Mental Health Flashcards
What are the three core symptoms of depression according to ICD-10 criteria?
Low mood
Anhedonia
Anergia/fatigue
Other than the core symptoms what are some other features of depression?
Disturbed sleep with early morning wakening Poor concentration Low self confidence Poor or increased appetite Suicidal thoughts or acts Psychomotor retardation Guilt or self blame
Important questions to ask in depression to rule out other things?
Hypomanic or manic episodes- bipolar disorder
Normal reaction to grief
Medical disorders - chronic eg hypothyroidism, MS, alcohol and substance abuse
Medication associated with depression
Corticosteroids Beta blockers Statins Oral contraceptives Isotretinoin
Manic symptoms
Symptoms that affect social or occupational functioning or psychosis or hospitalisation distinguishes it from hypomanic
Abnormally elevated, expansive or irritable mood
Abnormal and persistent increased activity or energy
Inflated self esteem, grandiosity, flight of thoughts
Unrestrained buying, spending or gambling sprees
No drugs or other causes
Side effects of sertraline
GI upset, dry mouth, decreased libido or sexual activity, reduced ability to orgasm, mild nausea, drowsiness
Uncommon- weight gain, tremor, palpitations, urinary incontinence, urinary retention
When to refer to psychiatric services ?
- significant perceived risk of suicide, harm to others or severe self neglect
- if there are psychotic symptoms
- if there is a history or clinical suspicion of bipolar disorder
- in all cases where child or adolescent is presenting with major depression
Assessing suicide risk
Thoughts of suicide or self harm What precipitated attempt Why then, there and now Planned or impulsive Suicide note left Intoxicated Any precautions against discovery Previous attempts at suicide or self harm How do they feel now Do a PHQ9 Is there support at home Any risks to anyone Are there children at home How do they feel about the future
What increases risk of suicide ?
Age over 45 Male Family history of depression, substance misuse or suicide Unemployed Physical illness Psychiatric illness Divorced or widowed or single Personal substance misuse Previous attempts
Treatment of mild depression
Do not routinely medicate but consider use if there is moderate to severe recurrent depression or depression has persisted for more than 2-3 months
Offer low intensity psychosocial intervention eg self guided CBT, computerised CBT, structured group physical activity programme
Treatment of moderate or severe depression
Provide a combo of antidepressant meds and high intensity psychological intervention such as CBT
- SSRI- sertraline or citalopram
- SNRI- venlafaxine, mirtazapine
- Add an augmenting agent eg second gen antipsychotic such as quetiapine or lithium
- Tri cyclic - amitriptyline
- MAOI
Important things to check in treatment resistant depression
Check diagnosis Check alcohol or drug abuse Further antidepressant trials ECT Neurosurgery
Electroconvulsive therapy
Most effective treatment for severe depression, life threatening depression, prolonged or severe mania, Catatonia
SE- memory loss, short term retrograde amnesia, confusion, headaches, clumsiness
Generalised anxiety disorder symptoms
Psychological- constant worries, pervasive feeling of apprehension or dread, poor concentration, frustration, instability to tolerate uncertainty
Physical- trembling, sweating, nausea, SOB, difficulty swallowing, hot flashes, headaches, muscle ache or tension, twitching, irritability, insomnia, feeling in the edge, restlessness
Behavioural-putting things off due to feeling overwhelmed, avoidance, drug taking
More than 6 months and not tied to specific situation or OCD
Things to exclude in GAD
Phobia Hyperthyroidism Angina Asthma Excessive caffeine Alcohol Drugs
Treatment for GAD
Simple lifestyle changes- increase exercise, improve work life balance, avoid excess caffeine and stimulant drugs, avoid excess alcohol
Long term interventions such as CBT, SSRI self help
Benzos not to be used for more than 2-4 weeks due to tolerance and dependence
Benzodiazepines
Symptoms of anxiety reduces in 30-90 minutes
SE- sedation, reps depression, tolerance, dependence, impaired cognition
Discontinuation of antidepressants
Do slowly over a period of at least four weeks to prevent withdrawals and a recurrence of symptoms
Stop at an appropriate time and not during times of stress
Antidepressant discontinuation syndrome
Common symptoms- dizziness, headache, nausea, lethargy
Rarer- ataxia, electric shock sensations, EPSE, hypomania or mania
