Depression Hx

Question 1

What should you be careful of when taking a depression history

Answer 1

• Use the patient’s own language when describing their feelings and use this to get them to expand on their presenting symptoms. Repeating parts of phrases can help develop the consultation and show the patient you are listening and trying to understand.
• Be careful with your “active listening” fillers – nodding and making affirmative noises to show engagement may be more appropriate than saying “Okay…”, however, be careful not to accidentally re-affirm some of the patient’s negative beliefs about themselves or their situation.
• Don’t be afraid to (sensitively) ask about suicide risk. Screening for risk and asking about suicide does not increase the likelihood of a patient attempting it!

Question 2

How do you open the consultation in a depression hx (4)

Answer 2

Wash your hands and don PPE if appropriate.

Introduce yourself to the patient including your name and role.

Confirm the patient’s name and date of birth.

Ask the patient if they’d be happy to talk with you about their current issues.

Question 3

How do you begin taking the depression history after opening

Answer 3

Open question about presenting complaint + golden minute
Then Screen for depression

Question 4

Who should be screened for depression

Answer 4

Depression should be screened for in at-risk individuals (e.g. those with a past history of depression or a chronic health problem with secondary functional impairment).

Question 5

How do you screen for depression

Answer 5

NICE guidelines recommend the questions below to briefly screen for depression.

“During the past month have you…”

“Felt low, depressed or hopeless?”
“Had little interest or pleasure in doing things?”

If there is an affirmative answer to either of these questions, further evaluation should be performed. It should be noted that a negative response to the questions does not exclude depression.

Question 6

What are the key types of symptoms you should explore in a depression hx?

3 categories with 4 subtypes in one and 2 in another

Answer 6

Biological (sleep, low mood, appetite, libido)
Cognitive (reduced concentration, negative perception of self, future and the world)
Suicide risk

Question 7

How do you assess sleep cycle disruption in depression (3 questions)

Answer 7

Questions useful for exploring sleep disruption include:

“How has your sleeping pattern been recently?”
“Have you had any difficulties with getting to sleep?”
“Do you find you wake up early, and find it difficult to get back to sleep?”

Question 8

How do you screen for low mood?

4 questions

Answer 8

Patients with depression typically experience persistent sadness/low mood on most days.

Explore the patient’s recent mood:

“How has your mood been recently?”
“How often have you felt sad recently?”
“Are there any particular times of day that you notice your mood is worse?”
“Does your mood vary throughout the day?”

Question 9

How do you assess appetite changes in depression

Answer 9

The appetite of patients with depression can be significantly altered:

“Have you noticed a change in your appetite?”
“What is your diet like at the moment?”
“What are you eating on a typical day?”

Question 10

How can you ask about altered libido

Answer 10

Patients with depression often experience reduced libido:

“Have you noticed a change in your libido recently?”
“Since you have been feeling this way, have you noticed a difference in your sex drive?”

Question 11

How can you ask about concentration problems in depression

Answer 11

Patients with depression typically exhibit reduced levels of concentration:

“How are your current levels of concentration?”
“Can you follow TV programmes/ read the newspaper/insert hobby here without getting distracted?”

Question 12

What is the negative triad of depression?

How can you screen for this?

Answer 12

refers to negative thoughts about self, world, and future

“How do you feel about your current situation?”
“How do you feel about the future?”

“How do you feel about yourself?”
“Do you often criticise yourself?”
“Do you blame yourself when things go wrong?”

Question 13

What is very important to assess in depression history

Answer 13

Suicide risk

Question 14

How can you assess suicide risk in depression

Answer 14

When people feel down and depressed, they can feel that life is no longer worth living. Have you ever felt like this?”
“Have you had any thoughts of taking your life?”
“How often do you think about taking your life?”
“Have you thought about how you would end your life?”
“Have you made any plans to end your life?”
“Have you ever tried to take your own life?”
“Have ever thought about hurting yourself?
“Have you tried to hurt yourself in any way?”
“What things do you have that you feel stop you from ending your life?”
“Are you drinking alcohol or using recreational drugs at the moment?”
“Have you felt able to see your friends and socialise recently?”

Question 15

What should you do after assessing biological and cognitive symptoms of depression

Answer 15

assess suicide risk

Question 16

What do you screen for after assessing suicide risk

Answer 16

It’s important to consider other psychiatric diagnoses which may also present with depression including:

Bipolar disorder
Schizophrenia

Question 17

How do you screen for bipolar

Answer 17

Screen for features of mania suggestive of bipolar disorder:

“Have you ever experienced periods of feeling particularly high, energetic or euphoric?’

Question 18

Give some questions to ask when screening for schizophrenia

Answer 18

“Have you ever heard voices speaking when there seems to be no-one around?”
“Do you ever feel that people are discussing you negatively?”
“Do you fear that people may be out to get you?”
“Have you ever felt that something or someone is able to put thoughts into your head?”
“Have you ever felt that something or someone can remove thoughts from your brain?”
“Have you ever felt that something or someone can hear your thoughts?”
“Have you noticed any sensations that seem odd or inexplicable?”

Question 19

What do you do in a depression Hx after screening for other psychiatric conditions

Answer 19

Past psychiatric and medical history

Question 20

How do you ask about previous psychiatric history in a depression hx

Answer 20

Previous episodes of depression:

“Have you ever had any other periods of feeling particularly low?”
“Have you ever been told you have depression in the past?”
“Have you ever received any treatment(s) for depression in the past and if so, did they help?”

General psychiatric history:

“Have you previously had any problems with your mental health?”
“Have you ever been diagnosed with a psychiatric condition?”
“What treatment(s) did you receive for this diagnosis and did they seem to help?”
“Have you ever been admitted to the hospital because of your mental health?”

Question 21

What should you look for in particular in the medical history part of a depression hx

Answer 21

Note any medical conditions which may directly cause mood disturbance through physiological mechanisms (e.g. hypothyroidism).

Chronic illness is also a major risk factor for depression (e.g. chronic pain, cancer, etc).

Also ask drug history, side effects, and allergies

Question 22

What do you ask about after past medical history in a depression hx

Answer 22

Family hx (Ask the patient if there is any family history of psychiatric disease in first-degree relatives)

Then, social hx

Question 23

How do you ask about social hx in a depression hx (5)

Answer 23

general (living situation, support network, independence -do they need assistance)

Assess the impact of patient’s depressive symptoms on their relationships and work:

Smoking

Alcohol/ drugs

Gambling

Question 24

What is the final thing to assess before closing the depression hx

Answer 24

Insight (Insight refers to the ability of a patient to understand that they have a mental health problem and that what they’re experiencing is abnormal. Patients with severe depression may demonstrate loss of insight into their illness.)

Question 25

How do you assess insight in depression

Answer 25

“What do you think the cause of the problem is?”
“Do you think you have a problem at the moment?”
“Do you feel you need help with your problem?”

Question 26

How do you conclude the depression consultation

Answer 26

Ask the patient if they have any questions or concerns that have not been addressed.

Thank the patient for their time.

Dispose of PPE appropriately and wash your hands.