Mental Health

Question 1

low mood presentation

Answer 1

tired
less confident
sad , frustrated/angry , worried/anxious 
stop doing things you like
cut social ties 
difficulty sleeping

if longer than 2 weeks can be sign of depression
common after distressing events, can occur randomly

Question 2

depression - diagnosis

Answer 2

core symptoms - >2wks most days most of the time:

1. low, mood, depressed, hopeless
2. loss of interest (anhedonia)

also ask about:

1. associated symptoms:
   - sleep disturbance,
   - low energy/fatigue
   - appetite/weight changes
   - poor concentration/indecisiveness
   - worthlessness/self-criticism and guilt
   - libido changes
   - suicidal thoughts/acts
   - agitation/slowing movements
2. risk factors

Question 3

Risk factors of depression

Answer 3

> 65
postnatal 
grievances - death/loss
conflict - personal turmoil/w others
personal history or FH 
abuse 
Chronic/physical illness 
alcohol/drugs misuse

Question 4

PHQ-9 what is it?

Answer 4

over last two weeks: answer w nearly every day (3) , > half the days (2), several days (1) not at all (0)

1. core symptoms
2. sleep
3. appetite
4. tired/low energy
5. bad about yourself - failure/letting fam down?
6. concentrating - newspaper/tv?
7. others notice? your slow movements, or fidgety/restless
8. thoughts that you’d be better off dead or any of hurting yourself in some way

5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe.

Question 5

grades of depression

Answer 5

subthreshold - 2-5 symptoms
mild - >5 symptoms
moderate
severe - functional impairment and many symptoms
persistent subthreshold - 2 years
seasonal affective disorder - remission between annual season of depression

Question 6

Management of mild depression

Answer 6

1. low -intensity psychosocial interventions:
   - individual guided self-help
   - CCBT or
   - group based physical activity
   1b. group - based CBT if 1. declined
2. antidepressants if:
   - symptoms persist after interventions
   - depression is complicating management of a chronic physical health problem

Question 7

M moderate/ severe

Answer 7

1. High intensity psychological intervention
   - individual CBT, interpersonal therapy, behavioural activation, (couples therapy)
2. counselling and short-term psychodynamic therapy
   - if decline 1. and antidepressants

consider antidepressants

Question 8

Antidepressants

inc. considerations

Answer 8

consider and explain:

• symptoms can initially worsen
• take time to work
• continued 6 months following remission
• suicide risk
• toxicity in overdose

1. SSRI - citalopram, fluoxetine, paroxetine, sertraline
   - citalopram - X in ppl taking medication which prolong the QT interval
   - generic SSRI - citalopram, sertraline - if chronic physical health problem

Question 9

give examples of 5 comorbid conditions which can occur with depression (inc management)

Answer 9

alcohol/substance abuse - treat this and depression usually resolves
anxiety - 2nd priority to depression
psychotic symptoms - antidepressants in ppl with bipolar disorder can trigger mania
dementia - psychological treatment > antidepressants
eating disorders - assess self-harm/suicide risk

Question 10

what to do if hospital admission required?

Answer 10

every attempt to persuade them to go voluntarily

if they decline - compulsory admission under mental health act