Unipolar depression and antidepressants Flashcards

Question

warfarin + fluoxetine or fluvoxamine

Answer 1

reduce dose and monitor warfarin

Answer 2

reduce dose of donepezil

Answer 3

avoid TCA and carbamazepine

Answer 4

SSRIs are first choice Mirtazepine safe in arrythmias Lithium can cause ECG changes Avoid TCA's

Answer 5

Low dose paroxetine, citalopram, escitalopram, desvenlafaxine Avoid lofepramine, nefazodone, sertraline Avoid TCAs- risk hepatic encephalopathy Avoid MAOi's hepatic toxicity

Answer 6

Citalopram and sertraline reaosnable choices

Answer 7

SSRIs may reduce glucose TCA can increase Amitryptilline, imipramine can be used in diabetic neuropathy

Answer 8

SSRI or nortryp

Answer 9

TCAs good for anticholinergic effects SSRIs caution with selegiline Lithium and valproate may exacerbate tremor

Answer 10

``` Individual: physical illness sensory impairment dementia- early with retained insight female medication (steroid, AP) personal or fhx of depression ``` Psychosocial: recent bereavement feeling lonely

Answer 11

``` in late life, more common: reduced expression of sadness more psychomotor retardation apathy more motivation late onset neurotic sx hypochondriasis, somatic complaints greater incidence of completed suicide less familial risk ``` anatomical: vascular disease. Alexopoulos 1997- damage to fronto-subcortical circuits can predispose, precipitate and perpetuate late onset depression

Answer 12

Increased PLT aggregation Both depression and ischemia may be secondary to atherosclerosis Recurrent depression across lifespan may increase risk of vascular pathology Damage to end arteries supplying subcortico triato-pallido-thalamo-cortical pathways may disrupt the neurotransmitted circuits involved in mood regulation, causing or predisposing to depression

Answer 13

Older, physically unwell+ pain, male, living alone, widowed (bereavement), alcohol misuse, hx psychiatric illness, previous suicide attempt

Answer 14

1. Guided discovery through socratic questioning= establish core dysfunctional assumptions about self, the world and future 2. Identifying negative thoughts and schemas using thought diaries 3. Modify negative automatic thoughts, restructure core beliefs and schemas. Use thought challenges worksheet to challenge extreme and unhelpful thoughts 4. Behavioural deficits- behavioural activation, pleasant event scheduling, graded task assignment, self reward 5. Graded exposure- mainy for panic and anxiety disorders 6. Problem solving 7. Relaxation 8. Sleep hygeine 9. Homework tasks 10. Compliance therapy 11. Relapse prevention

Answer 15

Unresolved grief Role disputes Role transitions Interpersonal deficits

Answer 16

indicated only if patients choice, or prior response | Side effects- tension muscle headache, discomfort at site, scalp tenderness, seizures

Answer 17

magnetic seizure therapy

Answer 18

Vagal nerve stimulation | useful in low to moderate treatment resistance

Answer 19

In depressive: Guilt other than steps that could have been done Thoughts of death other than wanting to be with the deceased Marked psychomotor retardation Hallucinatory experiences other than thinking he or she hears the voice/ sees images of the deceased Delayed reaction- mummification, feeling stuck Prolonged and marked functional impairment According to DSM5: In grief feelings are emptiness and loss, no depressed mood/inability to anticipate happiness or pleasure Dysphoria in grief is likely to decrease in intensity over days and weeks, occurring in waves. In depression, depressed mood in more pervasive. Grief may be accompanied by positive emotions and humour as opposed to pervasive unhappiness Grief- preoccupations with thoughts and memories of the deceased, rather than self critical ruminations In grief self esteem preserved. Derogatory feelings in grief are associated with perceived failings, related to the deceased If bereaved think about dying, it the possibility of "joiging the deceasd"

Answer 20

``` A. 1+ Threat of death witnessing learned repeated exposure B. 8+ 1. Intrusion sx 2. Negative mood 3. Dissociative sx 4. Avoidance 5. Arousal Occurs for 3+ day, lasting <1 month after traumatic event ```

Answer 21

``` A: stressor 1+ direct witnessing learning repeated B. intrusive sx 1+ memories nightmares dissociative prolonged distress avoid exposing to reminders ++physiologic response after exposure to stimuli C. avoidance 1+ trauma related thoughts/feeling trauma related external D. negative mood/cognitions inability to recall key features of traumatic event persistent (often distorted) negative beleifs and expectations about oneself or the world blame of self / others negative trauma related emotions diminished interests alienated from others constricted affect E. altered arousal 2+ irritable/aggression Self-destructive/reckless hyper-vigilance exaggerated startle problems in concentration sleep disturbance F. duration > 1 month ```

Answer 22

1 in 10 patients in primary care present with depressive sx Lifetime risk of depression is 15% and 12 month prevalence is 4.1% 2:1 female:male

Answer 23

Mean age onset 27, 40% have first episode by age 20 | >80% of those affected by depression will experience at least 2 episodes of illness in their lifetime

Answer 24

54% recover within 6 months, 70% within a year | 12-15% fail to recover and develop an unremitting chronic illness