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
