Mental Health Flashcards
What are the 2 core symptoms of depression?
Feeling down/depressed/hopeless Little interest or pleasure in doing things
Symptoms of depression
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
Symptoms of atypical depression
Reactive mood, increased appetite, weight gain, excessive sleepiness, sensitivity to rejection
Number of symptoms required to be diagnosed with depression
At least five out of the nine symptoms with at least one core symptom
What is dysthymia
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
Which investigations may you do to rule out other causes for depressive symptoms
Glucose, urea and electrolytes, creatinine, liver function tests, thyroid function tests, calcium, full blood count, ESR
What should a biopsychosocial assessment cover
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
3 scoring systems for depression
PHQ-9 HADS BDI-II
Treatment for subthreshold or mild-moderate depression
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
Treatment for moderate or severe depression
Antidepressant + psychological intervention
Psych interventions for depression
Low intensity- guided self help, CBT, group physical activity programme, peer support High intensity- group CBT, individual CBT, interpersonal therapy, behavioural activation, couples therapy
First line antidepressant
SSRIs e.g. citalopram, fluoxetine, paroxetine, sertraline
How long should treatment for depression last for?
At least 6 months after remission
How soon do antidepressants work
Within 2 weeks, if not seen after 4 weeks then check adherence and consider changing dose/drug
Starting dose of citalopram
20mg
Starting dose of fluoxetine or paroxetine
20mg
Starting dose of sertraline
50mg
Treatment for obesity/being overweight
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
Signs/categories of acute alcohol withdrawal and when they occur
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
Hospital admission is needed for people in alcohol withdrawl who…
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
