low mood Flashcards

1
Q

what is depression?

A

depressed you feel persistently sad for weeks or months, rather than just a few days

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2
Q

symptoms of depression?

A

can cause a wide variety of symptoms:

  • lasting feelings of unhappiness and hopelessness
  • to losing interest in the things you used to enjoy
  • feeling very tearful

physical symptoms:

  • such as feeling constantly tired
  • sleeping badly
  • having no appetite or sex drive
  • various aches and pains
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3
Q

how can the symptoms of depression vary?

A
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4
Q

what is social prescribing?

A

Social prescribing, also sometimes known as community referral, is a means of enabling health professionals to refer people to a range of local, non-clinical services. The referrals generally, but not exclusively, come from professionals working in primary care settings, for example, GPs or practice nurses.

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5
Q

what is the aim of social prescribing?

A

social prescribing seeks to address people’s needs in a holistic way. It also aims to support individuals to take greater control of their own health.

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6
Q

what type of activities can be provided with social prescribing?

A

Schemes delivering social prescribing can involve a range of activities that are typically provided by voluntary and community sector organisations. Examples include volunteering, arts activities, group learning, gardening, befriending, cookery, healthy eating advice and a range of sports.

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7
Q

what type of people would benefit from social prescribing?

A

Those who could benefit from social prescribing schemes include people with mild or long-term mental health problems, people with complex needs, people who are socially isolated and those with multiple long-term conditions who frequently attend either primary or secondary health care.

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8
Q

what do most social prescribing schemes involve?

A

Most involve a link worker (other terms such as community connector, navigator and health adviser are also used) who works with people to access local sources of support

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9
Q

does social prescribing work?

A

Overall, the evidence available today offers good reason to think social prescribing can deliver benefits for some people. But, as a number of recent meta-analyses and Public Health England have concluded, further work is needed to strengthen the evidence base and clarify expectations of what benefits can be delivered and for whom.

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10
Q

what are some weaknesses in the evidence base?

A

Many studies are small scale, do not have a control group, focus on progress rather than outcomes, or relate to individual interventions rather than the social prescribing model. Much of the evidence available is qualitative and relies on self-reported outcomes.

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11
Q

how have the NHS tried to encourage social prescribing?

A

national NHS bodies have embraced social prescribing and committed resource to rolling it out across England. The NHS five year forward view (2014) opened the door with its focus on prevention, its emphasis on the role of the voluntary and community sector, and by citing examples of social prescribing schemes having a positive impact.

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12
Q

What did the NHS long term plan in 2019 mark?

A

marked a step change in ambition by incorporating social prescribing into its comprehensive model of personalised care. Composed of six programmes including personalised care planning and personal health budgets, the model aims to enable people, particularly those with more complex needs, to take greater control of their health and care.

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13
Q

who does the Long-term plan commit to funding?

A

Rather than seeking to directly fund the groups that deliver social interventions, the Long-Term Plan commits funding to the link workers who connect people to the range of support and engagement opportunities – largely run by charity and voluntary organisations – in their local area.

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14
Q

what further attention is need with regard to social prescribing?

A

. For example, further insight is needed into the impact of different models of link working, and how link workers can be effectively supported and embedded within a wider multidisciplinary team.

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15
Q

what effect did Covid-19 have on social prescribing?

A

Covid-19 has seen the voluntary and community sector’s income fall, while the need for the sector has increased

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16
Q

partnership between _____ and _________ is integral to effective health and care?

A

Partnership between the NHS and the voluntary and community sector is integral to effective health and care

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17
Q

what is CBT?

What does it teach you?

A

Cognitive behavioural therapy (CBT) is a type of talking therapy. It is a common treatment for a range of mental health problems.

CBT teaches you coping skills for dealing with different problems. It focuses on how your thoughts, beliefs and attitudes affect your feelings and actions.

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18
Q

theory behind CBT?

A

CBT is based on the idea that how we think about situations can affect the way we feel and behave. For example, if you interpret a situation negatively, you might experience negative emotions.

19
Q

what two therapies does CBT combine?

A

CBT combines two types of therapy to help you deal with these thoughts and behaviours:

cognitive therapy, examining the things you think

behaviour therapy, examining the things you do.

20
Q

what does CBT treat?

A

CBT is a common treatment for many mental health problems and experiences, including:

  • anger problems
  • anxiety and panic attacks
  • bipolar disorder
  • depression
  • drug or alcohol problems
  • eating problems
  • hoarding
  • obsessive-compulsive disorder (OCD)
  • perinatal mental health problems
  • phobias
  • post-traumatic stress disorder (PTSD)
  • psychosis
  • schizoaffective disorder
  • schizophrenia
  • self-harm
  • sleep problems
  • stress
21
Q

what adaptation of CBT is offered for PTSD?

A

For example, you may be offered trauma-focused CBT (TF-CBT) to treat post-traumatic stress disorder (PTSD).

22
Q

Can you be offered CBT for a physical problem?

A

You may also be offered CBT for physical health problems. This includes if you experience a mental health problem alongside a physical health problem.

23
Q

what is stepped care?

A

If you are offered NHS treatment for your mental health, they might offer you CBT as a first treatment. They might then offer you other types of talking therapy or counselling if CBT doesn’t work.

This approach is sometimes called stepped care

24
Q

what are CBT sessions like?

A

n CBT, you work with a therapist to identify and challenge negative thought patterns and behaviour.

You and your therapist might focus on what is going on in your life right now. You might also talk about how your past experiences have affected you.

CBT is usually a short-term treatment where you have a set number of sessions.

25
Q

what might the CBT session include?

A

A typical CBT session may include:

  • working through exercises with your therapist to explore your thoughts, feelings and behaviour
  • agreeing some activities to work on in your own time
  • going over what you did in previous sessions and discussing what progress you’ve made
26
Q

can CBT be done by yourself?

what CBT treatment does NICE not recommend for specific phobias?

A

You might be able to do CBT by yourself, including through a computer or workbook. For example, the NHS apps library lists some mental health apps that may help.

This could be useful to try if you are waiting for treatment. Or it might remind you of some good techniques, if you’ve had CBT in the past.

computerised CBT should not be used routinely to treat specific phobias.

27
Q

targets for antidepressants?

A

increasing the level of monoamines and certain neurotransmitters

28
Q

What does monoamine oxidase do?

A

breaks down neurotransmitters in the pre-synaptic terminal that aren’t in vesicles

29
Q

what do monoamine oxidase inhitors do?

A

inhibit monoamine oxidase -> therefore increase the amount of neurotransmitter capable of being released in synapse

the more NTs in synapse increases likelihood it will attach to post synpatic terminal

30
Q

how do tricyclics work as antidepressants (TCAs)?

A

they’re named after their shape -> 3 rings

increases levels of norepinephrine and serotonin -> they do this by interfering with reuptake. TCAs block reuptake channels and NTs stay in synapse for longer and can have continued effect

31
Q

how do SSRIs (selective serotonin reuptake inhibitors) work as an antidepressant?

A

they block reuptake channels for serotonin and only for very specific for serotonin receptors

32
Q

how do doctors know what antidepressant to prescribe?

A

differentiating through side effects

33
Q

out of MAOIs, TCAs and SSRIs, which have the least side effects?

A

MAOIs and TCAs are 1st generation -> because they’re older, have more side effects

MAOIs notorious for more side effects

SSRIs are 2nd generation

34
Q

Why do MAOIs have more side effects?

A

affects all monoamine neurotransmitters -> also activates all neurotransmitters in the body, not just the brain

  • epinephrine
  • norepinephrine
  • serotonin
  • dopamine

leads to a lot of side effects -> e.g. MAOIs inhibit process in liver that metabolises medication

35
Q

what do people taking MAOIs need to be careful of?

A
  • drug interactions when taking other prescription and non-prescription medications -> MAOIs can inhibit enzyme in liver that metabolises drugs
  • this leads to a dangerous buildup of drugs in your body
  • eating certain foods -> MAOIs prevent breakdown of foods e.g. fruit, alcohol, dairy + some meats
  • RESTRICTIVE DIET
36
Q

why do TCAs have fewer side effects than MAOIs?

A

affects some monoamine neurotransmitters:

norepinephrine

serotonin

37
Q

why do some people have severe side effects with TCAs?

A
  • TCAs can affect things other than norepinephrine and serotonin e.g. histamines -> can lead to fatigue and sluggishness
  • TCAs are very toxic at higher levels and someone could go into cardiac arrest if overdose
38
Q

with what condition are TCAs preferrably prescribed?

A

bipolar condition -> lithium and TCAs prescribed (TCAs are safer)

SSRIs and lithium can trigger manic episodes

39
Q

why are SSRIs preferred?

A

least side effects, very effective

they are the most selective as they only affect serotonin in the brain and in the body

40
Q

common side effects of SSRIs?

A

sexual dysfunction

sleeping problems

weight gain

these side effects have negative effect on quality of life

41
Q

what is serotonin syndrome?

A

A condition resulting from accumulation of high levels of serotonin in the body. Serotonin is a chemical which plays a role in overall wellbeing and especially a mood stabiliser -> may occur if taking another drug w SSRI

42
Q

what are some new anti-depressants?

A
  • SSRI + SNRI -> selective serotonin and norepinephrine reuptake inhibitors
  • NDRIs -> selective norepinephrine + dopamine reuptake inhibitors
  • NDRAs -> selective norepinephrine + dopamine releasing agents
43
Q

what do SSRI + SNRIs do?

A

SSRIs and SNRIs block reuptake for both serotonin and norepinephrine but only for specific types of each

restrictive version of TCAs

44
Q

what do NDRAs do?

A

one blocks reuptake of norepinephrine and dopamine

other triggers additional release of norepinephrine and dopamine

both lead to an increase of these NTs in synapse