Psych - Depression and ECT Flashcards

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1
Q

What are the core symptoms of depression?

A
  • Low mood
  • Anhedonia
  • Decreased energy (or increased fatiguability)
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2
Q

What tools are available to assess someone’s depression?

A

Hospital Anxiety and depression scale (HAD)

  • 7 questions for anxiety and 7 for depression.
  • Produces a score out of 21 for both anxiety and depression, anything >11 is indicative of anxiety or depression

Patient Health Questionaire (PHQ-9)

  • Asks patients how they have been feeling in last 2 weeks
  • The closest to 27, the more severe the depression
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3
Q

How would you quantify the severity of someone’s depression?

A
  • Mild depression: few, if any of the 5 sx required o make a diagnosis. Sx result in only minor functional impairment
  • Moderate depression: sx or functional impairment between ‘milk’ and ‘severe’
  • Severe depression: has most sx and these markedly interfere with functioning. Can occur with or without psychotic sx
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4
Q

What are other sx of depression?

A
  • Reduced concentration and attention
  • Reduced self esteem and self confidence
  • Ideas of guilt and worthlessness
  • Feeling of hopelessness regarding the future
  • Thoughts of self harm
  • Decreased sleep and/or appetite
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5
Q

Describe some clinical features of depression

A

-Thought content: negative, pessimistic thoughts
-Biological symptoms: reduced sleep, appetite and libido, sleep pattern of waking up hours before you are supposed to
• Motor activity: altered - psychomotor agitation or retardation or both
• Cognition: reduced attention, concentration and decisiveness
• Ahnedonia can be accompanied by loss of motivation and emotional reactivity
• Psychotic features

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6
Q

What type of psychotic features can be present in depression?

A
  • Psychotic features are usually mood-congruent
  • Delusions are nihilistic, delusional or hypochondriacal (illness or death)
  • Hallucinations: auditory, 2nd person and accusing, condemning or urging patient to commit suicide
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7
Q

What is atypical depression?

A

-Initial anxiety related insomnia, subsequent oversleeping, increased appetite and relatively bright and reactive mood. Common in adolescence

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8
Q

What is the differential diagnosis for depression?

A
  • Normal sadness (eg bereavement) or severe physical illness. Predominant negative, guilty or suicidal thoughts favour depression
  • Psychotic depression vs schizophrenia: differentiate based on through the content (mood-congruent psychotic features) and temporal sequence in which the sx developed
  • Alcohol/drug withdrawal can mimic depression
  • Depressive retardation vs flat (unreactive) affect of chronic schizophrenia
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9
Q

What else should you screen for when taking a history for depression?

A
  • Hypomania and mania (if someone is low, ask if they ever feel high)
  • Anxiety sx
  • Psychotic sx
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10
Q

What is the management of depression? When should you make referrals to psych?

A
  • Most depressive illnesses can be managed in primary care
  • Make a referral to psych if suicide risk is high, depression is severe, unresponsive to initial treatment, bipolar or recurrent
  • Mild depression: self help, CBT, structured physical activity
  • Moderate depression: psychological therapy, antidepressants (SSRIs are 1st line, try 2 SSRIs and then switch to SNRIs)
  • Resustant depression: can augment with lithium
  • ECT in treatment resistant depression
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11
Q

Prescribing antidepressants: What should you do if you are switching from citalopram, escitalopram, sertraline or paroxtine to another SSRI?

A

-First SSRI should be withdrawn (with dose reduction before stopping) before an alternative SSRI is started

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12
Q

Prescribing antidepressants: what should you do if switching from fluoxetine to another SSRI?

A

-Withdraw fluoxetine and then leave a gap of 4-7 days (has a long T1/2) before starting a low0dose of the alternative SSRI

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13
Q

Prescribing antidepressants: What should you do when switching from a SSRI to a TCA?

A
  • Cross-tapering is recommended: reduce current drug dosage whilst slowly increasing the dosage of the new drug
  • Apart from fluoxetine, which should be withdrawn before starting a TCA
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14
Q

What does ECT involve? What are the indicators for ECT?

A

-Involves the induction of a modified cerebral seizure

Indications:

  • Moderate depression that has not responded to multiple drug and psychological treatment
  • Severe depressive illness
  • Prolonged or severe episode of mania that has not responded to treatment
  • Catatonia
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15
Q

Name some contra-indications of ECT

A
  • Raised ICP
  • Recent stroke
  • Recent MI
  • Crescendo Angina
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16
Q

Name some side effects of ECT

A

Short term cognitive impairment: must assess cognitive function prior to, during and after tx

  • Orientation and time to orientation post tx
  • New learning
  • Retrograde amnesia
  • Subjective memory impairment