Reproductive Mental Health

Question 1

What are some questions that can be asked to screen for depression?

Answer 1

• During the last month, have you often been bothered by feeling down, depressed or hopeless?
• During the last month, have you often been bothered by having little interest or pleasure in doing things?

Question 2

What diagnostic criteria are used for depression?

Answer 2

• ICD 10 (4/10 depressive symptoms)
• DSM IV (5/9 to diagnose major depression)
• Symptoms must be present for at least 2 weeks and should be present for most of every day
• Often has a remitting relapsing course

Question 3

Stepped care model
What is step 1 in managing depression?

Answer 3

Step 1: all known and suspected presentations of depression
- Assessment
- Support
- Psychoeducation
- Active monitoring
- Referral for further assessment and intervention

Question 4

Stepped care model
What is step 2 in managing depression?

Answer 4

Step 2: Persistent subthreshold depressive symptoms; mild to moderate depression
- Low-intensity psychosocial interventions
- Psychological interventions
- Medication
- Referral for further assessment and intervention

Question 5

Stepped care model
What is step 3 in managing depression?

Answer 5

Step 3: persistent subthreshold depressive symptoms or mild to moderate depression with inadequate response to initial interventions; moderate and severe depression
- Medication
- High-intensity psychological interventions
- Combined treatments
- Collaborative care
- Referral for further assessment and interventions

Question 6

Stepped care model
What is step 4 in managing depression?

Answer 6

Step 4: severe and complex depression; risk to life; severe self-neglect
- Medication
- High intensity psychological interventions
- ECT
- Crisis service
- Combined treatment
- Multi-professional and inpatient care

Question 7

What are some low-intensity psychological interventions to manage depression?

Answer 7

• Self-help based on CBT
• Computerised CBT
• Structured group physical activity programme

Question 8

What is first-line medical treatment for depression?

Answer 8

SSRIs
- Citalopram or sertraline
- Fluoxetine and paroxetine have the risk of more drug interactions
- Give gastric protection in the elderly and for those on NSAIDs

Question 9

Describe venlafaxine

Answer 9

• SNRI
• Greater risk of death from overdose
• Needs to be stopped gradually
• Can exacerbate cardiac arrhythmias and hypertension

Question 10

What are high-intensity psychological interventions for depression?

Answer 10

• CBT
• Interpersonal therapy (IPT)
• Behavioural activation
• Behavioural couples therapy

Question 11

Describe the medical therapy for generalised anxiety disorder

Answer 11

• First line: SSRIs (sertraline usually)
• Second line: SNRI
• Third line: pregabalin
• Benzodiazepines should only be used short-term

Question 12

How do you manage panic disorders?

Answer 12

Mild-moderate
- Individual facilitated self-help
Moderate-severe
- CBT
- Antidepressants
– Do not prescribe benzos or sedating anti histamines
– SSRIs are first-line
– Review at 12 weeks
– SNRIs and TCAs are licensed for panic disorder
- Can be referred for intensive CBT if the above has failed