General Depression Flashcards
What is meant by ‘social stratification’?
An individual that is disadvantaged in one area of life tends to be disadvantaged in others too
Describe the socio-economic pattern of health.
- A positive correlation between ill-health and poverty/deprivation
- But ill-health is not always attributed to deprivation. For examples, environments/areas have an impact on an individual’s behaviours regardless of that individual’s socio-economic status.
List 4 different explanations for socioeconomic inequalities in health.
1- Absolute deprivation (those with absolute deprivation means bad housing so more likely to be ill, no areas for physical activities, lack of essential possessions like clothes and food so also more likely to be ill - a lot of evidence on this!)
2- Psychosocial effects (people in crap jobs will feel more stressed, people in low positions will feel crap, lower incomes will feel crap, lack of control at work will feel crap all will mean they are more likely to get ill)
3- Area effects (even if you poor but in a wealthy neighbourhood you have better outcomes health-wise than poor in poor areas)
4- Cultural/behavioural (so people in middle class more likely to smoke and drink - doesn’t explain all inequalities, the behaviour is only one part of the puzzle when working out the cause of health inequalities)
Describe the criteria (symptoms and durations etc..) for diagnosing depression.
- MUST have persistent low mood or anhedonia for at least 2 weeks, most days, most of the time
- Other symptoms: Insomnia, Feeling of guilt and worthlessness, poor concentration, poor appetite, Psychomotor agitation or retardation (restlessness or slowness), Suicidality, loss of energy, loss of libido
(OSCE Tip: Ask about duration, associated disability, FH, and social support)
List risk factors of depression.
- Gender (2:1 female to male ratio)
- Genetics and Family History (remember genes alone do not cause it, there need to be environmental factors)
- Early Life Experiences
- Stressful life events (E.g chronic illness, loss of job)
List protective factors of suicide.
- Good Social Support (from family and friends)
- Spirituality or religious beliefs
- Not wanting to cause pain to family or friends
Why is depression linked with a 2- to 4-fold increase in the risk of cardiac mortality among patients hospitalised of MI.
- Less adherence to cardiac medication regimens
- Less adherence to lifestyle risk factors interventions.
How is depression linked to chronic illness?
- Adapting unhealthy behaviours such as smoking and alcohol
- Not adhering to medical regimens
State three risk factors / red flags of suicide.
- Mental Disorders (E.g Depression)
- Life events: divorce/bereavement
- Past attempts of suicide /family history
What are the psychosocial interventions that should be offered to people with persistent subthreshold depressive symptoms or mild or moderate depression?
Self-guided help:
- with leaflets and books that use the principles of CBT
- Computerised CBT (CCBT) and using the internet for self-help
- Structured group physical activity program
Talking treatments:
- Counselling
- CBT
Describe the mechanism of action of benzodiazepines.
Allosteric activation of the GABA(A) receptors –> Increase frequency of opening channels for Cl- ions
Describe the pharmacodynamics of benzodiazepines.
- Well absorbed orally (peak effect within 2 hours)
- Highly lipophilic (distributes well and enters CNS quickly)
- Highly protein bound (long-lasting effects)
- Hepatic metabolism (cytochrome p450)
A) Which subunits of the GABA (A) receptors does benzo work on for anxiolytic (reduce anxiety) effects?
B) Which subunits does it act on for the hypnotic effect (induce sleep)?
A) Alpa 2 and 3
B) Alpha 1
List the 5 effects of benzodiazepines.
1- Anxiolytic 2- Hypnotic 3- Reduce muscle tone 4- Anterograde amnesia 5- Anti-convulsant
Name 2 other class of drugs used to treat anxiety aside from benzodiazepines.
- non-selective B-blocker (propanolol)
- SSRI’s
Define the following terms:
A) Tolerance
B) Dependence
C) Withdrawal
(These happen for people on benzo’s, and common!)
A) Physiological reaction (neuroadaptation) characterised by a decrease in the effects of a drug with chronic administration
B) develops when neurons adapt to repeated drug exposure and individual only functions normally in presence of the drug: Compulsions to take the drug, difficulty controlling the use, neglect of alternative pleasures as a result, use of the drug despite harmful consequences, characteristic of withdrawal state, evidence of tolerance (need 3/6 in last 12 months)
C) A result of physical dependence where there may be increased anxiety, disturbed sleep, pain, stiffness, convulsions, and muscular aches
Describe the non-pharmacological management of anxiety.
- Reduce alcohol and caffeine
- Mindfulness
- CBT
(Benzo’s are only used for 2-4 weeks in severe cases of disabling anxiety)
List indications of anxiolytics.
1- Anxiety Disorders (E.g Generalised anxiety and Social Phobia) - only if you must!
2- Insomnia (benzo or Z-drugs) - only if you must!
3- Prolonged seizures - (IV Lorazepam)
4- Sedation for therapeutic procedures
What is melatonin used for?
- children with sleep disturbance
licensed for insomnia in 55< but no evidence of effect
Describe the non-pharmacological treatment of depression.
1- Physical exercise 2- Bibliotherapy 3- Self-support groups 4- Counselling 5- Therapy (CBT)
describe CBT
a type of talking treatment that focuses on how your thoughts, beliefs and attitudes affect your feelings and behaviour, and teaches you to coping skills for dealing with different problems
it combines cognitive therapy (examining the things you think) and behaviour therapy (examining the things you do).
recommended in anxiety and depression!
how would you assess a patients risk of suicide?
involves exploring if the patient has any ideas, intent or plans of suicide and exploring both risk and protective factors. for example:
IDEATION - how often do you think about taking your own life? intensity and duration.
PLAN - have you thought how you would kill or hurt yourself? have you made any plans? what is the closest you have come to doing it?
BEHAVIOURS: have you made any past attempts/aborted attempts? vs non-suicidal self-injurious actions? why and what was going through your head? do they regret it? are they glad to be alive?
MEANS: do you have access to means to carry out your plan?
INTENT: explore reasons to die vs reasons to live
*what can I do to help you?
Describe recent trends in the incidence of mental health conditions
- proportion of adults who have reported 2 or more symptoms of anxiety from 2008-2009 has increased
- steady and significant increase in the proportion of adults who have 2+ symptoms of depression (Scottish health survey 2017)
- ‘around 1 in 3 people are estimated to be affected by mental illness in any one year. improving mental health is a priority for the Scottish government’
- since patient level data was first available (09/10), the no. of pt’s in Scotland prescribed at least one antidepressant rose by 42.3% in 17/18
outline some Public Health and population responses/approaches to improving mental health
Scotland’s MH strategy (2017-27): works to achieve parity between mental + physical health (e.g. atm 1 in 3 people who would benefit from treatment for mental health currently receive it)
population response: promoting good mental wellbeing (good employment, reduce discrimination), preventing mental illness (social prescribing, tackle issues like isolation, bullying and domestic abuse), early Dx and support (improve referral pathway, embed mental health workers in GP), effective Rx (physical and mental health treated holistically, adequately-funded services)
