Psychiatry

Question 1

how is depression classified?

Answer 1

less severe = PHQ-9 of <16
more severe = PHQ-9 ≥16

Question 2

what is the PHQ-9?

Answer 2

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

Question 3

what are the screening questions for depression?

Answer 3

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

Question 4

what is the HAD?

Answer 4

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

Question 5

how do you interpret the PHQ-9 score?

Answer 5

maximum score of 27

<16 less severe
≥16 more severe

Question 6

how do you interpret the HAD scale?

Answer 6

maximum score 21 for anxiety and depression each

0-7 normal
8-10 mild
11-15 moderate
≥16 severe

Question 7

how is major depressive disorder (MDD) defined as per DSM-5?

Answer 7

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

Question 8

what is ECT?

Answer 8

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

Question 9

what is a contraindication for ECT?

Answer 9

raised intracranial pressure

Question 10

what are side effects of ECT?

Answer 10

headache
nausea
short term memory impairment
amnesia
cardiac arrhythmia

Question 11

if a patient with anxiety can’t tolerate an SSRI or SNRI, what other medication may be considered?

Answer 11

pregabalin

reduces excessive synaptic release of excitatory neurotransmitters e.g. glutamate, noradrenaline, dopamine, serotonin