Low Mood - Effective consulting Flashcards
How do patients with depression present to doctors?
- feeling low
- lost interest
- tired all the time (somatic syndromes)
- stomach pain/ headaches
What can depression lead to?
- weight loss
- lack of self care
- not taking medication
- unexplained symptoms
- disturbed sleep
- fatigue
- poor concentration
- suicidal thoughts
What are core symptoms?
(one must be present >2 weeks affecting patients life for a diagnosis of depression)
eg, persistent low mood, loss of interest/ pleasure
What areas of sleep might be affected?
- initial or middle insomnia
- early morning waking
- over sleeping
What family history might lead to mental illnesses?
- schizophrenia
- bipolar disorder
- major depression
What is the spectrum of risk to self?
- self harm can be physical self abuse to engaging in risky behaviour
- self harm and suicidal thinking can be a coping mechanism
What are some red flags for suicidial thoughts?
- clear and detailed plan
- social isolation
- hopelessness
- chronic illness
- background risk factors
- severity of psychiatric state
How to examine a patient with potential mental health issues?
- appearance
- behaviour
- speech
- mood and affect
- thought
- perception
- cognition
- insight and judgement
What is the human condition?
- stress, anxiety, worry, guilt, remorse
- fluctuations in mood
- fluctuations in energy, motivation and sleep
- normal response to distressing external events eg. loss, illness, traumatic events
What is grief?
- distressing normal reaction to intense emotional pain
- numbness, unreality, yearning, anger
- impact on appetite and sleep
How to diagnose depression?
- not attributable to other causes
- causing significant distress or functional impairment
What is severe depression?
has most of the 9 symptoms including one of the core symptoms
-symptoms interfere with functioning
What is depressive symptoms?
lasting 2 years or more
What is the subthreshold for depression?
at least 2, less than 5 symptoms
What is used to assess the severity of depression?
PHQ-9 questionnaire
What is atypical depression?
present with reactive mood, weight gain, increased appetite and excessive sleepiness
Why is depression still underdiagnosed? (patient factors)
- stigma/ embarrassment/ shame
- fear
- doesn’t fit with socio cultural perspective
- thinking no one can help
Why is depression underdiagnosed? (doctor factors)
- more pressing problems
- missed (lack of recognition, hidden or time pressure)
What are some specific risks for depression?
- social problems eg. unemployment
- psychiatric problems eg. substance misuse
- physical disorders eg. diabetes, CHD
- drugs that cause symptoms of depression eg. beta blockers
What are the options to treat depression?
- lifestyle
- therapy
- pharmacological
What lifestyle changes can be done?
- establish routines
- eat well
- exercise
- re-engage
- sleep hygiene
- avoid alcohol and mood depressants
What are some supportive interventions?
- therapeutic conversations/ brief interventions
- self help programmes eg. books
- counselling
What are some therapy interventions?
- CBT/ psychological interventions
- therapeutic services eg. RELATE, CRUSE, trauma focused, sexual assault
What is CBT?
Cognitive behavioural therapy
What medications might be used for treatment?
selective serotonin reuptake inhibitors (SSRIs)
What should patients be advised about with SSRIs?
- takes time to work
- common side effects eg. GI upset, headaches, anxiety
- serious side effects eg. vivid dreams, suicidal ideation
- take for 4-6 months after feeling better
What is anxiety a main symptom of?
- panic disorder
- social anxiety
- PTSD
- phobias
- generalised anxiety disorder
