-depressants?

A

Citalopram, fluoxetine, sertraline

20
Q

What time of the day should SSRIs be taken?

A

In the morning.

21
Q

What time of day should mirtazapine be taken?

A

At night.

22
Q

Roughly how long can it take for anti-depressants to work?

A

2-6 weeks

23
Q

When switching from an ineffective SSRI, what should be tried?

A

Another SSRI or a better tolerated newer- generation anti-depressant.

24
Q

What are the symptoms of serotonin syndrome?

A
  • Restlessness
  • Myoclonus
  • Tremor and rigidity
  • Hyperreflexia
  • Shivering/elevated temperature
  • Arrhythmias
25
Q

What causes serotonin syndrome?

A

It can occur when a combination of serotonergic drugs e.g. SSRI, SNRI, Tramadol, Triptans

26
Q

What is serotonin syndrome?

A

A potentially life-threatening drug-induced condition caused by too much serotonin in the synapses of the brain.

27
Q

What are the discontinuation symptoms from sudden stopping of SSRIs?

A
  • Dizziness, light-headedness
  • Sleep disturbances
  • Electric shocks in the head
  • Nausea
  • Fatigue
  • Headache
  • Flu like symptoms
28
Q

What are the discontinuation symptoms from sudden stopping of SNRIs?

A
  • Dizziness, light-headedness
  • Sleep disturbances
  • Electric shocks in the head
  • Nausea
  • Fatigue
  • Headache
  • Flu like symptoms
  • Restlessness
  • Abdominal distension
  • Congested sinuses
29
Q

What is the interaction between warfarin and SSRIs?

A

SSRIs significantly raise INR

30
Q

What effect does smoking have on duloxetine levels?

A

It decreases them.

31
Q

What is the NICE recommended first line anti-depressant for children and teenagers?

A

Fluoxetine

32
Q

Can citalopram be used in under 18 year olds?

A

No

33
Q

Paroxetine in pregnancy?

A

Paroxetine is best avoided in pregnancy.

34
Q

What are the risks of using SSRIs in the elderly?

A
  • Increased the risks of bleeds
  • Increased risk of hyponatraemia
  • Postural hypotension
35
Q

What type of anti-depressant is typically recommended in cardiac disease?

A

SSRIs but mirtazapine may be a suitable alternative

36
Q

What is the anti-depressant of choice post MI?

A

Sertraline

37
Q

Which two anti-depressants are contraindicated in patients with prolonged QT?

A

Citalopram and escitalopram

Year 3 Exam 2 (19 decks)

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