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year three - psychiatry > Depression > Flashcards

Depression Flashcards

1
Q

What is depression?

A

It is a defined as a condition in which individuals experience persistent low mood, anergia and anhedonia

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2
Q

What is anergia?

A

It is defined as low energy

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3
Q

What is anhedonia?

A

It is defined as a loss of interest/enjoyment in everyday activities

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4
Q

What are the two neurochemical imbalances associated with depression?

A

Decreased serotonin

Decreased noradrenaline

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5
Q

What are the four classifications of depression?

A

Mild Depression

Moderate Depression

Severe Depression

Recurrent Depression

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6
Q

What is mild depression?

A

It is defined as the presentation of two core features plus two cognitive features

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7
Q

What is moderate depression?

A

It is defined as the presentation of two core features plus at least three cognitive features

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8
Q

What is severe depression?

A

It is defined as the presentation of three core features plus at least four cognitive features

There is usually the presence of psychotic features.

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9
Q

What is recurrent depression?

A

It is defined as the presentation of more than two depressive episodes

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10
Q

What are the twelve risk factors associated with depression?

A

Female Gender

Young Age, 18 – 40 Years Old

Family History

Childhood Trauma

Traumatic Life Events

Personality Traits

Chronic Disease

Co-Morbid Substance Use

Drug Administration

Lack of Social Support

Separated/Divorced Marital Status

Poor Economic Status

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11
Q

What six chronic diseases are associated with depression?

A

Parkinson’s Disease

Multiple Sclerosis

Hypothyroidism

Psoriasis

Addison’s disease

Wilson’s disease

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12
Q

What four drugs are associated with depression?

A

Beta-blockers

Steroids

Levodopa

Isotretinoin

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13
Q

What are the three protective factors of depression?

A

Employment

Good Social Support

Married

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14
Q

What are the three core symptoms of depression?

A

Persistent Low Mood

Anhedonia

Anergia

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15
Q

What are the eight cognitive clincial features of depression?

A

Weight Changes

Disturbed Sleep

Psychomotor Retardation/Agitation

Reduced Libido

Feelings of Worthlessness/Guilt

Decreased Concentration

Psychotic Features

Suicidal/Self-Harm Thoughts

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16
Q

What are the two psychotic features of depression?

A

Delusions of Guilt & Personal Inadequacy

Hallucinations

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17
Q

What are the seven somatic/biological features of depression?

A

Anhedonia

Loss of Emotional Reactivity

Diurnal Mood Changes

Early Morning Wakening

Psychomotor Agitation/Retardation

Appetite Loss

Weight Loss

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18
Q

Describe the diurnal mood changes in depression

A

The mood tends to be worse in the morning

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19
Q

Describe the early morning waking in depression

A

Individuals wake 2 - 3 hours earlier than usual

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20
Q

What though disorder is associated with severe depression?

A

Cotard syndrome

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21
Q

What is cotard syndrome?

A

It is defined as a condition in which individuals believe that they are dead or non-existent

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22
Q

What are the four investigations used to diagnose depression?

A

Patient Health Questionnaire (PHQ-9)

Hospital Anxiety & Depression (HAD) Scale

Blood Tests

CT Scans

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23
Q

What is the most common depression screening tool?

A

PHQ-9

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24
Q

What is PHQ-9?

A

It involves asking questions whether they have experienced nine clinical features over the last two weeks – which are scored 0 – 3 in terms of severity

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25
Q

What PHQ-9 score defines mild depression?

A

5 - 9

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26
Q

What PHQ-9 score defines moderate depression?

A

10 - 14

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27
Q

What PHQ-9 score defines moderately severe depression?

A

15 - 19

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28
Q

What PHQ-9 score defines severe depression?

A

20 - 27

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29
Q

What is the HAD scale?

A

It involves asking 7 questions screening for depression and 7 questions screening for anxiety – which are scored 0 – 3 in terms of severity

This provides a score for both depression and anxiety

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30
Q

What HAD scale score is considered normal?

A

0 - 7

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31
Q

What HAD scale score is considered borderline for anxiety and depression diagnosis?

A

8 - 10

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32
Q

What HAD scale score defines a diagnosis of depression/anxiety?

A

> 11

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33
Q

How are blood tests used to diagnose depression?

A

They are used to exclude organic causes to the patient’s presentation

34
Q

What five blood tests are used to investigate depression?

A

Full Blood Count

Urea & Electrolytes

Liver Function Tests

Thyroid Function Test

Vitamin B12 Deficiency

35
Q

How are CT scans used to investigate depression?

A

They are used to exclude organic causes

36
Q

When are CT scans used to investigate depression?

A

In cases where patient’s present with atypical features – such as low mood associated with a sudden loss of memory or change in personality

37
Q

What are the three diagnostic criteria of depression?

A

The clinical features must be present for at least 2 weeks

The clinical features are not attributable to other organic or substance causes – normal bereavement, etc.

The clinical features result in functional impairment and cause significant distress

38
Q

What five psychological therapies are used to treat depression?

A

Psychoeducation

Cognitive Behaviour Therapy (CBT)

Behavioural Activation

Interpersonal Psychotherapy (IPT)

Psychodynamic Psychotherapy

39
Q

What is psychoeducation?

A

It involves providing patients with information about depression and ways in which they can control and minimise it

40
Q

What is CBT?

A

It is a talking therapy used to manage the way in which patients think, feel and behave

41
Q

What is behavioural activation?

A

It is a talking therapy that encourages patients to use behaviour in influencing their emotional state

42
Q

What is IPT?

A

It is a talking therapy used to identify and address problems in the patients’ relationship with family, partners and friends

43
Q

What is psychodynamic psychotherapy?

A

It is talking therapy which focuses on the psychological roots of emotional suffering

44
Q

What five pharmacological management options are used for depression?

A

Selective Serotonin Reuptake Inhibitors (SSRIs)

Serotonin Noradrenaline Reuptake Inhibitors (SNRIs)

Tricyclic Antidepressants (TCAs)

Monamine Oxidase Inhibitors (MAOIs)

Antipsychotics

45
Q

When are SSRIs used to manage depression?

A

They are the first line pharmacological management option

46
Q

Name five SSRIs used to manage depression

A

Sertraline

Fluoxetine

Citalopram

Escitalopram

Paroxetine

47
Q

What SSRI is prescribed to patients with depression, alongside other chronic health problems? Why?

A

Sertraline

There is a reduced risk of drug interactions

48
Q

How long does it usually take for SSRIs to become effective?

A

4 - 6 weeks

49
Q

When are SNRIs used to manage depression?

A

They are the second line pharmacological management option

50
Q

Name two SNRIs used to manage depression

A

Duloxetine

Venlafaxine

51
Q

In which patient group is SNRIs the first line anti-depressant drug class?

A

Children

Adolescents

52
Q

When are TCAs used to manage depression?

A

They are the third line pharmacological management option – which should be administered under psychiatric advice

53
Q

Name four TCAs used to manage depression

A

Amitriptyline

Desipramine

Imipramine

Nortriptyline

54
Q

When are MAOIs used to manage depression?

A

They are the fourth line pharmacological management option – which should be administered under psychiatric advice

55
Q

Name three MAOIs used to manage depression

A

Selegiline

Isocarboxazid

Phenelzine

56
Q

When are antipsychotics used to manage depression?

A

They are recommended in severe depressive episodes with psychotic features

57
Q

Name four antipsychotics used to manage depression

A

Olanzapine

Risperidone

Quetiapine

Aripiprazole

58
Q

How do we switch individuals from an SSRI (citalopram, escitalopram, sertraline, paroxetine) to another SSRI?

A

The first SSRI should be withdrawn, through a gradual dose reduction then stopped, before the alternative SRRI is started

59
Q

How do we switch individuals from an fluoxetine to another SSRI? Why is fluoxetine different to other SSRIs?

A

It should be withdrawn, through a gradual dose reduction then stopped, leave a gap of 4 - 7 days before starting a low dose of the alternative SSRI

It has a longer half life

60
Q

How do we switch individuals from SSRIs (citalopram, escitalopram, sertraline, paroxetine) to TCAs?

A

There should be cross-tapering, which is when the current dose drug is reduced slowly whilst the dose of the new drug is slowly increased

61
Q

How do we switch individuals from fluoxetine to a TCA? Why is fluoxetine different to the other SSRIs?

A

It should be withdrawn, through a gradual dose reduction then stopped, before starting a TCA

It has a longer half life

62
Q

How do we switch individuals from SSRIs (citalopram, escitalopram, sertraline, paroxetine) to venlafaxine?

A

There should be cross-tapering cautiously, which is when the current dose drug is reduced slowly whilst the dose of the new drug is slowly increased

Venlafaxine should be started at 37.5mg daily and increased very slowly

63
Q

How do we switch individuals from fluoxetine to venlafaxine? Why is fluoxetine different to the other SSRIs?

A

It should be withdrawn, through a gradual dose reduction then stopped, before starting venlafaxine

It has a longer half life

64
Q

When are physical management options used to treat depression?

A

When depression is unresponsive to other treatment options

65
Q

What are the four physical management options used in depression?

A

Electroconvulsive Therapy (ECT)

Deep Brain Stimulation (DBS)

Vagus Nerve Stimulation (VNS)

Psychosurgery

66
Q

In which four circumstances is ECT considered to manage depression?

A

The patient has a strong preference to ECT

Rapid treatment is required due to the patient not eating or drinking

When multiple other treatment have been trialled unsuccessfully

There is severe depression, with catatonia features

67
Q

What is ECT?

A

A procedure in which small electric currents are passed through the brain, intentionally triggering a brief seizure

This leads to neurochemical changes, which can reverse the clinical features of depression

68
Q

How do we modify antidepressant medication prior to ECT?

A

We reduce the daily dose, however it should not be stopped

Towards the end of the ECT course, an increase dose of antidepressant may be added

69
Q

What are the five short term side effects of ECT?

A

Headache

Nausea

Short Term Memory Impairment

Retrograde Amnesia

Cardiac Arrythmia

70
Q

What is a long term side effect of ECT?

A

Impaired Memory

71
Q

What is an absolute contraindication of ECT?

A

Raised ICP

72
Q

What is DBS?

A

It involves implanting electrodes within certain areas of the brain

These electrodes produce electrical impulses that regulate abnormal impulses or can affect certain cells and chemicals within the brain

73
Q

What is VNS?

A

It involves the use of a device to stimulate the left vagus nerve with electrical impulses

When stimulated, the left vagus nerve will send electrical signals to the brainstem, which are then transmitted to certain areas in the brain

74
Q

What is psychosurgery?

A

It is the selective surgical removal or destruction of nerve pathways in order to influence psychiatric disorders

75
Q

What are the eleven management options recommended in mild depression - in order of preference?

A

Self-Guided Cognitive Behavioural Therapy

Group Cognitive Behavioural Therapy

Group Behavioural Activation

Individual Cognitive Behavioural Therapy

Individual Behavioural Activation

Structured Group Physical Activity Programme

Group Mindfulness & Mediation

Interpersonal Psychotherapy

Selective Serotonin Reuptake Inhibitors

Psychological Counselling

Short-Term Psychodynamic Psychotherapy

76
Q

It is recommended that antidepressant medication should not be routinely offered as first line management of mild depression. In which four circumstances are there exceptions to this rule?

A

Moderate/Severe Depression History

Mild Depression For At Least 2 Years

Mild Depression That Is Resistant To Psychological Interventions

Patient Preference

77
Q

What are the ten management options recommended in moderate/severe depression - in order of preference?

A

Individual Cognitive Behavioural Therapy & Antidepressant

Individual CBT

Individual Behavioural Activation

Antidepressant Medication

Individual Problem Solving

Psychological Counselling

Short Term Psychodynamic Therapy

Interpersonal Psychotherapy

Self-Guided Cognitive Behaviour Therapy

Structured Group Physical Activity Programme

78
Q

Following initial presentation of depression, when should a follow up appointment be arranged?

A

2 weeks

Then monthly for 3 months

79
Q

In which patient group should weekly follow up appointments be arranged following intial presentation of depression?

A

Those who are at high suicide risk

80
Q

What are the six risk factors of suicidal attempt?

A

Male

Age< 30

Previous Suicidal Attempt

Alcohol/Drug Use

No Spouse Or Other Social Support

Stated Future Intent

81
Q

What is the strongest risk factor of suicide?

A

Previous Suicidal Attempt

82
Q

How long does it usually take patients with depression to recover?

A

4 - 6 months

year three - psychiatry (23 decks)

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