Schwenk > Depression & Primary Care

Question 1

what impacts physical and social functioning the most?

Answer 1

depression

greater than HTN, diabetes, angina, arthritis, GI, lung probs, or low back pain

Question 2

T/F: you can be depressed without feeling sad

Answer 2

true

Question 3

Depression is an (blank) for poor prognosis

Answer 3

independent risk factor

Question 4

depression causes (poor/better) adherence to meds & tx

Answer 4

poor

Question 5

T/F: depression should be solved alone

Answer 5

false

that’s a myth

Question 6

what are 6 clues to the depressed pt?

Answer 6

verbally unproductive
flat
problem pt
multiple complaints, sx, visits
sx-sign mismatch
physician dysphoria when w/ pt

Question 7

T/F: pts experiencing depression come to the doctor and complain of depression

Answer 7

false

more often it’s chronic pain

Question 8

who prescribes over half of antidepressants?

Answer 8

primary care MDs

Question 9

more than half of antidepressants are prescribed for what?

Answer 9

something other than depression

Question 10

what are the 6 indications for referral of a mental health pt?

Answer 10

severe suicidal thinking
psychosis, bipolar (axis II)
complicated substance abuse
poor psychosocial support
disorganized rapid deterioration
failed tx

Question 11

What are the 10 rules for caring for depressed pts?

Answer 11

1. dispel myths
2. use epidemiology
3. indirect clues
4. focus on fxnal impairment
5. counter competing priorities
6. co-morbidity
7. psychopharm
8. education, supportive counseling
9. chronic disease tx
10. psych consult

Question 12

T/F: depression is a failure of willpower

Answer 12

false

Question 13

T/F: depression can be associated with feelings of inadequacy & guilt

Answer 13

true

Question 14

Depression in primary care is (under/over)appreciated

Answer 14

under

Question 15

depression (increases/decreases) healthcare costs

Answer 15

increases

Question 16

are medical & psych co-morbidities common?

Answer 16

yes

and complicating

Question 17

how effective are physician educational interventions?

Answer 17

not very

“show little effect”

Question 18

what is the general barrier to improvement in primary care & mental health?

Answer 18

systemic problem

not really physician/professional barrier

Question 19

how might a physician cope with depression (poorly)?

Answer 19

by working HARDER

Question 20

when do medical student severe depression rates peak?

Answer 20

2nd year

Question 21

when did suicidal ideation among medical students peak?

Answer 21

4th year (6.6%)

Question 22

do female or male medical students have higher rates of depression?

Answer 22

female

15.2% vs 7.9%

Question 23

are depression rates among medical students higher or lower than the age-matched population?

Answer 23

higher

Question 24

what 4 groups of medical students had the highest risk of depression?

Answer 24

women
unmarried students
students w/ kids
Hispanic students

Question 25

what is the prevalence (%) of XS alcohol use among med students?

Answer 25

20%

Question 26

T/F: less students are entering medical school with a hx of depression

Answer 26

FALSE | it's MORE

Question 27

is the suicide risk higher or lower among physicians?

Answer 27

higher 1. 5-3x in men 2. 5-6x in women

Question 28

what increases the risk of suicide in physicians?

Answer 28

disabling physical conditions professional loss financial probs overwork

Question 29

what 4 things are depressed physicians more likely to do?

Answer 29

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)

Question 30

do depressed or non-depressed medical students say they would seek treatment?

Answer 30

non-depressed

Question 31

what are DEPRESSED medical student attitudes about depression?

Answer 31

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

Question 32

what 5 factors affect medical students w/ depression?

Answer 32

``` personal weakness social/professional discrimination devaluation of depressed students perceptions of poor performance need for secrecy ```

Question 33

what is the "conspiracy of silence"?

Answer 33

the fact that stigma reduction in physicians & med students is LAGGING BEHIND stigma reduction in pts