Introduction to anxiety and depression

Question 1

Risks of depression and anxiety

Answer 1

Suicide 
Self harm 
Neglect of self
Neglect of vulnerable others 
Exploitation by others 
Addiction 
Homicide/infanticide (often as an act of kindness in a perceived awful world)

Question 2

Core symptoms of depression

Answer 2

2 weeks of low mood
Loss of interest or pleasure (in everything) plus 3 or 4 of the following:

• change in sleep (increase or decrease>30min, 10/14 days)
• Change in appetite (increase or decrease, loss of interest in food and sex)
• low energy/fatigue
• Restlessness, agitation or slowed down in movement and thinking
• Low self-worth or self-blame/guilt
• Suicidal ideas/plans/acts
• Concern over impending death

Question 3

2 screening questions to ask to recognise depression

Answer 3

during the last month, have you been bothered by feeling down, depressed, or hopeless?

During the last month, have you been bothered by having little interest or pleasure in doing things?

Question 4

What are the suicide risks

Answer 4

Intention
Thinking:hopeless, helpless, painfulness of living
Behaviour: Can occur with very little planning-evidence of recklessness with their own life, recent self-harm, disinhibition, alcohol and drug misuse, unstable mental illness, past violence
Medical risk: likelihood of death or serious damage e.g. hanging, asphyxia, fall from a great height
Protective factors: responsibilities e.g. to children, beliefs e.g. suicide is wrong, events to look forward to, caring, responsible and available support

Question 5

Mental state examination for those with depression

Answer 5

Appearance: look for neglect, lack of eye contact, agitation, slowed down movement, sadness
Behaviour: socially withdrawn
Speech: slow to answer, hesitant, slow in speech, monotone, short answers, agitated
Mood: depressed, irritable, anxious
Thought: low self-worth, hopeless about future, helpless, low self confidence, pre-occupied by guilt, persecution, suicical ideation and plans
Hallucinations: sad music, derogatory voices
Cognition: poor concentration (count backwards in 7s from 100) and attention (remember 7 figure number forwards and 5 number backwards, memory intact
Insight, undeserving of help

Question 6

Types of depression

Answer 6

Major depression: 2 weeks, more severe

Dysthmia: 2 years persistent, mild (2-5 symptoms)

Melancholia: most severe, slowed down/agitated, worse in morning, early morning waking, weight loss

Bipolar depression: separate episodes of mania >4days of elation or irritability, increased energy and activity

Depression with psychosis

Atypical depression: sleep more, eat more, worse in evening

seasonal affective disorder

Adjustment disorder to life change

Life stress

Question 7

What are the anxiety disorders

Answer 7

Simple phobias 
Agorophobia 
PTSD
Generalised anxiety disorder
Panic disorder
Health anxiety 
OCD
Social anxiety disorder

Question 8

Environmental predisposing factors of anxiety

Answer 8

Insecure attachment: lack of parenting/absence of consistent secure parental figure

Childhood sexual abuse

Childhood physical abuse

Childhood emotional abuse

Childhood physical neglect

Childhood emotional neglect

Question 9

Environmental precipitating and protective factors for anxiety

Answer 9

Life events: sudden events that might have long-lasting catastrophic implications for that person

Life difficulties: domestic violence, aggressive noisy neighbours

Organic: alcohol and some drugs are depressants, or amplify stress, hormonal effects from tumours, sudden change in oestrogens

Social support: life events may be buffered by sharing distress with someone you trust

Secure attachment: confers resilience limiting adverse life events

Positive life events: fresh start, do not have to address life events and difficulties