Mood disorders Flashcards
screening questions depression
last month: feeling down, depressed, hopeless // last month: feeling little interest or pleasure
nice criteria to grade depression
DSM-IV = depressed mood most of day, nearly every day // little interest or pleasure in activities // weight loss or weight gain // insomnia (early waking) or hypersomnia // psychomotor agitation or retardation // loss of energy // feelings of worthlessness or guilt // loss of concentration + indecisive // recurrent thoughts of death or suicide
how many criteria need to be present for depression diagnosis
5
hospital assessment of depression
hospital anxiety and depression (HAD) // patient health questionnaire (PHQ9)
what PHQ-9 score indicated less vs more severe depression
PHQ9 < 16 // PHQ9 >16
what is dythymia
subclinical depression
CT depression
low hippocampal
CSF depression
low monoamine eg serotonin, Na, dopamine
when would antidepressants be recommended in less severe depression
not routinely offered - only if person’s preference // trial psychological first, move to SSRI after 2 weeks
1st treatment option less severe depression
guided self help
order treatment options less severe depression
guided self help // group CBT // group behavioural activation // solo CBT // sola BA // group exercise + mindfulness // interpersonal psychotherapy // SSRI // counselling // STPP
1st treatment severe depression
group CBT + SSRI
examples first line SSRIs in depression
citalopram, fluoxetine, sertraline
if first SSRI not working what is next steps
change to another SSRI –> switch to TCA, MAOi, SNRI
guidance when Switching from citalopram, escitalopram, sertraline, or paroxetine to another SSR
withdraw first SSRI before starting alternative
guidance when switching from fluoxetine to another SSRI
leave gap of 4-7 days
when is ECT indicated in depression
severe + treatment resistant // those with catatonia
contraindication ECT
raised ICP
SE ECT
headache // nausea // short term memory loss //loss of memory before ECT // cardiac arrhythmia
mx SAD
same was a depression - psychological for 2 weeks then trial SSRI // do not give sleeping tablets
if sleep or weight loss a particular issue was antidepressant can be given
mitrazipine
increased risk suicide
male // SH // alcohol + drugs // mental health // chronic disease // older // unemployed // single + isolated
RF of completing suicide at a later date after failed event
secretive // planning // leave a note // sort out financed // violent method
factors the reduce chance of suicide
family support // children at home // religious
stages of grief
denial (numbness, psuedohallucinations) // anger // bargaining // depression // acceptance
what is delayed grief reaction
takes 2 weeks to settle in
what is prolonged grief reaction
over 12 months
symptoms of depression > dementia
rapid onset // biological eg weight gain, sleep changes // reluctant to do test // global memory loss (dementia short)
what is type I bipolar
mania + depression
what is type II bipolar
hypomania + depression
what is mania
lasts 7+ days // severe functional impairment // flight of ideas, disinhibition (over friendly), sexual energy, very reckless + unsettled, delusions of grandeur, auditory hallucinations
what is hypomania
lasts 4 days // mild spending sprees // increased talkative, make lots of plans but dont commit
mood stabilisers bipolar
1 = lithium // 2 = valproate
mx mania bipolar
stop antidepressant –> antipsychotic eg olanzapine ir haloperidol
mx depression bipolar
quitipeine or fluoxetine
referral to mental health in bipolar
hypomania = routine to community mental health // mania = urgent referral
when starting a SSRI for depression when does the patient need to be reviewed
1 week if under 25 // 2 weeks if over 25
