Low Mood Flashcards
Biological factors in depression?
Endocrine, immune, neurotransmitter, physical disorders
sleep, genetics, diet, physical health
Psychological factors in depression?
Negative thinking patterns
Deficits in coping
Judgement problems
Impaired emotional intelligence
sleep, self-esteem, attitudes/beliefs, trauma
Social factors in depression?
Traumatic situations
Early separation
Lack of social support
Harassment
trauma, financial security, family circumstances, diet
Symptoms of depression?
Indecisiveness
Disturbed sleep
Fatigue
Increased appetite
Persistent sadness
Anhedonia
Agitation or slowing of movement
Feelings of worthlessness or inappropriate guilt
Suicidal thoughts or acts
Somatic symptoms (like unexplained pain)
DSM?
Diagnostic and Statistical manual of mental disorders
ICD
International Criteria of Diseases
DSM-V criteria
1 or more key symptom
AND
5 or more total symptoms
Key symptoms? (DSM)
- Persistent sadness or low mood
- Marked loss of interest or pleasure
Associated symptoms? (DSM)
- Disturbed sleep
- Decreased or increased appetite and/or weight
- Fatigue or loss of energy
- Agitation or slowing of movements
- Poor concentration or indecisiveness
- Feelings of worthlessness or excessive or inappropriate guilt
- Suicidal thoughts or acts
PHC-9?
Patient health questionnaire - 9 question depression screen
Suicide most common in?
Males aged 40-59
Self harm most common in?
Females aged 17-19
Risks…
To self
To others
From others
ACEs?
Adverse childhood experiences
Potentially traumatic events that can have negative, lasting effects on health and well-being
BRFSS test asks about these (references experiences prior to 18)
ACE categories?
- Abuse
- Family destruction
- Neglect
Behaviours that have significant association with ACE scores?
Binge drinking
Heavy drinking
Smoking status
High risk HIV behaviour
Depression
Disability caused by poor health
Use of special equipment because of disability
P value
Below 0.05 = statistically significant
Bias
Systematic error is introduced into sampling or testing by selecting or encouraging one outcome or answer over others
Statistical significance
Looking at the reliability of a study through numbers from statistical tests
vs clinical significance - clinicians decision
What do SSRIs work on?
Blocks serotonin transporter so serotonin continues bouncing around in synapse and acting on receptors
must be serotonin released for it to work
What do serotonin receptor agonists act on?
Binds to serotonin receptor and activates it
Serotonin autoreceptors?
Negative feedback - serotonin binds to receptor and switches off further neurodepolarisation
Inhibitory receptor for serotonin - antagonist would prevent this inhibition
Tryptophan hydroxylase antagonist?
Tryptophan hydroxylase is the rate limiting step in serotonin production, so blocking enzyme will be pro-depressive
Monoamine oxidase inhibitors?
Monoamine oxidase metabolises serotonin which slows down transportation
Blocking it slows down transporter, more serotonin remains in synapse, and acts on receptors
Anti-depressive
Anti-depressant prescription - what to tell patients
- Take several weeks to work
- Symptoms may worsen initially
- Need to continue for 6 months after remission of symptoms
- Need to wean drugs gradually
- Interact with other drugs
book follow up appointment and give suicide hotline numbers
Drug interactions of anti-depressants?
Sertaline and acalabrutinib can increase risk of bleeding
Sertaline and aceclofenac can increase risk of bleeding and risk of hyponatraemia
Severity and anti-depressant relationship?
More severe depression = bigger improvement from drugs vs placebo
not much research
Non-pharmacological interventions for depression
Support groups, art therapy, financial help, exercise groups
Social prescribing
Connects people to activities, groups and services in their community
CBT?
Talking therapy
Explores thoughts, feelings and behaviour
Outside of sessions - diary,
TF-CBT
Trauma focused CBT for PTSD
