Psychiatry

Question 1

What is Depressive disorder

Answer 1

A mood disorder that causes a persistent feeling of sadness and loss of interest

Question 2

What are risk factors for Depressive disorder

Answer 2

• Female
• Past history of depression
• Significant physical illness causing disability or pain
• Other mental health problems (e.g. dementia)
• Being part of a refugee community

Question 3

What are the signs and symptoms of Depressive disorder

Answer 3

Major depression requires at least one of the core symptoms:

• Persistent sadness or low mood nearly every day
• Loss of interests or pleasure in most activities

Along with some of the following symptoms:

• Fatigue or loss of energy
• Worthlessness, excessive or inappropriate guilt
• Suicidal thoughts
• Diminished ability to think or concentrate
• Psychomotor agitation and retardation
• Insomnia
• Changes in appetite and/or weight loss

Question 4

How is Depressive disorder investigated

Answer 4

Assessment tools:

• Patient health questionnaire (PHQ-9)
• Hospital anxiety and depression (HAD) scale
• Beck’s depression inventory

Consider organic cause to the depression (Hypothyroidism, Hypercalcaemia, Addison’s disease, Cushing’s disease)

Question 5

What is the process to aid a patient in Smoking cessation

Answer 5

Ask: systems should be established in each clinic that identify the smoking status of each patient and that communicate this status to physicians.

Advise: a personalised, open, and reflective patient-centred discussion should be provided on how smoking cessation can help patients achieve their goals.

Assess: it should be determined whether patients are ready to consider attempting to stop and, if ready, how confident they are about success.

Assist: for those not yet ready to attempt stopping, communication lines should be kept open for motivational messages, to let them know help is available when they are ready. For those who are ready, a menu of available pharmacotherapy and counselling options should be provided. First-line pharmacotherapy doubles the success rate of a stopping attempt.

Question 6

What medications can aid Smoking cessation

Answer 6

1. NRT - Nicotine replacement therapy
2. Bupropion or Varenicline
3. Bupropion and nicotine transdermal
4. Clonidin or nortriptyline

Question 7

What are complications of Smoking cessation

Answer 7

Nicotine withdrawal symptoms
Weight gain - 4 to 6kg

Altered HR and BP
Changes in glycemic control in diabetes