Mental Health

Question 1

what criteria is used to diagnose depression?

Answer 1

the DSM-5 criteria

Question 2

what are the two core symptoms of depression?

Answer 2

• low mood

- little interest in doing things

Question 3

name some other associated symptoms of depression apart from teh two core symptoms

Answer 3

• sleep disturbance
• low libido
• weight/appetite change
• fatigue/low energy
• agitated
• poor concentration
• feeling or worthlessness
• suicidal thoughts

Question 4

what is the severity of mild moderate and severe depression?

Answer 4

mild - excess of five symptoms and they only result in minor functional impairment

moderate - symptoms or functional impairment are between mild and severe

severe - most symptoms and they markedly interfere with functioning – they can occur with or without psychotic symptoms

Question 5

what is teh most commonyl used depression questionaire?

Answer 5

PHQ-9

Question 6

how do you manage a patient with depression in primary care?

Answer 6

• manage suicide risk (consider contacting CRHT)
• manage safeguarding risk
• manage comorbid condition associated with depression (substance/alchol abuse, anxiety, demetia, eatign disorder , psychotic symptoms)
• for ppl who dont want an intervention, consider period of ‘active monitoring’
• Mild depression – self referral to talk therapy​, consider CBT
• Moderate to severe depression – start CBT or counselling, antidepressants​
• offer sleep hygeine advice is struggling to sleep

Question 7

which antidepressant shoudl you prescribe in depression?

Answer 7

• 1st episode start w a SSRIs eg. Sertraline, citalopram, fluoxetine ​
• For subsequent episodes use what a patient might prefer based on their past experiences
• other options eg. SNRIs eg. Duloextine (more effective than SSRIs in some) and tricylic antidepressants e.g. amitriptylline (have more side effects)

Question 8

when do you review someone with depression?

Answer 8

Not increased risk of suicide: ​

• Initial review within 2 weeks.​
• Review regularly after, every 2–4 weeks for the first 3 months ​

Increased risk of suicide, or people aged under 30 years: ​- Initial review within 1 week. ​
- Review frequently after until the risk is no longer considered clinically important.​

Question 9

how shoudl anitdepressants be stopped?

Answer 9

In general, reduce the dose or frequency of the antidepressant gradually over a 4-week period to minimize discontinuation symptoms

Question 10

what is teh diagnostic criteria to diagnose GAD?

Answer 10

DSM-V diagnostic criteria:
- >=6 months of excessive, difficult to control worry about everyday issues, that is disproportionate to any inherent risk, and causes distress, or impairment.
- The worry is not confined to features of another mental disorder
- at least 3 of the following symptoms most of the time:
restlessness/nervousness
being easily fatigued
poor concentration
irritability
muscle tension
sleep disturbance.

overall, clinical judgement is used to determine diagnosis

Question 11

what is the validated assessment tool for GAD?

Answer 11

GAD-7 questionnaire

Question 12

name some risk factors for GAD.

Answer 12

Female sex.
Family history of anxiety.
Current/Hx of physical or emotional stress.
History of other anxiety disorders such as panic disorder, social phobia, or specific phobias.
Chronic pain or physical illness
History of substance abuse.
certain medications

Question 13

how do you manage a person with GAD?

Answer 13

1. offer low-intensity psychological interventions based on CBT e.g. self help or psychoeducational grps
2. CBT
3. (SSRI) such as sertraline, paroxetine, or escitalopram OR (SNRI), such as duloxetine or venlafaxine
4. Refer for specialist treatment