Mental Health

Question 1

What are the 2 core symptoms of depression?

Answer 1

Feeling down/depressed/hopeless Little interest or pleasure in doing things

Question 2

Symptoms of depression

Answer 2

Feeling down, depressed or hopeless Little interest or pleasure in doing things Fatigue/loss of energy Worthlessness/excessive or inappropriate guilt Thoughts of death/suicide Reduced concentration or indecisiveness Psychomotor agitation or retardation Insomnia/hypersomnia Appetite and/or weight loss

Question 3

Symptoms of atypical depression

Answer 3

Reactive mood, increased appetite, weight gain, excessive sleepiness, sensitivity to rejection

Question 4

Number of symptoms required to be diagnosed with depression

Answer 4

At least five out of the nine symptoms with at least one core symptom

Question 5

What is dysthymia

Answer 5

Persistent subthreshold depressive symptoms At least two years of depressed mood for more days than not Has at least two but less than five of the symptoms required for diagnosis of depression

Question 6

Which investigations may you do to rule out other causes for depressive symptoms

Answer 6

Glucose, urea and electrolytes, creatinine, liver function tests, thyroid function tests, calcium, full blood count, ESR

Question 7

What should a biopsychosocial assessment cover

Answer 7

Current symptoms including duration and severity Personal history of depression Family history of mental illness Interpersonal relationships Living conditions Social support Employment/financial worries Alcohol and substances Suicidal ideation Discussion of treatment options Any past experience of, and response to, treatments

Question 8

3 scoring systems for depression

Answer 8

PHQ-9 HADS BDI-II

Question 9

Treatment for subthreshold or mild-moderate depression

Answer 9

Psychological intervention Avoid antidepressants unless patient has history of moderate depression, subthreshold symptoms for >2 years, or if mild depression is complicating care of a chronic physical heath problem

Question 10

Treatment for moderate or severe depression

Answer 10

Antidepressant + psychological intervention

Question 11

Psych interventions for depression

Answer 11

Low intensity- guided self help, CBT, group physical activity programme, peer support High intensity- group CBT, individual CBT, interpersonal therapy, behavioural activation, couples therapy

Question 12

First line antidepressant

Answer 12

SSRIs e.g. citalopram, fluoxetine, paroxetine, sertraline

Question 13

How long should treatment for depression last for?

Answer 13

At least 6 months after remission

Question 14

How soon do antidepressants work

Answer 14

Within 2 weeks, if not seen after 4 weeks then check adherence and consider changing dose/drug

Question 15

Starting dose of citalopram

Answer 15

20mg

Question 16

Starting dose of fluoxetine or paroxetine

Answer 16

20mg

Question 17

Starting dose of sertraline

Answer 17

50mg

Question 18

Treatment for obesity/being overweight

Answer 18

Tailored weight management programme incl behaviour change strategies

Drug treatment in BMI 30+ or BMI 27+ with risk factors e.g. T2DM, HTN, dyslipidaemia:

• Orlistat + hypocalorific diet
• Liraglutide + reduced calorie diet + increased physical activity

Bariatric surgery if BMI >50 if other interventions not effective (or for some adults with BMI 40+, or 35-40

Question 19

Signs/categories of acute alcohol withdrawal and when they occur

Answer 19

Mild- HTN, tachycardia, anorexia, anxiety, emotional lability, insomnia, irritability, diaphoresis, headache, fine tremor

Moderate- worsening mild symptoms + agitation and coarse tremor

Severe/delirium tremens: worsening moderate symptoms + confusion/delirium, generalised tonic-clonic seizures, auditory, visual or tactile hallucinations, hyperthermia secondary to psychomotor agitation

Mild-moderate withdrawal- can begin 4-6hr after last drink, peaks at 24-36hrs

Severe symptoms- occur after 24hrs and usually peak at day 2

Delirium tremens- after 3 days of abstinence/decreased drinking

Question 20

Hospital admission is needed for people in alcohol withdrawl who…

Answer 20

Have alcohol withdrawal seizures/delirium tremens

or those who are at high risk of developing them (hx alcohol withdrawal seizures/delirium tremens, or signs of autonomic overactivity e.g. sweating, tremor, tachycardia, palpitations, and signs of intoxication)

People with clinical features of Wernicke’s encephalopathy