Psychiatry

Question 1

What is the DSM-5 criteria for depression?

Answer 1

5 or more symptoms in the same 2 week period
at least 1 symptom has to be:
🔹low mood
🔹anhedonia
other symptoms
🔹physical: weight loss/gain, fatigue, lack of energy
🔹sleep: insomnia/hypersomnia, early morning wakening
🔹psychomotor agitation or retardation observable by others
🔹thought: feeling of worthlessness or guilt, recurrent thoughts of death, suicidal ideation
🔹lack of concentration

Question 2

How is depression classified as per NICE?

Answer 2

Less severe depression - PHQ-9 < 16

More severe depression - PHQ-9 >/= 16

Question 3

What is the management of less severe depression according to NICE?

Answer 3

discuss treatment options with pt and reach a shared decision
consider ‘the least intrusive and least resource intensive treatment first’
recommends not routinely offering ‘antidepressant medication as first-line treatment for less severe depression, unless that is the person’s preference’.

Treatment options, listed in order of preference by NICE
🔹guided self-help
🔹group cognitive behavioural therapy (CBT)
🔹group behavioural activation (BA)
🔹individual CBT
🔹individual BA
🔹group exercise
🔹group mindfulness and meditation
🔹interpersonal psychotherapy (IPT)
🔹selective serotonin reuptake inhibitors (SSRIs)
🔹counselling
🔹short-term psychodynamic psychotherapy (STPP)

Question 4

What is the management of more severe depression?

Answer 4

NICE recommend a shared decision should be made.

Treatment options, listed in order of preference by NICE
🔹a combination of individual cognitive behavioural 🔹therapy (CBT) and an antidepressant
🔹individual CBT
🔹individual behavioural activation (BA)
🔹antidepressant medication: selective serotonin reuptake inhibitor (SSRI), or serotonin-norepinephrine reuptake inhibitor (SNRI), or another antidepressant if indicated based on previous clinical and treatment history
🔹individual problem-solving
🔹counselling
🔹short-term psychodynamic psychotherapy (STPP)
🔹interpersonal psychotherapy (IPT)
🔹guided self-help
🔹group exercise

Question 5

What are the different types of dementia?

Answer 5

Mild cognitive impairment involves a deficit in cognition and memory that is greater than expected with age but not significant enough for a diagnosis of dementia. People with mild cognitive impairment can usually live independently.

Alzheimers dementia is the most common type of dementia. The underlying pathophysiology involves brain atrophy, amyloid plaques, reduced cholinergic activity and neuroinflammation.

Vascular dementia is the second most common type. It is caused by vascular damage and impaired blood supply to the brain. Risk factors are the same as other cardiovascular diseases (e.g., hypertension, diabetes and smoking).

Dementia with Lewy bodies is a type of dementia associated with features of Parkinsonism. It causes a progressive cognitive decline. There are associated symptoms of visual hallucinations, delusions, REM sleep disorders and fluctuating consciousness.

Frontotemporal dementia is a rarer type that notably affects people at a younger age (starting aged 40-60). It mainly affects the frontal and temporal lobes. The initial presentation typically involves abnormalities in behaviour, speech and language. It can be familial (inherited).

Question 6

What are some cognitive screening tests?

Answer 6

Six Item Cognitive Impairment Test (6CIT)
10-point Cognitive Screener (10-CS)
Mini-Cog
General Practitioner Assessment of Cognition (GPCOG)
Montreal Cognition Assessment (MoCA)

Question 7

How is dementia assessed?

Answer 7

Addenbrooke’s Cognitive Examination-III (ACE-III)
88/100 = possible dementia