Schwenk > Depression & Primary Care Flashcards
what impacts physical and social functioning the most?
depression
greater than HTN, diabetes, angina, arthritis, GI, lung probs, or low back pain
T/F: you can be depressed without feeling sad
true
Depression is an (blank) for poor prognosis
independent risk factor
depression causes (poor/better) adherence to meds & tx
poor
T/F: depression should be solved alone
false
that’s a myth
what are 6 clues to the depressed pt?
verbally unproductive flat problem pt multiple complaints, sx, visits sx-sign mismatch physician dysphoria when w/ pt
T/F: pts experiencing depression come to the doctor and complain of depression
false
more often it’s chronic pain
who prescribes over half of antidepressants?
primary care MDs
more than half of antidepressants are prescribed for what?
something other than depression
what are the 6 indications for referral of a mental health pt?
severe suicidal thinking psychosis, bipolar (axis II) complicated substance abuse poor psychosocial support disorganized rapid deterioration failed tx
What are the 10 rules for caring for depressed pts?
- dispel myths
- use epidemiology
- indirect clues
- focus on fxnal impairment
- counter competing priorities
- co-morbidity
- psychopharm
- education, supportive counseling
- chronic disease tx
- psych consult
T/F: depression is a failure of willpower
false
T/F: depression can be associated with feelings of inadequacy & guilt
true
Depression in primary care is (under/over)appreciated
under
depression (increases/decreases) healthcare costs
increases
are medical & psych co-morbidities common?
yes
and complicating
how effective are physician educational interventions?
not very
“show little effect”
what is the general barrier to improvement in primary care & mental health?
systemic problem
not really physician/professional barrier
how might a physician cope with depression (poorly)?
by working HARDER
when do medical student severe depression rates peak?
2nd year
when did suicidal ideation among medical students peak?
4th year (6.6%)
do female or male medical students have higher rates of depression?
female
15.2% vs 7.9%
are depression rates among medical students higher or lower than the age-matched population?
higher
what 4 groups of medical students had the highest risk of depression?
women
unmarried students
students w/ kids
Hispanic students
what is the prevalence (%) of XS alcohol use among med students?
20%
T/F: less students are entering medical school with a hx of depression
FALSE
it’s MORE
is the suicide risk higher or lower among physicians?
higher
- 5-3x in men
- 5-6x in women
what increases the risk of suicide in physicians?
disabling physical conditions
professional loss
financial probs
overwork
what 4 things are depressed physicians more likely to do?
avoid seeking care
self-prescribe antidepressants
seek care outside community or pay cash
don’t seek care at all (d/t concern abt staff privileges or licensing)
do depressed or non-depressed medical students say they would seek treatment?
non-depressed
what are DEPRESSED medical student attitudes about depression?
telling someone abt the depression would be risky
admitting depression = inadequate coping skills
makes pt feel less intelligent
means that pt is unable to handle responsibilities
respect opinions less
what 5 factors affect medical students w/ depression?
personal weakness social/professional discrimination devaluation of depressed students perceptions of poor performance need for secrecy
what is the “conspiracy of silence”?
the fact that stigma reduction in physicians & med students is LAGGING BEHIND stigma reduction in pts
