Psychiatry Flashcards
how is depression classified?
less severe = PHQ-9 of <16
more severe = PHQ-9 ≥16
what is the PHQ-9?
patient health questionnaire-9
9 items scaled 0-3 (0 not at all, 3 nearly every day)
maximum score of 27
<16 less severe, ≥16 more severe
includes questions on mood, sleep, energy, appetite, concentration, thoughts of self-harm/suicide, guilt
what are the screening questions for depression?
1) during the last month, have you been bothered by feeling down, depressed, or hopeless?
2) during the last month, have you been bothered by having little pleasure or interest in doing anything?
if yes to either of these, complete more thorough assessment
what is the HAD?
hospital anxiety and depression scale
14 questions, 7 for anxiety, 7 for depression
each question scaled 0-3
maximum score of 21 for each anxiety and depression
patients encouraged to not overthink questions
how do you interpret the PHQ-9 score?
maximum score of 27
<16 less severe
≥16 more severe
how do you interpret the HAD scale?
maximum score 21 for anxiety and depression each
0-7 normal
8-10 mild
11-15 moderate
≥16 severe
how is major depressive disorder (MDD) defined as per DSM-5?
5 or more of the following within the same two week period
must have depressed mood or loss of pleasure as one of them:
1) depressed mood
2) diminished pleasure
3) significant weight loss or gain
4) insomnia or hypersomnia
5) psychomotor agitation or retardation
6) fatigue/low energy
7) feelings of worthlessness or guilt
8) poor concentration or decisiveness
9) recurrent thoughts of death or suicide
what is ECT?
1) brief electric current passed through the brain while pt under GA
2) usually a course of 6-12 sessions twice a week
3) for patients with severe treatment resistant depression
what is a contraindication for ECT?
raised intracranial pressure
what are side effects of ECT?
headache
nausea
short term memory impairment
amnesia
cardiac arrhythmia
if a patient with anxiety can’t tolerate an SSRI or SNRI, what other medication may be considered?
pregabalin
reduces excessive synaptic release of excitatory neurotransmitters e.g. glutamate, noradrenaline, dopamine, serotonin
what is section 2?
admission for assessment up to 28 days
tx can be given against pt’s wishes
what is section 3?
admission for treatment up to 6 months
tx can be given against pt’s wishes
what is section 4?
72 hour assessment order
used as an emergency
what is section 5(2)?
pt who is in hospital can be detained by doctor for 72 hours
what is section 5(4)?
pt who is in hospital can be detained by nurse for 6 hours
what is section 17a?
community treatment order
what is the difference between section 135 and section 136?
135- police can break into property to take someone to place of safety
136- police can take someone from the public to a place of safety (24 hours until MHA assessment arranged)
