Mood disorders

Question 1

screening questions depression

Answer 1

last month: feeling down, depressed, hopeless // last month: feeling little interest or pleasure

Question 2

nice criteria to grade depression

Answer 2

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

Question 3

how many criteria need to be present for depression diagnosis

Answer 3

5

Question 4

hospital assessment of depression

Answer 4

hospital anxiety and depression (HAD) // patient health questionnaire (PHQ9)

Question 5

what PHQ-9 score indicated less vs more severe depression

Answer 5

PHQ9 < 16 // PHQ9 >16

Question 6

what is dythymia

Answer 6

subclinical depression

Question 7

CT depression

Answer 7

low hippocampal

Question 8

CSF depression

Answer 8

low monoamine eg serotonin, Na, dopamine

Question 9

when would antidepressants be recommended in less severe depression

Answer 9

not routinely offered - only if person’s preference // trial psychological first, move to SSRI after 2 weeks

Question 10

1st treatment option less severe depression

Answer 10

guided self help

Question 11

order treatment options less severe depression

Answer 11

guided self help // group CBT // group behavioural activation // solo CBT // sola BA // group exercise + mindfulness // interpersonal psychotherapy // SSRI // counselling // STPP

Question 12

1st treatment severe depression

Answer 12

group CBT + SSRI

Question 13

examples first line SSRIs in depression

Answer 13

citalopram, fluoxetine, sertraline

Question 14

if first SSRI not working what is next steps

Answer 14

change to another SSRI –> switch to TCA, MAOi, SNRI

Question 15

guidance when Switching from citalopram, escitalopram, sertraline, or paroxetine to another SSR

Answer 15

withdraw first SSRI before starting alternative

Question 16

guidance when switching from fluoxetine to another SSRI

Answer 16

leave gap of 4-7 days

Question 17

when is ECT indicated in depression

Answer 17

severe + treatment resistant // those with catatonia

Question 18

contraindication ECT

Answer 18

raised ICP

Question 19

SE ECT

Answer 19

headache // nausea // short term memory loss //loss of memory before ECT // cardiac arrhythmia

Question 20

mx SAD

Answer 20

same was a depression - psychological for 2 weeks then trial SSRI // do not give sleeping tablets

Question 21

if sleep or weight loss a particular issue was antidepressant can be given

Answer 21

mitrazipine

Question 22

increased risk suicide

Answer 22

male // SH // alcohol + drugs // mental health // chronic disease // older // unemployed // single + isolated

Question 23

RF of completing suicide at a later date after failed event

Answer 23

secretive // planning // leave a note // sort out financed // violent method

Question 24

factors the reduce chance of suicide

Answer 24

family support // children at home // religious

Question 25

stages of grief

Answer 25

denial (numbness, psuedohallucinations) // anger // bargaining // depression // acceptance

Question 26

what is delayed grief reaction

Answer 26

takes 2 weeks to settle in

Question 27

what is prolonged grief reaction

Answer 27

over 12 months

Question 28

symptoms of depression > dementia

Answer 28

rapid onset // biological eg weight gain, sleep changes // reluctant to do test // global memory loss (dementia short)

Question 29

what is type I bipolar

Answer 29

mania + depression

Question 30

what is type II bipolar

Answer 30

hypomania + depression

Question 31

what is mania

Answer 31

lasts 7+ days // severe functional impairment // flight of ideas, disinhibition (over friendly), sexual energy, very reckless + unsettled, delusions of grandeur, auditory hallucinations

Question 32

what is hypomania

Answer 32

lasts 4 days // mild spending sprees // increased talkative, make lots of plans but dont commit

Question 33

mood stabilisers bipolar

Answer 33

1 = lithium // 2 = valproate

Question 34

mx mania bipolar

Answer 34

stop antidepressant –> antipsychotic eg olanzapine ir haloperidol

Question 35

mx depression bipolar

Answer 35

quitipeine or fluoxetine

Question 36

referral to mental health in bipolar

Answer 36

hypomania = routine to community mental health // mania = urgent referral

Question 37

when starting a SSRI for depression when does the patient need to be reviewed

Answer 37

1 week if under 25 // 2 weeks if over 25