Week 1 Clinical Relevance

Question 1

Core and additional symptoms of depression

Answer 1

core:
- depressed mood >2 weeks
- anhedonia
- decreased energy

additional:
- loss of confidence/self-esteem
- unreasonable feelings of guilt
- thoughts of suicide/suicidal behaviour
- reduced concentration
- change in psychomotor activity
- sleep disturbance
- change in appetite

Question 2

Depression severities

Answer 2

mild = 2 core symptoms + additional symptoms = 4 total

moderate = 2 core symptoms + additional symptoms = 6 total

severe = 3 core symptoms + additional symptoms = 8 total

severe + psychotic symptoms = 3 core + additional symptoms = 8 + delusions/hallucination

Question 3

What screening tools can be used for depression?

Answer 3

PHQ-9 (patient health questionnaire 9)
HADS (hospital anxiety and depression scale)
BDI-II (beck depression inventory -II)

Question 4

Pharmacological treatment of depression in adults

Answer 4

1st line = SSRI (fluoxetine, citalopram, sertraline)
2nd line = alternative SSRI or venlafaxine or mirtazapine
3rd line = alternative 2nd line agent, consider vortioxetine or other (MAOI, TCA)
psychiatric referral - consider combo of 2 antidepressants or augmentation with antipsychotic/lithium

Question 5

Adverse effect of citalopram

Answer 5

prolonged QT

Question 6

What should a patient be told when starting an antidepressant?

Answer 6

expect 4 weeks to see benefit
side effects may ease in first couple of weeks
ideally review every couple of weeks/dose increases
likely to need to be continued for at least 6 months after remission
shouldn’t be stopped suddenly

Question 7

Who can be detained under the mental health act?

Answer 7

suspected presence of a mental disorder
disorder is of a nature and degree that warrants detention/medical treatment in hospital
risk to health, safety or protection of the patient or others
appropriate treatment is available at a designated hospital (section 3 only)

Question 8

electroconvulsive therapy (ECT) indications

Answer 8

severe depression
catatonia
mania

after an adequate trial of other treatment options have proven ineffective and/or when the condition is considered to be potentially life-threatening

Question 9

Risks of ECT

Answer 9

confusion (usually temporary)
retrograde amnesia
headache/muscle stiffness
complications from anaesthesia

Question 10

What is a SOAD?

Answer 10

second opinion approved doctor
independent doctor who reviews patients to help assess what treatments should be offered if patient lacks capacity/is under long section