Mental health Flashcards
What are the 2 core and 6 additional symptoms of depression
CORE:
- Persistant sadness or low mood nearly everyday
- loss of interests or pleasure in most activities
ADDITIONAL:
- fatigure/ low energy
- worthlesness, guilt, low self confidence
- thoughts of suicide/ death
- poor concentration/ indecisiveness
- psychomotor agitation
- insomnia/ hypersomnia/ EMW
- appetite/ weight changes
Give 4 differentials for depression
- bipolar
- schizophrenia
- seasonal affective disorder
- hypothyroidism
- hypercalcaemia
- diabetes (low energy)
- progesterone contraceptives can cause
What are risk factors for suicide in depressed patients?
- male <30 or old age, single or living alone
- prior suicide attempts or FHX
- Hx substance or alcohol abuse
- recently started on antidepressants
- few protective factors (family etc)
- method and plan
What questionnaires can be used in primary care to asses depression?
Patient health questionnaire 9 (PHQ-9)
HADS
Back depression inventory 2
How should suicidal patients be managed in primary care?
- contact crisis team
- voluntary admission or compulsory admission may be required
- r/v the pt frequently in primary care
how should mild to moderate depression be managed in primary care?
- individual, group based or computerised CBT and counselling (can self refer for computer or group)
- avoid antidepressants unless PMH severe depression, persistant, or as a complication of a long term condition
How is moderate to severe depression managed in primary care?
- high intensity CBT or interpersonal therapy
- Usually use antidepressants as well
What is first line antidepressant drug used in primary care and why?
- SSRI (eg fluoxetine, citalopram, sertraline): as effective as TCA and less likely to cause side effects and less toxic on OD
Which SSRI is favoured in depressed pts with chronic physical health problems and why?
Sertraline as fewer drug interactions
Other than SSRIs, what other drugs can be used for treatment of depression?
Venlafaxine or duloxetine (SNRI)
Amitriptyline (TCA- rarely used)
How long do anti depressants take to work and how long should they be taken for after symptoms have improved?
- Take at least 2 weeks to work and can make you worse in this time
- if no effect after 4 weeks, increase the dose, if still no effect after a further 2-4 weeks then switch drugs (can be different ssri or different class altogether)
- need to be continued for 6 months after symptoms stopped or 2 years if >1 severe depressive episode
how should antidepressants be stopped?
reduce dose gradually over 4 week period
When should secondary care referral be made for depression? (5)
- uncertain diagnosis (?bipolar)
- failed response to 2 interventions
- depression for >1 year
- persistant suicidal thoughts
- substance, physical or sexual abuse
- rapid deterioration
What are the risk factors for generalised anxiety disorder?
age 35-35
female
being divorced or seperated
living alone or lone parent
What are major and minor symptoms of GAD?
- excessive anxiety and worry occuring more days than not for <6 months about a wide range of events or activities
- worry is difficult to control
- restlessness, feel on edge
- fatigue easily
- difficulty sleeping and concentrating, mind blanks
- muscle tension
- irritability
- high HR, palpitations, sweating, trembling/ shaking
- difficulty breathing, chocking feeling, chest pain, nausea
- lightheadedness
- fear of dying or losing control
