Depression-Shwenk

Question 1

T or F

You can feel sad without being depressed and depressed without feeling sad

Answer 1

T

It is a disease with impaired function of day to day activities

Question 2

Depression is an indepenent risk factor for (blank)

Answer 2

poor prognosis (due to poor adherence, biological impairment, have high levels of morbidity and mortality, reduced function, meds have SEs)

Question 3

T or F

Depression patients have feelings of inadequacy causing guilt

Answer 3

T, though they shouldnt since it is truly a disease

Question 4

Depression involves (single/multiple) organ system

Answer 4

multiple

Question 5

What shoud you ask immediately with a depressed individual?

Answer 5

hows your sleep?

look into emotion and cognition

Question 6

What are co-morbid medical conditions associated with depression?

Answer 6

CHF, DM, HTN, CAD

Question 7

ANy chronic pain diseases or a difficult patient should trigger your mind to think what?

Answer 7

that your patient is depressed

Question 8

What is this:
Verbally unproductive
Flat, “energy sump”
“Problem” patient
Multiple complaints, systems, visits
Symptom-sign mismatch
Physician dysphoria when with patient

Answer 8

depressed patient

Question 9

(blank) of all visits for depression in primary care
(blank)% of visits for antidepressants to primary care
More than (blank) of antidepressants prescribed by primary care physicians
More than half of antidepressants prescribed for reasons other than (blank)

Answer 9

Third
41%
half
depression

Question 10

What are indications for referral?

Answer 10

Severe suicidal thinking
Psychosis, bipolar disorder, Axis II
Complicated substance abuse
Poor psychosocial support
Disorganized, rapid deterioration
Failed treatment

Question 11

Where should you always start with depression?

Answer 11

DISPEL MYTHS

Question 12

What are the 10 rules for caring for depressed patients?

Answer 12

1. Dispel myths
2. Use epidemiology
3. Indirect markers and clues
4. Focus on functional impairment
5. Counter competing priorities (make sure depression is prioritized)
6. Co-morbidity
7. Psychopharmacology
8. Education and supportive counseling
9. Treat as a chronic disease
10. Psychiatric consultation

Question 13

T or F
Physician educational interventions show little effect
Barriers to improvement more systemic than professional

Answer 13

T

Question 14

What medical student are the most depressed?

Answer 14

2nd year female medical students who are unmarried or have children
(medical students are more likely to commit suicide then age matched peers)

Question 15

Why do you think physicians commit suicide more than other occupations?

Answer 15

Avoid seeking care due to privacy concerns/stigma
Prescribe own antidepressant (30% vs. 9.9%)
Seek care outside community and/or pay cash for care
Not seek care due to concern about medical staff privileges or licensing

Question 16

What are the Factors Affecting Medical Students with Depression?

Answer 16

• Med students see depression as personal weakness
• There is social/professional discrimination
• Devaluation of depressed students (think they are not worthy of good school performance)
• Perceptions of poor performance by depressed medical students
• Need for secrecy