Low Mood/Depression

Question 1

Sequence of events

Answer 1

Open question
Timeline- how long? How did it start? Has it gotten worse?
Ideas- what caused it?
Effect on life/ feelings

Question 2

Core symptoms

Answer 2

Low mood
Anhedonia
Energy levels/ fatigue

Question 3

Other common symptoms

Answer 3

Sleep- waking up early? Ruminating?
Appetite- eating okay, lost any weight?
Libido 
Diurnal variation- worse in morning or early evening?
Concentration 
Self- worthlessness or guilt
Future- hopelessness

Question 4

Risk

Answer 4

Consider a mini summary
Then tentatively discuss self harm, harm towards others
Previous self harm or suicide attempts?

Question 5

Systems review

Answer 5

Psychosis- auditory hallucinations/ visual hallucinations/ altered sensations/ delusions of thought and control
Mania- energy levels/ have people said you are hyper/ spending habits/ libido
Depression- mood/anhedonia/ sleep/ future
Others- memory loss/ anxiety/ insight/ relationship with food
Hypothyroidism- ask about hypo Sx

Question 6

Low Mood red flags

Answer 6

Thoughts of self harm 
Previous suicide attempts 
No protective factors 
FH suicide 
Significant adverse life event

Question 7

Patients perspective

Answer 7

Concerns

Expectations

Question 8

PMH

Answer 8

Suffered from medical or mental health conditions?
Ask about thyroid, mania, depression, psychosis
Pre-morbid- how would friends and family describe you before this? How would you see yourself?

Question 9

DH

Answer 9

Allergies
OTC
Regulars

Question 10

FH

Answer 10

Anything run in the family eg. Depression, BAD

Question 11

SH

Answer 11

Job- what does it involve. Impact on job
Home situation- occupants and difficulties
How is mood affecting home life
Support from family or friends
Smoke alcohol recreational drugs
Have you been looking after yourself and the home eg. showering and cleaning

Question 12

To finish

Answer 12

Insight and support- do you think you are unwell/ this is normal?
Follow up- see you next week?

Question 13

Differentials to consider

Answer 13

Sleep disorders
Dehydration
Drug side effects eg. Beta blocker
Anaemia (fatigue and energy levels)

Question 14

Depression

Answer 14

Sx must be present for 2 weeks

Question 15

BAD

Answer 15

Don’t forget to ask about mania (DIGFAST)- if previous manic episode: BAD

Question 16

Schizoaffective disorder

Answer 16

Schizophrenia and mood disorder
Ask about delusions and hallucinations (typical schizophrenia hallucinations eg. 3rd person auditory, running commentary- not mood congruent seen in depression and mania)

Question 17

Hypothyroidism

Answer 17

Intolerance of cold, constipation, menstrual changes, weight gain

Question 18

Investigations

Answer 18

MSE, risk assessment
Hydration status and thyroid exam
FBC UE LFT TFT B12 folate

NB- ECG (citalopram)

Question 19

Mild depression

Answer 19

Lifestyle- exercise, sleep hygiene

Psychotherapy- CBT (online course?)

Question 20

Moderate to severe depression

Answer 20

Lifestyle advice
Medication- SSRI (then another one, then SNRI)
Psychotherapy- high intensity CBT

NB- if high risk to themselves or others, admit to psychiatric ward (use MHA if necessary (section))

NB- if they have been in bed for a while make sure they haven’t got pressure sores/DVT

Question 21

SH

Answer 21

Job- what does it involve. Impact on job
Home situation- occupants and difficulties
How is mood affecting home life
Support from family or friends
Smoke alcohol recreational drugs

Question 22

SAD MOPP psychiatric differential diagnoses

Answer 22

Substance misuse
Anxiety disorder
Developmental disorder (autism)

Mood disorder (depression and BAD)
Organic- syphillis encephalitis
Psychosis
Personality disorder