Primary Care Management

Question 1

In terms of screening for depression, what should you be alert to in patients?

Answer 1

• PMH of depression
• Significant illness - causing disability
• Other mental health issues
  
  • e.g. dementia

Question 2

What are 2 key questions you should ask of those suspected of depression?

Answer 2

“During the last month, have you often been bothered by feeling down, depressed or hopeless?”

“During the last month, have you been bothered by having little interest or pleasure in doing things?”

Question 3

What are the NICE Guidelines of depression baed off?

Answer 3

DSM-5

Question 4

Outline the DSM-5 definition of depression.

Answer 4

Symptoms must have been present nearly every day for at least 2w.

At least one of the first 2 criteria, and a total of 5 out of the 9 criteria in total:

First 2 criteria (you must have at least one of these):

• Depressed mood.
• Loss of interest or pleasure (anhedonia).

If both criteria above are met, you need a further 3 criteria from the list below.

Mild - 5 or more (one must be from first 2)

Severe - at least 5 - with marked function impairment

Moderate - falls between mild and severe.

If only 1 criterion above is met, you need a further 4 criteria from the list below:

• Significant weight loss or gain, or change in appetite.
• Sleep difficulties (including hypersomnia).
• Psychomotor agitation or retardation.
• Fatigue.
• Feelings of worthlessness or inappropriate guilt.
• Reduced concentration or indecisiveness.
• Recurrent thoughts of death or suicidal thoughts.

Question 5

When asking a patient about suicide risk what must be discerned?

Answer 5

• Ideation
• Intent
• Plans - vague, detailed, specific, already in motion
• Previous attempts
• Homicidal risk
• Support - social support, or aware of help

Advise patient to seek further help if the situation deteriorates.

Or refer to mental health services if at risk to themselves or others.

Question 6

What is the stepped care model?

Answer 6

In treating depression, the least intrusive intervention is provided first, if that intervention in ineffective, or declined, offer an appropriate intervention from ht next step.

Question 7

What is step one of management in depression?

Answer 7

Recognise, asses and intial management.

• Interventions
  
  • Assessment
  • support
  • psycho-education
  • LIfestyle advice
  • Active monitoring
  • refer for further assesment and interventions

Question 8

What is step 2 in the management of depression?

Answer 8

Recognised depression - persistent subthreshold depressive symptoms or mild to moderate depression.

• Advice on sleep hygiene
• Offer active monitoring
  
  • discuss concerns
  • provide information about depression
    *