SLA 13 - Mental Health (A) Flashcards
What are the core symptoms of depression?
Depression is defined as the presence of a depressed mood or diminished interest in activities occurring most of the day, nearly every day, for at least two weeks.
Other symptoms include:
- reduced ability to concentrate or sustain attention
- beliefs of low self-worth or guilt
- hopelessness about the future
- recurrent thoughts of death or suicidal ideation
- evidence of attempted suicide
- disrupted sleep or excessive sleep
- changes in appetite or weight
- psychomotor agitation or retardation
- reduced energy / fatigue
What is the prevalence of depression?
Approximately 4.5% in the UK.
Suggest some risk factors for depression.
- chronic comorbidities (e.g. diabetes mellitus, COPD, CVD)
- medicines (e.g. corticosteroids)
- female gender (although males have higher risk of suicide)
- recent childbirth
- personal / family history of depression
- adverse childhood experiences (e.g. poor parent-child relationship, physical or sexual abuse)
What is the name of the questionnaire that can be used to assess depression severity in newly diagnosed patients.
Give the respective threshold score in order to make a diagnosis of:
a) minimal depression
b) mild depression
c) moderate depression
d) moderately severe depression
e) severe depression
PHQ-9 - helps to both diagnose depression and assess severity.
a) 1-4
b) 4-9
c) 10-14
d) 15-19
e) 20-27
NICE recommends which two questions are asked in order to screen for depression?
- During the last month have you often been feeling down, depressed or hopeless?
- During the last month have you often been bothered by having little interest or pleasure in doing things?
What important safeguarding questions must always be asked when assessing a patient with depression?
Directly ask about suicidal thoughts and identify risk factors for suicide.
Give some differentials for depression.
- schizophrenia
- seasonal affective disorder
- hypothyroidism
- vitamin D deficiency
- progesterone contraceptives
What is dysthmia?
A chronic depressive state of more than two years in duration, which does not meet the full criteria for major depression.
Which diseases are associated with depression?
- eating disorders
- substance misuse
- other psychiatric conditions co-existing
- pancreatic cancer
What are some risk factors for suicide?
- previous suicide attempt
- previous self-harm
- male gender
- unemployment
- living alone
- unmarried
- alcohol / drug dependence
- active mental illness
Suggest some protective factors to suicide.
- strong religious faith
- family support
- children at home
- sense or responsibility for others
What are the red flags for suicide?
- sense of hopelessness
- feeling of entrapment
- well-formed plans
- perception of no social support
What are the physical treatment options for depression?
- engage in physical activity on a regular basis*
- engage in outdoor activity
- maintain a healthy lifestyle (e.g. diet, sleep, reduce alcohol use)
*evidence that regular exercise releases same number of endorphins as a low-dose antidepressant.
How should an individual with severe depression, who you deem to be at significant risk of self-harm or suicide, be managed?
Arrange an urgent referral to crisis resolution and home treatment (CRHT) team.
What is the Mental Health Act (1983)?
Allows compulsory admission of people who have a mental disorder that warrants assessment or treatment in hospital, or people who need to be admitted in the interest of their own health or safety.
What is the mode of action of selective serotonin reuptake inhibitors (SSRIs) in the treatment of depression?
Block the reabsorption of serotonin into neurones, increasing the amount of serotonin in the synaptic cleft and thus increasing active serotonergic pathways.
Examples include sertraline and fluoxetine.
What are the absolute contraindications for prescribing SSRIs?
- poorly controlled epilepsy
- QT interval prolongation
- severe hepatic impairment
What are the potential side effects of SSRIs?
- palpitations
- diarrhoea, nausea
- headache
- dizziness
- drowsiness
- low libido
What is serotonin syndrome?
A potentially life-threatening drug-induced conditions caused by excessive serotonin, often as a consequence of:
- therapeutic drug use
- self-poisoning
- drug interactions
What is the triad of serotonin syndrome?
- Autonomic hyperactivity (e.g. hypertension, tachycardia, hyperthermia, excessive sweating)
- Neuromuscular dysfunction (e.g. tremor, clonus, hypertonicity, hyperreflexia)
- Altered mental state (e.g. anxiety, agitation, confusion, coma)
What is the mode of action of serotonin and norepinephrine reuptake inhibitors (SNRIs) in the treatment of depression?
SNRIs block the reabsorption of serotonin and norepinephrine, increasing the availability of the neurotransmitters in the synaptic cleft.
Examples include venlafaxine or duloxetine.
What are the absolute contraindications of prescribing SNRIs?
- uncontrolled hypertension
- hepatic impairment
- severe renal impairment
What are some common side-effects of SNRIs?
- palpitations
- nausea
- dry mouth
- headache
- dizziness
- insomnia
- abnormal dreams
- sweat changes
What is the mechanism of action of tricyclic antidepressants (TCAs) in the treatment of depression?
Block the reuptake of serotonin and adrenaline in the presynaptic terminal, increasing the concentration of the neurotransmitters in the synaptic cleft.
Note TCAs are less selective than SSRIs and SNRIs, so are more potent reuptake inhibitors.
Examples include amitriptyline.
