Depression, Self harm + suicide, Bipolar

Question 1

what is the ratio of F:M with depression?
who is more suicidal?

Answer 1

F>M (2:1)
Males

Question 1

what is the definition of depression?

Answer 1

2+ weeks of anhedonia (loss of interest in things prev interested in), low mood and low energy most days

Question 2

what are some bio-psycho-social risk factors for depression?

Answer 2

Bio: chronic pain, post partum, steroid use, Low T4

Psycho: Trauma, low esteem, abuse

Social: Bereavement, divorce, very stressed

Question 3

what are the 2 hypothesis of depression?
explain them?

Answer 3

stress - vulnerability = diff ppl = diff thresholds

Monoamine hypothesis = low DA, serotonin, NAd

Question 4

Sx of depression Acronym?

Answer 4

SIGE CAPS

Question 5

SIGE CAPS?

Answer 5

Suicidality/self harm
Interest Low
Guilt + worthlessness
Energy low

Concentration Low
Appetite low
Psychomotor retardation
Sleep low

Question 6

what are the Sx in atypical depression?
Tx?

Answer 6

high appetite, sleep + mood may be okay on good occasions, catatonia, VERY SENSITIVE
Tx: CBT + MAOI/SSRI

Question 7

what bloods would we do for depression?

Answer 7

FBC, U+E, TFT, Prolactin, syphillis serology, B12 + Folate

Question 8

what 4 questionnaires are done?

Answer 8

PHQ9
HADS
BDI - II
Edinburgh

Question 9

PHQ9 (scores and levels?)
HADS
BDI-II
Edinburgh
Used in?

Answer 9

PHQ9 - used in community
0-4 = none, 5-9 = mild, 10-14 = mod, 15+ = severe

HADS (only hospital use) - anxiety and depression

BDI-II (Beck depression inventory - self reporting)

Edinburgh (post natal depression)

Question 10

What is the criteria for:
subclinical
Mild
moderate
severe

Answer 10

subclinical = 4 or less SIGECAPS

Mild = 5 or more SIGECAPS + little functional impairment

Moderate = 5 or more SIGECAPS + marked functional impairment

severe = 5 or more SIGECAPS + marked functional impairment +/- psychosis

Question 11

Tx for mild depression?

Answer 11

1. CBT (group/individual) + advice 12-16 weeks
2. SSRI (can give first if want Tx)

Question 12

Mod/severe depression Tx?
Refractory/severe Tx?

Answer 12

SSRI + high intensity CBT
Can consider ECT

Question 13

IAPT referral for what?
what does IAPT stand for?

Answer 13

Improving access to psychological therapies
NHS initiative for mild-moderate depression

Question 14

Non pharmacological Tx for depression?

Answer 14

CBT
IPT (interpersonal)
Psychodynamic therapy

Question 15

seasonal affective disorder
describe its nature and time its worse?
Tx?

Answer 15

Recurrent
winter
Tx= light therapy, SSRI

Question 16

what is dysthymia?
Tx?

Answer 16

Subclinical depression for 2+ years
Tx = low intensity CBT

Question 17

what can depression also cause to happen?

Answer 17

pseudo dementia

Question 18

how can we tell the different between dementia and pseudo dementia?

Answer 18

‘I don’t know’ answers but normal MSE

Question 19

what does self harm consist of?

Answer 19

cutting, head banging

Question 20

RF for self harm?

Answer 20

LGBTQ, female, EUPD, depression, bereavement, trauma/abuse

Question 21

what does suicide consist of? ways?

Answer 21

cutting
ligatures
overdose
jumping from height

Question 22

RF for suicide acronym?

Answer 22

SAD PERSONS

Question 23

What does SAD PERSONS Stand for?

Answer 23

Sex Male
Age old + teens
Depressed
PHx parasuicide
EtOH (alcohol)
Rational loss (psychotic)
Social support low
Organised plan
Non married
Sick chronic illness

Question 24

what increases risk of reoccurrence of suicide attempt?

Answer 24

makes conscious effort NOT to be found leaves note plans death NO regret afterwards

Question 25

What is bipolar affective disorder (BAD) ?

Answer 25

extremes of mania and depression

Question 26

what are the 3 types of BAD?

Answer 26

Bipolar 1 Bipolar 2 Cyclothymia

Question 27

what is bipolar 1?

Answer 27

Alternating mania and depression with or without a depressive episode Psychotic, No insight, grandiosity

Question 28

what is bipolar 2?

Answer 28

Alternating hypomania and depression With a depressive episode no psychosis, mild insight, no grandiosity

Question 29

what is cyclothymia?

Answer 29

alternating hypomania and subclinical depression

Question 30

what is rapid cycling?

Answer 30

4+ manic episodes in a year

Question 31

what are the 2 hypotheses of BAD?

Answer 31

Impaired cortical regulation DA hypothesis (high DA in reward pathway)

Question 32

RF for BAD?

Answer 32

family Hx 1st degree stress abuse/trauma substance abuse ~24y

Question 33

what can precipitate mania?

Answer 33

benzos SSRIs Alcohol LSD

Question 34

what are the symptoms of mania acronym and time length?

Answer 34

7+ days of IDIG FAST SIGNS OF PSYCHOSIS AND FUNCTION POOR

Question 35

what does IDIG FAST stand for?

Answer 35

Irritability Distractable Insomnia Grandiose delusions Flight of ideas Activity high Speech high Thoughtless - high risk +/- Hallucinations

Question 36

what are the Sx of hypomania? time and signs?

Answer 36

4+ days of good mood, mild distractibility, low sleep and food need, no grandiosity, talkative and mildly reckless No hallucination NOT PSYCHOTIC AND FUNCTIONING WELL

Question 37

What is the Dx of bipolar?

Answer 37

depression bloods clinical Dx

Question 38

Tx of BAD acutely in mania? biopsychosocial model

Answer 38

antipsychotics (and stop SSRI if taking for depression) consider InPx in bipolar 1 CMHT, Crisis team, CBT

Question 39

Tx of BAD long term? monitoring?

Answer 39

Lithium monitor serum Li 12h post dose, weekly till stable then 3 monthly

Question 40

what do we need to look out for with lithium?

Answer 40

LITHIUM CON and Silent SE

Question 41

what GP referral is done in mania and hypomania?

Answer 41

mania = urgent cmht hypomania = routine cmht

Question 42

what Tx for depressive episodes?

Answer 42

antipsychotics fluoxetine + olanzipine

Question 43

in a manic episode, if on SSRI?

Answer 43

taper and discontinue