Mental Health Assessment Flashcards
DSM-5 Means
Diagnostic and Statistical Manual of Mental Disorder
“Bible of neuropsychiatry
DSM provides what information?
Age of onset of illness Clinical course of disease Complication Predisposing factors Prevalence Differential Diagnoses Diagnostic criteria Number of symptoms/time course required
MSE is what?
Mental Status Examination
MSE includes:
Appearance Attitude Psychomotor Activity (over or underactive) Speech/Language/Eye Contact Mood Affect (reactive, limited/excessive facial expression) Thought content/process Insight/judgment Neuropsychiatric evaluation
Depression has been associated with:
increased risk of morbidity and mortality in pts with chronic medical conditions such as CVD
Medical Conditions that can cause Depression
Hypothyroidism Alzheimer's disease Decreased Vit B12/folate PK disease Severe anemia Cancer Infxn Autoimmune Post-stroke Menopause HF Electrolyte imbalance CAD
Substance disorders that can cause depression
Alcoholism Marijuana Nicotine Opiate Stimulant
Medications that can cause depression
BB Benzo Opioids Clonidine Barbiturates Anticonvulsants Interferon Oral Contraceptive Isotretinoin Glucocorticoids
Define Dysthymia
Persisttent Depressive Disorder
- Chronic disturbance of mood involving depressed mood combined with at least 2 other symptoms
- Experienced a depressive mood more days than not for at least 2 years
Other symptoms include
Appetite disturbance Low energy Sleep disturbance Feelings of hopelessness Low self-esteem Poor concentration or indecisiveness
Define Major Depressive Disorder
- Five or more of the following symptoms with at least 1 being the first two
- Depressed mood
- Decreased interest or pleasure
- Decreased energy
- Feeling worthlessness/guilt
- Changes in body weight
- Poor concentration
- Sleep disturbances
- Recurrent thoughts of death
- Psychomotor agitation or retardation - Experience 5+ symptoms nearly every day for at least 2 week and they’ve caused a change in daily function
- Symptoms are not due to substance or medical condition
Assessing Symptoms of Depression
SIGE CAPS S: sleep I: Interested G: Guilt E: Energy C: Concentration A: Appetite P: Psychomotor (agitated or motivation problems) S: Suicide
What increases a patient’s risk for suicide
Widowed/unmarried/living alone Male Feelings of hopelessness Prior suicide attempts/plans FH Serious medical conditions Lack of social support Substance abuse History of psych admission
Black box warning for antidepressants?
High risk of suicidal behavior was found during the first 30 days
Why treat depression?
Increase QofL
Decreased suicide risk
Decreased morbidity/mortality of other disease states
Psychotherapy options
Cognitive Behavioral Therapy
Interpersonal therapy
Group Therapy
Electroconvulsive Therapy Used for
Only for severe depression, resistant depression, depression + psyotic/catatonic feature, or severe suicidal ideation
How does electroconvulsive therapy work?
Electrical charge is applied to stimulate the brain and produce a seizure which last about 1 minute
- 6 to 12 treatments then continued antidepressant therapy
Bright Light Therapy
For seasonal affective disorder
Exposed to 30 of artificial light upon rising
1-2 weeks long
Vagal Nerve Stimulation Uses
Adjunctive to long-term, chronic or recurrent depression (>2 years), no responding to at least 4 trials of drugs
Vagal Nerve Stimulations works how?
Surgical implantation under the skin on the chest causes electrical connection to vagal nerve
When activated mild pulses are sent to nerve and travel to brainstem which results in improved mood and depressive symptoms
Take 10 weeks to see a response
Decreased Positive Affect =
Anhedonia Lack of Motivation Decreased Energy Apathy Decreased executive function
Treatment of decrease positive affect
Drugs that increase NE and DA
Increased Negative Affect =
Worry Worthlessness Suicidal ideation Anxious Guilt
Treatment of increased negative affects
Drugs that increase 5HT
Treatment Guidelines Overview
- Perform full history/physical, lab evaluation, mental health assessment
- Initial Therapy
- Partial Response
- No response
- TCA no recommend but can be used for partial or no response
- MAOI should be last line therapy
Initial Therapy Options
SSRI SNRI Bupropion Mirtazapine - Titrate to therapeutic dose and assess for efficacy in 4-6 weeks
Partial Response Options
- Increase dose if not at max
2. Add psychotherapy if agrees AND/OR add augmentation agent
Augmentation agent options
Non-MAOI with different MOA
Lithium
THyroid hormone
2nd gen antipsychotic
No Response Options
D/c initial drug and try another
May switch to drug in the same class
Acute Phase Treatment
Usual 6-12 weeks
Goal: reach remission of symptoms
Continuation Phase Treatment
Continue effective drug for 4-9 months after remission is achieved
Goal: prevent relapse
Maintenance Phase Treatment
Continued treatment for 12 months and longer after remission
Goal: prevent recurrences
After 1 episode of depression,
pt has a 50% chance of recurrence
After 2 episodes of depression,
pt has a 70% chance of recurrence
After 3 episodes of depression,
pt has a 90% chance of recurrence, so lifetime antidepressants therapy is recommended